Achiles: an imortal eponymous / Aquiles: um epônimo imortal

ABSTRACT The conditions affecting the calcaneal tendon remain extremely prevalent in the clinical practice. The search for information about these diseases in national and international scientific databases are commonly hampered in the use of search tools, requiring the use if an eponym in the strategy. Achilles, in reference to the hero of the Greek mythology, is often used by several authors in scientific publications despite the new Nomina Anatomica. Objective: This article intends to recover the history behind the use of this term, which heroically resists in the clinical discussions of everyday life in articles and textbooks. Level of Evidence V, Literature Review.

RESUMO As afecções que afetam o tendão calcâneo permanecem extremamente prevalentes na prática clínica. A busca por informações sobre essas doenças na produção científica nacional e internacional comumente esbarra em uma dificuldade na utilização das ferramentas de procura e na necessidade de acrescentar um epônimo na estratégia. Aquiles, em referência ao herói da mitologia grega, é frequentemente empregado por diversos autores em suas publicações científicas a despeito da nova nômina anatômica. Objetivo: Esse artigo busca resgatar a história da utilização desse termo, que resiste heroicamente tanto nas discussões clínicas do cotidiano quanto nos artigos e livros-texto. Nível de Evidência V, Revisão da Literatura.

Achilles tendon extension and tibialis transfer combined with tendon transposition for cerebral palsy-induced talipes equinovarus：ankle recovery and foot function evaluation / 中国组织工程研究

BACKGROUND:It has a variety of treatments for equinovarus in spastic cerebral palsy, including physical therapy, orthotic therapy, systemic anti-spasticity drug therapy, local intramuscular injection of botulinum toxin type A and a variety of surgical operations. These treatments aim at different severity of deformities and different age in children patients, and each has its own merits. OBJECTIVE:To investigate the therapeutic effect of Achiles tendon “Z”-type extension, tibialis anterior and posterior transfer combined with tendon transposition to treat equinovarus in spastic cerebral palsy. METHODS: Twenty-two children with spastic cerebral palsy combined with equinovarus were colected from 2012 to 2014, and then these children were subject to Achiles tendon “Z”-type extension, tibialis anterior and posterior transfer combined with tendon transposition. Postoperative plaster external fixation was done for 6 weeks, and then rehabilitation training was given. RESULTS AND CONCLUSION:Al the 22 patients were folowed for an average of 1-2 years, and then were evaluated according to the degree of patient’s satisfaction and the degree of foot deformity. Satisfactory results were obtained from al the patients. Achiles tendon “Z”-type extension, tibialis anterior and posterior transfer combined with tendon transposition to treat spastic cerebral palsy combined with equinovarus is a good method, and it is characterized as good appearance of the ankle and favorable foot function.

Acute closed rupture of the Achilles tendon：a Meta-analysis of nonsurgical and surgical treatment / 中国组织工程研究

BACKGROUND:There is always a controversy about nonsurgical and surgical repair of acute Achiles tendon rupture. Except retrospective analysis, there is a lack of high-level evidence-based medicine data. OBJECTIVE:To systemicaly evaluate the clinical effectiveness of the nonsurgical versus surgical treatment for acute closed rupture of the Achiles tendon. METHODS:The randomized controled trials about the nonsurgical versus surgical treatment for acute Achiles tendon rupture were searched in PubMed, EMbase, CBM, CNKI, Ovid, and WanFang Data by computer as wel as in relevant journals by hand, which were reported before February 2014. The Cochrane Library (Issue 1, 2014) was also retrieved. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then Meta-analysis was conducted using RevMan 5.2 Software. RESULTS AND CONCLUSION:Nine randomized controled trials were included, and totaly 874 patients were involved, 441 cases in the nonsurgical group and 433 in the surgical group. The results of Meta-analysis showed that compared with the surgical group, the incidence of complications was lower [OR=0.41, 95%CI(0.26, 0.63), P< 0.000 1], but the rate of tendon re-rupture [OR=2.86, 95%CI(1.62, 5.02),P=0.000 2] and incidence of cicatricial adhesion [OR=0.07, 95%CI(0.03, 0.19),P < 0.000 1] were higher in the nonsurgical group. However, there were no significant differences between the two groups in patient satisfaction, superficial infection, motion recovery, and deep infection. Compared with the surgical treatment, the nonsurgical treatment can reduce the incidence of complications, but has a higher incidence of re-rupture. Because of sample-size and methodological quality restrictions, this conclusion needs further verification of large-sample, multicenter, and high-quality randomized controled trials.

Plastía del tendón de Aquiles en lesiones inveteradas: Técnica modificada de Pérez Teuffer / Achilles tendon plasty in inveterate lesions: Pérez Teuffer modified technique

El propósito del presente trabajo es transmitir la experiencia que se tuvo con la técnica utilizada en lesiones crónicas de tendón de Aquiles en el Hospital Regional "1º de Octubre" del ISSSTE. Se realizó un estudio prospectivo con seguimiento longitudinal descriptivo de 30 pacientes con ruptura de tendón de Aquiles con más de 10 días de evolución tratados con una técnica modificada de Pérez Teuffer realizada en el Servicio de Ortopedia y Traumatología de Marzo de 2004 a Marzo de 2008. Se efectuó una plastía con transposición de peroneo lateral corto a muñón de tendón. El lado derecho fue el más afectado en 70%; el promedio de edad fue 31.1 años; predominó el sexo masculino con 90%. El tiempo de evolución fue de 10 días a 62, con una media de 26 días. Obtuvimos resultados excelentes en 90%. Con 10% de buenos resultados; un caso presentó necrosis de piel y limitación para la movilidad y dos más con dolor. No se consideraron como malos por no interferir con los resultados funcionales finales.

The purpose of this paper is to convey our experience with the technique used to treat chronic Achilles tendon lesions at ISSSTE "1º de Octubre" Regional Hospital. A prospective study with descriptive longitudinal follow-up was conducted in 30 patients with Achilles tendon rupture that occurred more than 10 days earlier. They were treated with the modified Pérez-Teuffer technique at the Orthopedics and Trauma Service from March 2004 to March 2008. Plasty with transposition of the lateral peroneus brevis to the tendon stump was performed. The right side was affected in 70% of patients, mean age was 31.1 years, and males were predominant and accounted for 90%. Time elapsed since the lesion was 10-62 days with a mean of 26 days. We obtained excellent results in 90%, and good results in 10% of patients. One case had skin necrosis and limited mobility and two had pain. They were not considered as poor results as this did not interfere with the final functional results.

Isokinetic muscle strength test for the muscular force after repair of ruptured Achilles tendon / 中国组织工程研究

BACKGROUND:Restoration of tendon integrity and tenacity, and maintenance of ankle joint flexibility, play a crucial role on the rupture of Achiles tendon. OBJECTIVE: To evaluate the muscular force using isokinetic muscle strength test after the ruptured Achiles tendon is repaired, and to assess the repairing effect. METHODS: Muscle power including peak torque, peak torque/body weight, total work, average peak torque, set total work of flexor and extensor of 17 patients with Achiles tendon rupture were assessed after reconstruction using Biodex system 4 at 60 (°)/s and 120(°)/s. RESULTS AND CONCLUSION:The peak torque, peak torque/body weight, total work, average peak torque, set total work of flexor muscle group at the injured side were significantly decreased compared with uninjured side at 60 (°)/s and 120 (°)/s (P < 0.05). Isokinetic muscle strength test can reflect the muscular force after the ruptured Achiles tendon is repaired, and evaluate the repairing effect.

Ruptured Achilles tendon repaired with hernia repair materials using a wrap method / 中国组织工程研究

BACKGROUND:The incidence of complications folowing conventional repairing for the ruptured tendon is up to 73%, such as delayed healing, adhesion, secondary rupture. These complications severely affect ankle joint function of the patients. OBJECTIVE:To reduce the complications folowing the repair and investigate the role of hernia repair materials in the repairing of ruptured Achiles tendon. METHODS:Eleven patients who underwent repair of ruptured Achiles tendon were retrospectively studied. Among them there were eight males and three females with the mean age of 42 years (26-58 years). Three cases were injured in left side and eight cases were in right side; four cases were open injury by sickle-induced damage and seven cases were closed injury by exercise-induced damage. The hernia repair materials after pruning was applied with a “wrap” method to strengthen the anastomosis repair of Achiles tendon after the conventional repair surgery had been completed. At the time of folow-up, al patients were observed for postoperative local appearance and function recovery, and assessed with Arner Lindholm standards. RESULTS AND CONCLUSION:The folow-up interval was 6-45 months (average 24.5 months). Two cases were lost to folow-up. According to the Arner Lindholm standards, the effects were excelent in seven cases (78%) and good in two cases (22%). Local appearance and function recovered wel postoperatively, and no complications occurred such as wound infection, secondary rupture and so on. A “wrap” method with hernia repair materials is suggested to strengthen the anastomosis repair of ruptured Achiles tendon after the conventional repair surgery is completed, it can significantly promote the healing of Achiles tendon ruptured end anastomosis, prevent Achiles tendon recurrent ruptures, local adhesion and infection.

Lesões agudas do tendão do calcâneo / Acute lesions of Achiles tendon

Objetivo: Apresentar o resultado do tratamento das lesões agudas do tendão do calcâneo tratadas no Grupo do Pé e Tornozelo da Santa Casa de Misericórdia de São Paulo e suas complicações. Casuística e métodos: Reavaliamos 14 pacientes, 11 do sexo masculino e 3 do feminino, com média idade de 35 anos. O tempo médio de seguimento foi de 63 meses. Avaliamos a amplitude de movimento do tornozelo e retropé, a hipotrofia da musculatura da perna, a força do tendão do calcâneo, a altura máxima atingida pelo calcâneo em relação ao solo e a capacidade de pular sobre o pé lesionado. Avaliamos também satisfação com o resultado obtido e a pontuação obtida na escala da ?American Orthopaedic Foot and Ankle Society? ? AOFAS ? para o retropé. Resultados: Houve uma perda média de 4,8° na flexão plantar do tornozelo. Apresentavam hipotrofia muscular da perna sete pacientes, com perda média de 2,1 cm. Todos tinham grau V de força muscular e nenhum mostrava déficit na deambulação na ponta dos pés. A altura máxima entre o calcâneo e o solo no lado lesado foi de 8,5 cm em média e no lado contralateral foi de 9,2 cm. Dos pacientes, 92% apresentaram um resultado excelente na avaliação da capacidade de pular sobre o pé lesionado em apoio monopodal. Nos pacientes tratados cirurgicamente, encontramos cinco casos com complicações (35,7%). Todos estavam completamente satisfeitos com o resultado do tratamento e nenhum tinha incapacidade funcional no momento da reavaliação. Todos retornaram aos mesmos níveis de atividades laborativas de antes da lesão, sendo que 58,3% retornaram aos mesmos níveis de atividades esportivas de antes da lesão. A média do escore AOFAS para o retropé foi de 98 pontos. Conclusão: O número de complicações nos pacientes tratados pelo método cirúrgico foi elevado. No entanto, estes pacientes apresentaram bons resultados clínico-funcionais, assim como aqueles tratados pelo método conservador. Acreditamos que a controvérsia quanto ao melhor método permaneça, e novos estudos prospectivos e randomizados sejam necessários para elucidar esta questão.