[Tendinosis and ruptures of the Achilles tendon]. / Tendinose und Ruptur der Achillessehne.

Tendinosis of the Achilles tendon is a degenerative-reparative structural change of the tendon with microdefects, increases in cross-section due to cicatricial tendon regeneration, neoangiogenesis and reduction of elasticity. The previously used term tendinitis is only rarely used for the chronic form since signs of inflammation such as redness and hyperthermia or elevated levels of inflammatory parameters on laboratory testing are generally absent. Duplex sonography with visualization of the neovascularization has become a valuable supplement not only for diagnostics but also for therapy planning. The classic, conservative therapy for painful tendinosis consists of oral anti-inflammatory drugs, pain-adapted load reduction, raising the heel, stretching the calf musculature, and various physiotherapeutic interventions. When conservative treatment over a period of 4 - 6 months fails to produce any or non-adequate pain relief, an indication for surgical treatment should be considered. In the therapy for fresh ruptures of the Achilles tendon further developments in minimally invasive techniques have led to a worldwide paradigm change over the past 10 years. The decisive advantage of minimally invasive surgical techniques is the lower risk of wound infection as compared to the sutures of the open technique. When compared with conservative functional therapy the minimally invasive repair has the advantage of being less dependent on the compliance of the patient since, in the early phase of tendon healing the suture prevents a separation of the tendon ends upon controlled movements. However, not every patient with a ruptured Achilles tendon should be treated with a minimally invasive repair. Open tendon reconstruction and functional conservative therapy are still justified when the correct indication is given.

[Surgical treatment of Achilles tendon rupture]. / Operative Behandlung der Achillessehnenruptur.

The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities. For recent Achilles tendon ruptures minimally invasive suturing is indicated but for older ruptures a reconstruction often has to be carried out. The decisive disadvantage of an open tendon suture is the relatively high risk of infection. Using minimally invasive surgical techniques the frequency of postoperative infection could be significantly reduced. The suture methods without opening the ruptured region can be collectively grouped under the term percutaneous suture techniques and the minimally invasive methods with opening of the rupture region as combined open percutaneous techniques. Documented problems with the Ma-Griffith technique, such as injury of the sural nerve, low stability of the suture and insufficient adaption of the tendon stumps have been minimized by new minimally invasive operation techniques. Achilles tendon ruptures which nearly always arise without any external influence or accidents can have substantial psychological consequences regarding the integrity of one's own body especially for people actively engaged in sport. This aspect should be considered and accepted in particular during postoperative treatment.

[Transfer of the flexor hallucis longus to replace the Achilles tendon: indications, technique and results]. / Der Flexor-hallucis-longus-Transfer zum Ersatz der Achillessehne : Indikation, Technik und Ergebnisse.

BACKGROUND: Transfer of the flexor hallucis longus (FHL) tendon is a therapeutic option to replace a dysfunctional Achilles tendon in cases of rerupture with large defects, loss of the Achilles tendon after postoperative infection or severe tendinosis. MATERIALS AND METHODS: Between January 1994 and December 2005, 35 patients (5 female and 30 male, average age 47 years) were treated with 36 FHL transfers and 25 patients with 26 FHL transfers could be re-evaluated at a mean follow-up time of 79 months (range 20-133 months) after surgery. RESULTS: Of the 25 patients, 18 (72%) subjectively rated the result as excellent, 5 (20%) as good, and 1 patient (4%) each as fair and poor. According to the criteria of Trillat and Mournier-Kuhn, 18 patients (72%) were rated excellent, 4 (16%) good and 3 (12%) fair. The AOFAS ankle/hindfoot score at follow-up averaged 91 (range 13-100), the AOFAS forefoot score averaged 95 (range 24-100). CONCLUSIONS: FHL transfer to the Achilles tendon provides favorable results in cases of complicated cases with defects, infections or severe tendinosis after Achilles tendon rupture.

[Damage to large tendons: Achilles, patellar and quadriceps tendons]. / Verletzung grosser Sehnen: Achilles-, Patellar- und Quadrizepssehne.

The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.

[Percutaneous technique for Achilles tendon repair with the Dresden Instruments]. / Die perkutane Achillessehnennaht mit dem Dresdner Instrument. Technik und Ergebnisse.

BACKGROUND: The percutaneous technique for Achilles tendon repair with the Dresden instruments (pDI suture) was developed to minimize the typical problems of percutaneous Achilles tendon sutures. METHODS: From 1 January 2000 to 31 December 2003, the pDI suture was performed in 61 patients with 62 Achilles tendon ruptures. We reviewed 39 of 47 patients (83%) with 40 ruptured Achilles tendons who had undergone percutaneous repair at a minimal interval of 12 months after the operation. RESULTS: In this study we observed no sural nerve injuries. The rerupture rate was 2/62 or 3.2%. In one patient (1.6%) a superficial late infection occurred after tendon healing. Using the criteria of Trillat and Mounier-Kuhn, 62% of the results were very good and 30% good. The average AOFAS score was 96 (78-100) points; 78% of the patients assessed the result of treatment as very good and 20% as good. CONCLUSIONS: The percutaneous suture using the Dresden instruments is a minimally invasive operative treatment of Achilles tendon rupture resulting in nearly all very good and good subjective and clinical results. It combines a low rerupture and infection rate with a minimized risk of sural nerve injury.