Combined quadriceps lengthening (using an external ring fixator) and patellar tendon reconstruction (using a tendoachilles allograft) in a case of chronic patellar tendon rupture: A case report.

BACKGROUND: Patellar tendon rupture is an infrequent and debilitating condition, which if left untreated, is complicated by quadriceps contracture and patella alta. This results in reduced function of the knee extensor mechanism including extension lag, reduced range of motion (ROM), chronic knee pain, and frequent falls. Early primary repair has good results in most cases and is performed by opposing and suturing the tendon ends. However, when there is a delay between rupture and repair or in case of a re-rupture, primary repair techniques may not work due to retraction of the extensor mechanism. Several treatment modalities have been proposed in such cases, but there is no clear consensus. METHODOLOGY: We present the case of a 39-year-old male with chronic rupture of patellar tendon that was reconstructed with a two-stage technique. In the first stage, a ring-fixator was applied to stretch the quadriceps muscle and the second stage consisted of reconstruction of the patellar tendon with a tendoachilles allograft. This procedure was performed in two stages five weeks apart and almost four years after the initial injury. RESULTS: Results were excellent at three years' follow-up with the patient achieving full extension, a ROM of 0-110° and 85% quadriceps strength. There was significant improvement in his pain, mobility and quadriceps bulk. CONCLUSION: To our knowledge, this treatment has not previously been described in the literature. We present this case as a proven treatment option for treatment of chronic patellar tendon injuries with extensor mechanism shortening.

Conservative treatments for greater trochanteric pain syndrome: a systematic review.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) can have a significant effect on quality of life. AIM: To evaluate the conservative treatments for GTPS. DESIGN: This systematic review assessed risk of bias using the Cochrane Risk of Bias Tool and Cochrane Risk of Bias Tool for non-randomised studies of interventions. DATA SOURCES: On 13 January 2016, a comprehensive search was conducted, with no limit on year of publication for relevant studies in the MEDLINE, CINAHL, AMED and EMBASE databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: English language randomised controlled trials, case-control or cohort studies reporting outcome data for conservative treatments for adults having a diagnosis of GTPS, or trochanteric bursitis, were included. RESULTS: 8 studies (n=696) were eligible for inclusion in the review; corticosteroid injections (CSI) (n=6), shockwave therapy (n=2), home training (n=1) and orthotics (n=1). Based on pain, CSI demonstrated superior outcomes for up to 3 months compared with home training, radial shockwave therapy (RSWT) and usual care, in 4 studies demonstrating either a low or moderate risk of bias. Fluoroscopy-guided injections failed to show additional benefit. RSWT and home training had limited evidence. No conclusions can be drawn regarding the use of orthotics due to the serious risk of bias and methodological flaws within that study. CONCLUSIONS: This review demonstrates a paucity of high-quality research for the conservative treatments of GTPS. The risk of bias was low in only one study, demonstrating no additional benefit with fluoroscopically guided injections. Risk of bias in all remaining studies was varied. Standardisation of diagnostic criteria and outcome measures is essential to enable more powerful analysis.

Distributed leadership, team working and service improvement in healthcare.

PURPOSE: The purpose of this paper is to analyse the introduction of distributed leadership and team working in a therapy department in a healthcare organisation and to explore the factors that enabled the introduction to be successful. DESIGN/METHODOLOGY/APPROACH: This paper used a case study methodology. Qualitative and quantitative information was gathered from one physiotherapy department over a period of 24 months. FINDINGS: Distributed leadership and team working were central to a number of system changes that were initiated by the department, which led to improvements in patient waiting times for therapy. The paper identifies six factors that appear to have influenced the successful introduction of distributed learning and team working in this case. RESEARCH LIMITATIONS/IMPLICATIONS: This is a single case study. It would be interesting to explore whether these factors are found in other cases where distributed leadership is introduced in healthcare organisations. PRACTICAL IMPLICATIONS: The paper provides an example of successful introduction of distributed leadership, which has had a positive impact on services to patients. Other therapy teams may consider how the approach may be adopted or adapted to their own circumstances. ORIGINALITY/VALUE: Although distributed leadership is thought to be important in healthcare, particularly when organisational change is needed, there are very few studies of the practicalities of how it can be introduced.