Allograft and Autologous Reconstruction Techniques for Neglected Achilles Tendon Rupture: A Mid-Long-Term Follow-Up Analysis.

Achilles tendon ruptures that are not immediately recognized and treated are sometimes diagnosed as delayed injuries and may require different surgical repair options based on gap size. The potential complications associated with using an allograft for reconstruction may lead some surgeons to prefer the use of autologous techniques. However, allografts are often considered a salvagement option when large defects are present. In this study, we examined the long-term clinical outcomes and complications of 17 patients who underwent surgical repair for chronic ruptures with large gaps using both autologous and allograft techniques. During an 11-year period, nine patients were treated with autologous techniques (mean gap of 4.33 ± 1.32 cm) and Achilles allograft reconstruction was performed in eight patients (47.1%) (mean gap of 7.75 ± 0.89 cm). At a mean of 82 ± 36.61 months of follow-up, all 17 patients (100%) were able to perform a single heel rise and improved AOFAS (American Orthopaedic Foot and Ankle Society) and ATRS (Achilles Tendon Total Rupture Score) scores. No infections, complications, or re-ruptures were recorded at the end of the follow-up. No significant differences were found in the AOFAS and ATRS scales between both techniques. When an extensive defect is present, the reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than autologous techniques achieving similar functional outcomes.

Inestabilidad sutil de la sindesmosis tibioperonea: diagnóstico mediante TAC con carga axial y posiciones forzadas del pie / Subtle tibiofibular syndesmotic instability: diagnosis by CT with axial load and forced foot positions

Objetivo: Probar un método diagnóstico objetivo, fiable y reproducible que permita detectar la inestabili- dad sutil de la sindesmosis tibioperonea. Material y métodos: Se presenta el caso de un paciente con dolor recurrente sobre la articulación tibioperonea tras un esguince de tobillo. Ante la sospecha de lesión de los ligamentos tibioperoneos se realizó un TAC con carga axial y posiciones forzadas de ambos pies. Resultados: La diferencia en el área del espacio tibiopero- neo entre la posición de relajación y la posición de tensión de la sindesmosis en el tobillo sano fue de 5,79 mm2, mientras que en el tobillo lesionado fue de 22,58 mm2. Conclusión: El TAC con carga axial y posiciones forzadas de ambos pies puede ser útil para el diagnóstico de la inestabilidad sutil de la sindesmosis tibio- peronea. (AU)

Objetive: To test an objective, reliable and reproducible diagnostic method to detect subtle tibiofibular syn- desmosis instability. Material and methods: A case with recurrent pain over tibiofibular joint after an ankle sprain is presented. It was sus- pected injury to the tibiofibular ligaments so a CT with axial load and forced foot positions was done. Results: Difference in tibiofibular space area between the syndesmosis relaxed position and the tension position in the uninjured ankle was 5.79 mm2, while in the injured ankle it was 22.58 mm2. Conclusion: CT with axial load and forced foot positions can be useful for the diagnosis of subtle tibiofibular syndesmosis instability. (AU)

Conservative Treatment of Ankle Osteoarthritis.

Despite the disabling nature of ankle osteoarthritis (OA), there is poor scientific evidence for a conservative treatment compared to the hip and knee OA. In this regard, most of the treatment options in use are not based on clinical studies of the ankle, and they are extracted from evidence obtained from clinical studies of other lower limb joints. However, this does not seem to be a good idea, since the aetiology of ankle OA is quite different from that of the hip or knee. Nonpharmacological and pharmacological treatments such as nonsteroidal anti-inflammatory drugs, hyaluronic acid, corticosteroid, platelet-rich plasma injection and mesenchymal stem cells injections have been reported. However, further research is required in this field to obtain a specific clinical practice guideline for the conservative treatment of ankle OA.