Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report.

Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon.

[Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature]. / Lek u chorych poddawanych alloplastyce stawów kolanowych w trybie skróconej hospitalizacji w swietle wspólczesnego pismiennictwa.

The rapid progress in knee implants technology and operational techniques go together with more and more modem medical programs, designed to optimize the patients' care and shorten their stay in hospital. However, this does not guarantee any elimination ofperioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence thefinal result of the treatment of patients after big joints arthroplasties.

[A knee clinical stateaffects the preoperative level of anxiety in patients undergoing knee arthroplasty - preliminary report]. / Stan kliniczny kolana wplywa na poziom przedoperacyjnego leku u chorych poddanych alloplastyce kolana - doniesienie wstepne.

AIM: The aim of this study was to evaluate whether intensity of state anxiety before operation depends on knee function. MATERIAL AND METHOD: The study was conducted among 81 patients qualified to knee arthroplasty because of severe arthrosis. A knee function was evaluated with Knee Society score and Oxford questionnaires, and level of anxiety - with State-Trait Anxiety Inventory by C.D. Spielberger a day before the operation. RESULTS: Patients with higher intensity of trait anxiety had higher level of state anxiety before operation. To a group with higher intensity of trait anxiety belonged above all elderly persons. In addition, in these patients the knee function was worse. It was indicated that the better knee state and knee function were, the higher level of state anxiety before operation was. CONCLUSIONS: The knee clinical state prior to knee arthroplasty and trait anxiety are the predictors of the preoperative state anxiety. In the group of patients undergoing knee arthroplasty trait anxiety levels were found to be higher in older persons. Before the operation worse clinical knee state was found in patients with primary education as compared to patients with secondary education and university degree. No statistically significant correlation were found between preoperative anxiety and gender, patient's work status and marital status.