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International Orthopaedics Oct 2021This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors... (Review)
Review
PURPOSE
This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research.
METHODS
A scoping review was performed according to the frameworks of Arksey and O'Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria.
RESULTS
A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%).
CONCLUSION
Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.
Topics: Achilles Tendon; Chronic Disease; Humans; Rupture; Tendon Transfer; Treatment Outcome
PubMed: 34089355
DOI: 10.1007/s00264-021-05102-5 -
Journal of Orthopaedic Surgery and... Feb 2024The diagnosis and management of Achilles tendon ailments continue to be widely discussed by the scientific community. Also, the nomenclature used to describe the... (Review)
Review
The diagnosis and management of Achilles tendon ailments continue to be widely discussed by the scientific community. Also, the nomenclature used to describe the tendinopathic lesion in patients changed over the last decades together with the evolution in the knowledge of the physiopathology of Achilles tendinopathy, and unfortunately, through ignorance and possibly laziness, confusion still abounds. To emerge from these foggy paths, some clarifications are still necessary. The present Editorial tries to clarify some of these issues.
Topics: Humans; Achilles Tendon; Tendinopathy; Scotland
PubMed: 38336789
DOI: 10.1186/s13018-024-04560-y -
ELife Feb 2021The unique structure of the Achilles tendon, combining three smaller sub-tendons, enhances movement efficiency by allowing individual control from connected muscles....
The unique structure of the Achilles tendon, combining three smaller sub-tendons, enhances movement efficiency by allowing individual control from connected muscles. This requires compliant interfaces between sub-tendons, but compliance decreases with age and may account for increased injury frequency. Current understanding of sub-tendon sliding and its role in the whole Achilles tendon function is limited. Here we show changing the degree of sliding greatly affects the tendon mechanical behaviour. Our in vitro testing discovered distinct sub-tendon mechanical properties in keeping with their mechanical demands. In silico study based on measured properties, subject-specific tendon geometry, and modified sliding capacity demonstrated age-related displacement reduction similar to our in vivo ultrasonography measurements. Peak stress magnitude and distribution within the whole Achilles tendon are affected by individual tendon geometries, the sliding capacity between sub-tendons, and different muscle loading conditions. These results suggest clinical possibilities to identify patients at risk and design personalised rehabilitation protocols.
Topics: Achilles Tendon; Adult; Age Factors; Aged; Aged, 80 and over; Biomechanical Phenomena; Computer Simulation; Female; Humans; Male; Middle Aged; Movement; Ultrasonography
PubMed: 33588992
DOI: 10.7554/eLife.63204 -
Journal of Biomechanics May 2023The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power... (Review)
Review
The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power amplification and power attenuation during locomotor tasks. The properties and the unique structure of the AT as a common tendon for three muscles have been studied frequently in humans using in vivo methods since 1990's. As a part of the celebration of 50 years history of the International Society of Biomechanics, this paper reviews the history of the AT research focusing on its mechanical properties in humans. The questions addressed are: What are the most important mechanical properties of the Achilles tendon, how are they studied, what is their significance to human movement, and how do they adapt? We foresee that the ongoing developments in experimental methods and modeling can provide ways to advance knowledge of the complex three-dimensional structure and properties of the Achilles tendon in vivo, and to enable monitoring of the loading and recovery for optimizing individual adaptations.
Topics: Humans; Achilles Tendon; Elastic Modulus; Movement; Muscle, Skeletal; Adaptation, Physiological; Biomechanical Phenomena
PubMed: 37086579
DOI: 10.1016/j.jbiomech.2023.111583 -
Knee Surgery, Sports Traumatology,... Oct 2023After four weeks from injury, tears of the Achilles tendon are considered chronic. Their management is challenging, and the use of a graft is suggested when the gap... (Review)
Review
PURPOSE
After four weeks from injury, tears of the Achilles tendon are considered chronic. Their management is challenging, and the use of a graft is suggested when the gap between proximal and distal stumps is greater than 6 cm. The present study systematically reviews the outcome of free tendon grafts in chronic ruptures of the Achilles tendon, evaluating clinical outcomes, complications and return to sport.
METHODS
The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in February 2023. All the published clinical studies reporting clinical outcome, return to sport and complications of free tendon grafts used the treatment of chronic rupture of the midportion of the Achilles Tendon were accessed. The mean CMS (Coleman Methodology Score) of 65.7 suggested an overall good quality of the available published articles, attesting to the low risk of bias.
RESULTS
Data from 22 articles (368 patients with a mean age of 47 years) were retrieved. The average time from rupture to surgery was 25.1 week. At last follow-up, the AOFAS (American Orthopaedic Foot and Ankle Surgery) and ATRS (Achilles Tendon Total Rupture Score) scores improved of 33.8 (P = 0.0004), and 45.1 points (P = 0.0001) respectively. Return to activity was reported in 105 patients, and 82 (78.1%) had no activity limitations, while 19 (18.1%) had limited recreational but not daily activity limitations, and 4 (3.8%) reported limitations in daily activities. Return to sport data was reported in six studies, and 45 of 93 (48.4%) patients returned to sport at an average of 22.6 weeks.
CONCLUSION
In chronic tears of the Achilles tendon, with a gap of at least 6 cm, free tendon grafts allow predictable return to sport and acceptable recovery function.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Middle Aged; Achilles Tendon; Treatment Outcome; Tendon Injuries; Plastic Surgery Procedures; Sports; Rupture; Retrospective Studies
PubMed: 37193823
DOI: 10.1007/s00167-023-07446-4 -
The Western Journal of Emergency... Jan 2015
Topics: Achilles Tendon; Humans; Male; Middle Aged; Rupture; Tendon Injuries; Ultrasonography
PubMed: 25671030
DOI: 10.5811/westjem.2014.10.24127 -
Journal of Visualized Experiments : JoVE Oct 2019Tendon disorders are common, affect people of all ages, and are often debilitating. Standard treatments, such as anti-inflammatory drugs, rehabilitation, and surgical...
Tendon disorders are common, affect people of all ages, and are often debilitating. Standard treatments, such as anti-inflammatory drugs, rehabilitation, and surgical repair, often fail. In order to define tendon function and demonstrate efficacy of new treatments, the mechanical properties of tendons from animal models must be accurately determined. Murine animal models are now widely used to study tendon disorders and evaluate novel treatments for tendinopathies; however, determining the mechanical properties of mouse tendons has been challenging. In this study, a new system was developed for tendon mechanical testing that includes 3D-printed fixtures that exactly match the anatomies of the humerus and calcaneus to mechanically test supraspinatus tendons and Achilles tendons, respectively. These fixtures were developed using 3D reconstructions of native bone anatomy, solid modeling, and additive manufacturing. The new approach eliminated artifactual gripping failures (e.g., failure at the growth plate failure rather than in the tendon), decreased overall testing time, and increased reproducibility. Furthermore, this new method is readily adaptable for testing other murine tendons and tendons from other animals.
Topics: Achilles Tendon; Animals; Biomechanical Phenomena; Female; Imaging, Three-Dimensional; Male; Mice; Mice, Inbred C57BL; Models, Animal; Printing, Three-Dimensional; Reproducibility of Results
PubMed: 31680671
DOI: 10.3791/60280 -
Australian Journal of General Practice Nov 2020The prevalence of acute and chronic conditions of the Achilles tendon is increasing among an ageing, active population. These conditions are a common cause of...
BACKGROUND
The prevalence of acute and chronic conditions of the Achilles tendon is increasing among an ageing, active population. These conditions are a common cause of presentation to general practitioners and allied health practitioners. Achilles tendon injuries have a bimodal demographical presentation, with acute injuries commonly occurring in younger people and chronic conditions presenting in patients who are elderly.
OBJECTIVE
The aims of this article are to discuss management of acute Achilles tendon ruptures in the primary care setting, explain the risks associated with calcaneal tuberosity fracture and discuss non-operative and surgical management of acute and chronic overload conditions of the Achilles tendon.
DISCUSSION
Achilles tendon injuries can be divided into acute ruptures and chronic overuse injuries. Both can be debilitating, with significant morbidity for patients; fortunately, both types of injuries respond well to non-operative interventions, with only a small proportion requiring surgery. Management of acute Achilles tendon rupture has evolved, with increasing evidence that non-operative management is appropriate providing patients participate in a functional rehabilitation protocol. Chronic conditions such as the sequalae of an untreated rupture or Achilles tendinopathy can be debilitating but often respond well to non-operative management.
Topics: Achilles Tendon; Chronic Disease; Foot Orthoses; Humans; Rupture; Tendon Injuries
PubMed: 33123713
DOI: 10.31128/AJGP-07-20-5506 -
Journal of Orthopaedic Surgery and... Sep 2023Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to...
Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.
Topics: Humans; Achilles Tendon; Tendon Injuries; Ankle Injuries; Dermatologic Surgical Procedures; Neurosurgical Procedures
PubMed: 37700324
DOI: 10.1186/s13018-023-04167-9 -
Foot & Ankle International Mar 2018Following Achilles tendon rupture, tendon elongation leads to long term deficits in calf function. A surrogate measure of Achilles tendon length, Achilles tendon resting...
BACKGROUND
Following Achilles tendon rupture, tendon elongation leads to long term deficits in calf function. A surrogate measure of Achilles tendon length, Achilles tendon resting angle (ATRA), has been described but has not been validated against length measured using ultrasound. Therefore, the purpose of this study was to validate the ATRA against ultrasound. Secondarily, this study aimed to identify the relationship of other factors (tendon mechanical properties, heel-rise test performance) to the ATRA.
METHODS
Individuals following unilateral Achilles tendon rupture were included. ATRA was measured in knee flexed and extended positions. Tendon elongation was measured using extended field of view ultrasound imaging. Continuous shear wave elastography quantified tendon mechanical properties. The relationship between variables was tested using Spearman's ρ. Subgroup analysis was used to compare subjects with less then or greater than 1 year following rupture. A total of 42 participants (with a mean of 18.2 months following rupture [SD = 35.9]) were included.
RESULTS
Tendon elongation related with relative ATRA with knee flexed (ρ = .491, P = .001) and knee extended (ρ = 0.501, P = .001) positions. In individuals greater than 1 year following rupture, relative ATRA with the knee flexed related to shear modulus (ρ = .800, P = .01) and total work on the heel-rise test (ρ = -.782, P = .008) relative to the uninjured side.
CONCLUSION
Relative ATRA in both knee flexed and knee extended positions has a moderate relationship to tendon elongation within the first year following rupture. After 1 year, the relative ATRA with knee flexed may be a better indicator of tendon elongation and also related to tendon mechanical properties and heel-rise test performance.
LEVEL OF EVIDENCE
Level III, case-control study.
Topics: Achilles Tendon; Adult; Aged; Case-Control Studies; Female; Heel; Humans; Male; Middle Aged; Muscle Weakness; Physical Examination; Postoperative Care; Range of Motion, Articular; Reference Values; Rupture; Tendon Injuries; Ultrasonography, Doppler
PubMed: 29272160
DOI: 10.1177/1071100717742372