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Clinics in Orthopedic Surgery Mar 2020There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation... (Review)
Review
There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation in the treatment of ruptured Achilles tendons. Hence, conservative treatment is preferred by a growing number of surgeons seeking to treat the condition without the risk of complications from surgery. However, operative treatment is still considered as a more reliable treatment option for acute Achilles tendon rupture. In this review article, we provide an overview of recent treatment strategies for acute rupture of the Achilles tendon.
Topics: Achilles Tendon; Humans; Rupture; Tendon Injuries; Treatment Outcome
PubMed: 32117532
DOI: 10.4055/cios.2020.12.1.1 -
Sports Medicine and Arthroscopy Review Sep 2021Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior... (Review)
Review
Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time. Surgical advances in operative techniques, modern instrumentation and biological enhancements collectively improve healing rates of meniscal repair. However, failed repair is not without consequences and can negative impact patient outcomes. Therefore, it is imperative for surgeons to have a thorough understanding of the vascular zones and biomechanical classifications of meniscal tears in order to best determine the most appropriate treatment.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Conservative Treatment; Humans; Magnetic Resonance Imaging; Meniscectomy; Menisci, Tibial; Physical Therapy Modalities; Rupture; Tibial Meniscus Injuries; Wound Healing
PubMed: 34398118
DOI: 10.1097/JSA.0000000000000311 -
Foot and Ankle Clinics Sep 2019The use of early functional rehabilitation in the treatment of nonoperative Achilles tendon ruptures has been shown to provide patients with outcomes similar to... (Review)
Review
The use of early functional rehabilitation in the treatment of nonoperative Achilles tendon ruptures has been shown to provide patients with outcomes similar to operative treatments. This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. Complications with nonoperative treatment of Achilles ruptures are significantly lower than with operative treatment; however, re-rupture and elongation of the tendon resulting in decreased strength are problematic and more common if patients are non-compliant. These can be minimized with good patient education, close supervision, and good communication between physical therapist and physician.
Topics: Achilles Tendon; Humans; Physical Therapy Modalities; Rupture; Tendon Injuries
PubMed: 31370992
DOI: 10.1016/j.fcl.2019.05.001 -
Clinics in Podiatric Medicine and... Jan 2023There are many factors to consider when treating an Achilles tendon rupture in the acute and chronic/neglected settings. For acute rupture, operative and nonoperative... (Review)
Review
There are many factors to consider when treating an Achilles tendon rupture in the acute and chronic/neglected settings. For acute rupture, operative and nonoperative management contribute to a good prognosis with low associated risks. Patient or injury characteristics can assist in the shared decision-making about treatment. In chronic rupture, MRI may help to determine rupture location, gap distance, and tissue material available for repair. Various surgical approaches are used for chronic rupture repair. Treatment of the Achilles tendon rupture generates many interesting and complex discussions on the optimal management.
Topics: Humans; Achilles Tendon; Rupture; Tendon Injuries; Plastic Surgery Procedures; Ankle Injuries; Treatment Outcome
PubMed: 36368849
DOI: 10.1016/j.cpm.2022.07.006 -
Medicina (Kaunas, Lithuania) Sep 2022Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been... (Review)
Review
Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been written on the topic, no actual consensus exists on the best treatment. We aimed to collect the highest quality of evidence on the subject and to produce a document to which to refer, from the diagnosis to the final treatment. Inclusion criteria were systematic reviews discussing Achilles tendon rupture, concerning either diagnostic criteria, classification, or treatment; English language; clearly stated inclusion and exclusion criteria for patients' selection. Thirteen systematic reviews were included in the study. A strong consensus exists about the higher risk of re-rupture associated with non-operative treatment and a higher risk of complications associated with surgical repair. The combination of minimally invasive repair and accelerated functional rehabilitation seems to offer the best results in the treatment of Achilles tendon rupture.
Topics: Achilles Tendon; Acute Disease; Ankle Injuries; Humans; Minimally Invasive Surgical Procedures; Rupture; Tendon Injuries; Treatment Outcome
PubMed: 36143872
DOI: 10.3390/medicina58091195 -
The Journal of Hand Surgery Jan 2020Distal biceps tendon ruptures can result in functionally significant loss of supination and flexion strength, as well as decreased resistance to fatigue. Although the... (Review)
Review
Distal biceps tendon ruptures can result in functionally significant loss of supination and flexion strength, as well as decreased resistance to fatigue. Although the diagnosis of distal biceps tendon ruptures remains straightforward, substantial debate continues with regards to surgical indications, pertinent surgical anatomy, single- versus double-incision surgical technique, and fixation options. This review discusses the latest evidence-based literature regarding distal biceps tendon repair/reconstruction including types of tears, demographics, clues for diagnosis, surgical indications, anatomy with special attention to how the distal tendon inserts distally and the relevant tuberosity anatomy (height and cam effect), common reconstruction techniques (single- vs double-incision and single-incision power optimizing cost-effective technique), fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw), surgical technique pearls, postoperative rehabilitation, postoperative outcomes, as well as the treatment of chronic tears with special reconstruction techniques including Achilles allograft, pedicled latissimus transfer, and the use of a free innervated gracilis.
Topics: Achilles Tendon; Elbow; Humans; Range of Motion, Articular; Rupture; Tendon Injuries
PubMed: 31901332
DOI: 10.1016/j.jhsa.2019.09.014 -
Foot and Ankle Clinics Sep 2019Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical... (Review)
Review
Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be defined to guide the rehabilitation of injured athletes.
Topics: Achilles Tendon; Athletic Injuries; Humans; Return to Sport; Rupture; Tendon Injuries
PubMed: 31370995
DOI: 10.1016/j.fcl.2019.04.003 -
Acta Ortopedica Mexicana 2021The rupture of the Achilles tendon is one of the most frequent of the lower limb, the increase in its incidence invites to evaluate its associated characteristics that...
INTRODUCTION
The rupture of the Achilles tendon is one of the most frequent of the lower limb, the increase in its incidence invites to evaluate its associated characteristics that act as triggers or as risk factors.
METHODS
Descriptive, retrospective, cross-sectional study, based on clinical history data, using mean, standard deviation and percentages.
RESULTS
We evaluated 49 patients: males 83.7%, administrative profession 46.9%, sport injury 61.2% (soccer 38.8%). 75.5% were acute injuries, affecting the left tendon (57.1%). The most referred symptom is sudden pain (95.9%) and the most common sign is Thompson's (89.8%). Ultrasonography was used in 42.9%. 95.5% received treatment by open surgery and spinal anesthesia 85.1%. Intraoperatively they reported complete rupture 95.7%, at 2-5 cm insertion 66%, 98% of them had no associated injuries. The repair was simple tenorrhaphy with Kessler's point (51%) and Vycril as suture material (95.7%). Immobilization was performed with warm-pedium plaster (98%) for a period of 6-8 weeks (91.9%). Surgical waiting was 3.6 days and hospital stay 4.9 days.
CONCLUSIONS
Achilles tendon rupture occurred more frequently in sedentary males between 29-48 years, acute presentation in sports activity, affecting the left tendon. Most were complete ruptures located between 2-5 cm from its insertion, performing simple tenorrhaphy.
Topics: Achilles Tendon; Cross-Sectional Studies; Humans; Male; Retrospective Studies; Rupture; Tendon Injuries
PubMed: 34921533
DOI: No ID Found -
The Cochrane Database of Systematic... Jan 2021Various rehabilitation treatments may be offered following surgery for flexor tendon injuries of the hand. Rehabilitation often includes a combination of an exercise... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Various rehabilitation treatments may be offered following surgery for flexor tendon injuries of the hand. Rehabilitation often includes a combination of an exercise regimen and an orthosis, plus other rehabilitation treatments, usually delivered together. The effectiveness of these interventions remains unclear.
OBJECTIVES
To assess the effects (benefits and harms) of different rehabilitation interventions after surgery for flexor tendon injuries of the hand.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials, the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, MEDLINE, Embase, two additional databases and two international trials registries, unrestricted by language. The last date of searches was 11 August 2020. We checked the reference lists of included studies and relevant systematic reviews.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs that compared any postoperative rehabilitation intervention with no intervention, control, placebo, or another postoperative rehabilitation intervention in individuals who have had surgery for flexor tendon injuries of the hand. Trials comparing different mobilisation regimens either with another mobilisation regimen or with a control were the main comparisons of interest. Our main outcomes of interest were patient-reported function, active range of motion of the fingers, and number of participants experiencing an adverse event.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias and assessed the quality of the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology.
MAIN RESULTS
We included 16 RCTs and one quasi-RCT, with a total of 1108 participants, mainly adults. Overall, the participants were aged between 7 and 72 years, and 74% were male. Studies mainly focused on flexor tendon injuries in zone II. The 17 studies were heterogeneous with respect to the types of rehabilitation treatments provided, intensity, duration of treatment and the treatment setting. Each trial tested one of 14 comparisons, eight of which were of different exercise regimens. The other trials examined the timing of return to unrestricted functional activities after surgery (one study); the use of external devices applied to the participant to facilitate mobilisation, such as an exoskeleton (one study) or continuous passive motion device (one study); modalities such as laser therapy (two studies) or ultrasound therapy (one study); and a motor imagery treatment (one study). No trials tested different types of orthoses; different orthosis wearing regimens, including duration; different timings for commencing mobilisation; different types of scar management; or different timings for commencing strengthening. Trials were generally at high risk of bias for one or more domains, including lack of blinding, incomplete outcome data and selective outcome reporting. Data pooling was limited to tendon rupture data in a three trial comparison. We rated the evidence available for all reported outcomes of all comparisons as very low-certainty evidence, which means that we have very little confidence in the estimates of effect. We present the findings from three exercise regimen comparisons, as these are commonly used in clinical current practice. Early active flexion plus controlled passive exercise regimen versus early controlled passive exercise regimen (modified Kleinert protocol) was compared in one trial of 53 participants with mainly zone II flexor tendon repairs. There is very low-certainty evidence of no clinically important difference between the two groups in patient-rated function or active finger range of motion at 6 or 12 months follow-up. There is very low-certainty evidence of little between-group difference in adverse events: there were 15 overall. All three tendon ruptures underwent secondary surgery. An active exercise regimen versus an immobilisation regimen for three weeks was compared in one trial reporting data for 84 participants with zone II flexor tendon repairs. The trial did not report on self-rated function, on range of movement during three to six months or numbers of participants experiencing adverse events. The very low-certainty evidence for poor (under one-quarter that of normal) range of finger movement at one to three years follow-up means we are uncertain of the finding of zero cases in the active group versus seven cases in the immobilisation regimen. The same uncertainty applies to the finding of little difference between the two groups in adverse events (5 tendon ruptures in the active group versus 10 probable scar adhesion in the immobilisation group) indicated for surgery. Place and hold exercise regimen performed within an orthosis versus a controlled passive regimen using rubber band traction was compared in three heterogeneous trials, which reported data for a maximum of 194 participants, with mainly zone II flexor tendon repairs. The trials did not report on range of movement during three to six months, or numbers of participants experiencing adverse events. There was very low-certainty evidence of no difference in self-rated function using the Disability of the Arm, Shoulder and Hand (DASH) functional assessment between the two groups at six months (one trial) or at 12 months (one trial). There is very low-certainty evidence from one trial of greater active finger range of motion at 12 months after place and hold. Secondary surgery data were not available; however, all seven recorded tendon ruptures would have required surgery. All the evidence for the other five exercise comparisons as well as those of the other six comparisons made by the included studies was incomplete and, where available, of very low-certainty.
AUTHORS' CONCLUSIONS
There is a lack of evidence from RCTs on most of the rehabilitation interventions used following surgery for flexor tendon injuries of the hand. The limited and very low-certainty evidence for all 14 comparisons examined in the 17 included studies means that we have very little confidence in the estimates of effect for all outcomes for which data were available for these comparisons. The dearth of evidence identified in this review points to the urgent need for sufficiently powered RCTs that examine key questions relating to the rehabilitation of these injuries. A consensus approach identifying these and establishing minimum study conduct and reporting criteria will be valuable. Our suggestions for future research are detailed in the review.
Topics: Adolescent; Adult; Aged; Bias; Child; Exercise Therapy; Exoskeleton Device; Female; Hand Injuries; Humans; Immobilization; Laser Therapy; Male; Middle Aged; Muscle Contraction; Postoperative Care; Randomized Controlled Trials as Topic; Range of Motion, Articular; Rupture; Tendon Injuries; Ultrasonic Therapy; Young Adult
PubMed: 33434949
DOI: 10.1002/14651858.CD012479.pub2 -
Clinics in Sports Medicine Jul 2020Distal biceps tendon injuries typically occur from forced eccentric contraction against a heavy load and are more common in males than females. Most patients who rupture... (Review)
Review
Distal biceps tendon injuries typically occur from forced eccentric contraction against a heavy load and are more common in males than females. Most patients who rupture their distal biceps tendon undergo operative repair to minimize strength loss and fatigue. Single-incision and two-incision techniques have been developed in recent decades and achieve satisfactory outcomes. Cortical button and bone tunnel fixation demonstrate superior strength relative to suture anchors and interference screws for acute repairs. Patients who present late or who undergo surgery greater than 4 to 6 weeks from their injury are deemed chronic ruptures and may require autograft or allograft reconstruction.
Topics: Female; Humans; Male; Middle Aged; Muscle, Skeletal; Orthopedic Procedures; Rupture; Suture Anchors; Tendon Injuries; Tendons; Transplantation, Autologous
PubMed: 32446582
DOI: 10.1016/j.csm.2020.02.004