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BMC Musculoskeletal Disorders Dec 2023A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to...
INTRODUCTION
A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft.
METHODS
A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS).
RESULTS
Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2-13) for all studies.
CONCLUSION
Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Achilles Tendon; Aponeurosis; Hamstring Tendons; Surgical Flaps; Muscle, Skeletal; Tendon Injuries; Rupture; Treatment Outcome
PubMed: 38066531
DOI: 10.1186/s12891-023-07064-8 -
Acta Ortopedica Mexicana 2022plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to...
INTRODUCTION
plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to conservative treatment, shock waves, or corticosteroid injections. The aim of this publications is to carry out a systematic review of the available literature and to describe a specific technique for the treatment of plantar fasciosis consisting of the longitudinal tearing of the plantar aponeurosis assisted with ultrasound.
MATERIAL AND METHODS
a systematic search was carried out for previous publications on longitudinal tenotomy in the treatment of plantar fasciitis. The Medical Subject Headings (MeSH) terms "Curettage", "Tenotomy" and "Plantar Fasciitis" were included. The electronic search included PubMed, Embase, Cochrane central register of controlled trials, Trip database, and National Institute for Health and Care Excellence (NICE) databases. A detailed description of the technique was included with the intention that it can be reproduced.
CONCLUSION
longitudinal tenotomy represents an alternative for the treatment of plantar fasciitis. It is based on the extrapolation of knowledge in the Achilles tendon territory with a supporting pathophysiological basis. It is a non-invasive technique that can be performed on an outpatient basis and that would allow the rapid incorporation of the patient to their activities. Longitudinal tenotomy would prevent the patient from undergoing major surgeries.
Topics: Humans; Fasciitis, Plantar; Ultrasonography; Foot; Pain; Ultrasonography, Interventional; Treatment Outcome
PubMed: 36977646
DOI: No ID Found -
Journal of Ultrasound Mar 2023To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis. (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis.
METHODS
A literature search was conducted on the PubMed and Medline databases for articles published up to August 2022. The Newcastle-Ottawa scale was used to assess the risk of bias. We included original research studies in English dealing with the evaluation of patients with plantar fasciitis by means of SWE and including shear modulus (KPa) and/or shear-wave velocity (m/s). We compared healthy and pathologic PF stiffness using the standardised mean difference (SMD) in a random-effects model (95% CI).
RESULTS
Five studies were included with a total of 158 pathologic PFs and 134 healthy PFs. No significant publication bias was detected. Studies were highly heterogeneous (p < 0.00001; I = 97%). Pathologic PFs showed significantly lower stiffness, with an SMD of - 3.00 m/s (95% confidence interval: - 4.95 to - 1.06, p = 0.002), compared to healthy PF.
CONCLUSION
Pathologic PFs present significantly lower stiffness than healthy PFs. However, the analysed studies are highly heterogeneous.
Topics: Humans; Elasticity Imaging Techniques; Fasciitis, Plantar; Muscle, Skeletal; Aponeurosis; Fascia
PubMed: 36662404
DOI: 10.1007/s40477-022-00770-4 -
European Journal of Radiology Oct 2022This meta-analysis aimed to investigate the utility of ultrasound (US) elastography in the assessment of plantar fasciitis (PF). (Meta-Analysis)
Meta-Analysis
PURPOSE
This meta-analysis aimed to investigate the utility of ultrasound (US) elastography in the assessment of plantar fasciitis (PF).
METHODS
We searched PubMed, Embase, and Scopus and systemically reviewed clinical studies that used US elastography for imaging PF. The primary outcome was the comparison of plantar fascia stiffness between healthy controls and patients with PF, quantified using the weighted mean difference (WMD) and standardized mean difference (SMD).
RESULTS
Eleven studies were included in the final systematic review and meta-analysis. In six studies that employed shear wave elastography, patients with PF had a lower shear wave velocity, with a WMD of -1.772 m/s (95 % confidence interval [CI], -2.663 to -0.880) and an SMD of -1.239 m/s (95 % CI, -1.876 to -0.603), compared to those with asymptomatic heels. One study using the strain ratio showed that the WMD and SMD of patients with diseased heels vs healthy controls were -0.400 (95 % CI, -0.850 to 0.050) and -0.442 (95 % CI, -0.946 to 0.062), respectively. In six articles that use the color histogram of strain elastography, less stiffness was consistently reported in the diseased plantar fascia compared with healthy controls.
CONCLUSION
This meta-analysis showed that the plantar fasciae were less stiff in the PF group than in asymptomatic subjects. The diagnostic performance of US elastography (over B-mode) warrants further investigation.
Topics: Aponeurosis; Elasticity Imaging Techniques; Fasciitis, Plantar; Foot; Humans; Muscle, Skeletal
PubMed: 36037585
DOI: 10.1016/j.ejrad.2022.110495 -
Journal of Functional Morphology and... Jan 2022Hamstring strains are a frequent injury in sports and are characterized by a high recurrence rate. The aim of this review was to examine the muscle and tendon...
Hamstring strains are a frequent injury in sports and are characterized by a high recurrence rate. The aim of this review was to examine the muscle and tendon architecture in individuals with hamstring injury. A systematic literature search in four databases yielded eleven studies on architecture following injury. Differences in the fascicle length (FL), pennation angle (PA) and muscle size measures (volume, thickness and physiological cross-sectional area) at rest were not significantly different between the previously injured limb and the contralateral limb (p > 0.05). There was moderate evidence that biceps femoris long head (BFlh) FL shortening was greater during contraction in the injured compared to the contralateral limb. The BFlh FL was smaller in athletes with a previous injury compared to uninjured individuals (p = 0.0015) but no differences in the FL and PA of other muscles as well as in the aponeurosis/tendon size were observed (p > 0.05). An examination of the FL of both leg muscles in individuals with a previous hamstring strain may be necessary before and after return to sport. Exercises that promote fascicle lengthening of both injured and uninjured leg muscles may be beneficial for athletes who recover from a hamstring injury.
PubMed: 35225902
DOI: 10.3390/jfmk7010016 -
Plastic and Reconstructive Surgery Nov 2021The factors typically considered to be associated with Dupuytren disease have been described, such as those in the "Dupuytren diathesis." However, the quality of studies...
BACKGROUND
The factors typically considered to be associated with Dupuytren disease have been described, such as those in the "Dupuytren diathesis." However, the quality of studies describing them has not been appraised. This systematic review aimed to analyze the evidence for all factors investigated for potential association with the development, progression, outcome of treatment, or recurrence of Dupuytren disease.
METHODS
A systematic review of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was conducted using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant methodology up to September of 2019. Articles were screened in duplicate. Prognostic studies were quality assessed using the Quality in Prognosis Study tool.
RESULTS
This study identified 2301 records; 51 met full inclusion criteria reporting data related to 54,491 patients with Dupuytren disease. In total, 46 candidate factors associated with the development of Dupuytren disease were identified. There was inconsistent evidence between the association of Dupuytren disease and the presence of "classic" diathesis factors. The quality of included studies varied, and the generalizability of studies was low. There was little evidence describing the factors associated with functional outcome.
CONCLUSIONS
This systematic review challenges conventional notions of diathesis factors. Traditional diathesis factors are associated with disease development and recurrence, although they are not significantly associated with poor outcome following intervention based on the current evidence.
Topics: Aponeurosis; Disease Progression; Dupuytren Contracture; Fascia; Fasciotomy; Humans; Injections, Intralesional; Microbial Collagenase; Prognosis; Recurrence; Risk Factors; Treatment Outcome
PubMed: 34705778
DOI: 10.1097/PRS.0000000000008420 -
Journal of Functional Morphology and... Sep 2021The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess... (Review)
Review
The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess and synthetize the existing evidence on the anatomy, variation and morphological characteristics of the TVI as well as to examine its clinical importance. A systematic review was performed evaluating both anatomical and medical imaging studies which provided information about TVI anatomy, prevalence, variations and morphological characteristics. The search strategy was conducted in major electronic databases. Two reviewers worked independently to screen all possible references via a title/abstract examination. Methodological quality was examined with the Anatomical Quality Assurance checklist. A total of 295 cadaveric knees were included in the nine studies where in 244 (82.7%) cases the TVI was identified. Based on this evidence, it appears that the TVI is located between the vastus lateralis and vastus intermedius. The muscle belly is located proximally, and it is combined with a broad and flat aponeurosis before forming a tendinous structure that is attached at the medial aspect of the patella. The TVI presented some morphological variations and complex muscle architecture that varied along its length. There is insufficient good quality evidence as more than half of the included studies were ranked as having a "High" risk of bias with various methodological issues. Higher quality studies are recommended to evaluate the TVI morphology to better understand its functional and clinical importance.
PubMed: 34564196
DOI: 10.3390/jfmk6030077 -
Orthopaedic Journal of Sports Medicine Aug 2021Low-cycle fatigue damage accumulating to the point of structural failure has been recently reported at the origin of the human anterior cruciate ligament under strenuous... (Review)
Review
BACKGROUND
Low-cycle fatigue damage accumulating to the point of structural failure has been recently reported at the origin of the human anterior cruciate ligament under strenuous repetitive loading. If this can occur in a ligament, low-cycle fatigue damage may also occur in the connective tissue of muscle-tendon units. To this end, we reviewed what is known about how, when, and where injuries of muscle-tendon units occur throughout the body.
PURPOSE
To systematically review injuries in the muscle-tendon-bone complex; assess the site of injury (muscle belly, musculotendinous junction [MTJ], tendon/aponeurosis, tendon/aponeurosis-bone junction, and tendon/aponeurosis avulsion), incidence, muscles and tendons involved, mechanism of injury, and main symptoms; and consider the hypothesis that injury may often be consistent with the accumulation of multiscale material fatigue damage during repetitive submaximal loading regimens.
METHODS
PubMed, Web of Science, Scopus, and ProQuest were searched on July 24, 2019. Quality assessment was undertaken using ARRIVE, STROBE, and CARE (Animal Research: Reporting In Vivo Experiments, Strengthening the Reporting of Observational Studies in Epidemiology, and the Case Report Statement and Checklist, respectively).
RESULTS
Overall, 131 studies met the inclusion criteria, including 799 specimens and 2,823 patients who sustained 3,246 injuries. Laboratory studies showed a preponderance of failures at the MTJ, a viscoelastic behavior of muscle-tendon units, and damage accumulation at the MTJ with repetitive loading. Observational studies showed that 35% of injuries occurred in the tendon midsubstance; 28%, at the MTJ; 18%, at the tendon-bone junction; 13%, within the muscle belly and that 6% were tendon avulsions including a bone fragment. The biceps femoris was the most injured muscle (25%), followed by the supraspinatus (12%) and the Achilles tendon (9%). The most common symptoms were hematoma and/or swelling, tenderness, edema and muscle/tendon retraction. The onset of injury was consistent with tissue fatigue at all injury sites except for tendon avulsions, where 63% of the injuries were caused by an evident trauma.
CONCLUSION
Excluding traumatic tendon avulsions, most injuries were consistent with the hypothesis that material fatigue damage accumulated during repetitive submaximal loading regimens. If supported by data from better imaging modalities, this has implications for improving injury detection, prevention, and training regimens.
PubMed: 34395681
DOI: 10.1177/23259671211020731 -
Hernia : the Journal of Hernias and... Aug 2021Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic... (Review)
Review
PURPOSE
Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias.
METHODS
PubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Student t tests were performed to compare differences in continuous outcomes.
RESULTS
Twenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic approaches using both non-absorbable and absorbable sutures. The majority of the techniques reported included mesh insertion either above the aponeurosis, retromuscular, preperitoneal, or intraperitoneal. Open techniques, compared to laparoscopic approaches, were associated with a significantly higher rate of skin dehiscence (6.79% vs. 2.86%; p = 0.003) and hematoma formation (4.73% vs. 1.09%; p < 0.001) and a significantly lower rate of post-operative seroma formation (2.47% vs. 8.29%; p < 0.001). No significant difference in RD recurrence rates were observed between open and laparoscopic repair (0.22 vs. 0.63%, p = 0.17).
CONCLUSION
Both open and laparoscopic surgery are safe and effective methods that can be used to repair RD in patients with RD and concurrent abdominal hernias as evident by the low recurrence and complication rates and almost negligible major complications post repair.
Topics: Abdominal Wall; Hernia, Abdominal; Herniorrhaphy; Humans; Laparoscopy; Recurrence; Seroma; Surgical Mesh; Sutures
PubMed: 34319467
DOI: 10.1007/s10029-021-02460-2 -
Foot and Ankle Surgery : Official... Jun 2020The aim of the present systematic literature review is to give an overview of ruptures of the plantar fascia. For this purpose, a detailed description of the patient...
BACKGROUND
The aim of the present systematic literature review is to give an overview of ruptures of the plantar fascia. For this purpose, a detailed description of the patient collective is provided. However, the focus of this analysis is based on the current therapy concepts. Based on the results the authors propose a standardized therapy concept.
MATERIAL AND METHODS
A systematic literature review was performed using the PubMed database using the terms: ("rupture plantar fascia" OR "plantar fascia tear" OR "rupture plantar aponeurosis"). All articles published in the PubMed database until 07.11.2018 were included. The articles were evaluated with regard to three research question: (1) Which patients are affected by a rupture of the plantar fascia? (2) Which therapy concept was used to treat rupture of the plantar fascia? And (3) which result was achieved and how was this measured?
RESULTS
A total of 78 studies were identified, of which the full text of 17 were analysed. 12 publications were cases reports, 5 studies were retrospective analyses. Data from 124 patients could be included. The average age of patients was 39.6 years. In 63.2% (n = 12) of the studies, patients with a high level of athletic activity or even professional athletes were analyzed. 94.4% of all patients were treated conservatively. The average duration of immobilization in a rigid walker was 2.6 weeks. In the majority of cases, pain-adapted weight-bearing was allowed in the rigid walker.
CONCLUSION
There are few available studies concerning the rupture of plantar fascia. The quality of data is poor. The maximum duration of immobilization of 3 weeks in a rigid walker with pain-adapted weight-bearing appears to be the most applied therapy concept. Further studies are needed to evaluate the efficacy of the therapy and to optimize the therapy concept.
Topics: Ankle Injuries; Aponeurosis; Disease Management; Fascia; Humans; Immobilization; Orthopedic Procedures; Rupture; Weight-Bearing
PubMed: 31176530
DOI: 10.1016/j.fas.2019.05.006