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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 -
Seminars in Musculoskeletal Radiology Jun 2023Tendinopathy is very common in the foot and ankle. Achilles tendinopathy is a painful overuse injury that often occurs in athletes, especially those who participate in...
Tendinopathy is very common in the foot and ankle. Achilles tendinopathy is a painful overuse injury that often occurs in athletes, especially those who participate in running and jumping sports. Plantar fasciitis is the most frequent cause of plantar pain in the adult heel. Initial treatment of these conditions is conservative. However, in some cases symptoms only improve slowly, and many cases are intractable. When conservative management fails, ultrasonography guided injections are indicated. We discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, retrocalcaneal bursitis, and plantar fasciitis. We describe the different agents that can be used and the various ultrasonography-guided procedures that offer technical and practical information to improve daily clinical practice.
Topics: Adult; Humans; Achilles Tendon; Fasciitis, Plantar; Tendinopathy; Ultrasonography; Fascia
PubMed: 37230134
DOI: 10.1055/s-0043-1766095 -
Journal of Ultrasound Sep 2020The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute... (Review)
Review
The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute Achilles ruptures. This article describes the postoperative imaging findings and their evolution after surgery. Ultrasound and magnetic resonance imaging provide crucial information regarding the morphology, structure, vascularization and mobility of the Achilles tendon on the surrounding planes. Morphologically, a repaired tendon is physiologically larger and wider than an intact one, with a loss of its fibrillary structure; the presence of surgical material in the context of the tendon is normal after the rupture has been repaired. After surgery, the tendon is more vascularized in power-Doppler imaging. Elastography and diffusion tensor Imaging are innovative tools which allow for the visualization of microstructural abnormalities not apprehensible using conventional imaging techniques. A treated Achilles tendon is unlikely to regain a normal imaging appearance, and the health care professional must distinguish between postoperative findings and actual pathological features. In this context, clinical examination still reigns supreme.
Topics: Achilles Tendon; Humans; Magnetic Resonance Imaging; Postoperative Period; Tendon Injuries; Ultrasonography
PubMed: 32488649
DOI: 10.1007/s40477-020-00479-2 -
Revista Espanola de Cirugia Ortopedica... 2023The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.
OBJECTIVE
The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.
MATERIAL AND METHODS
A prospective cohort study including patients treated for an achilles tendon rupture from January 2016 to March 2019 was conducted.
INCLUSION CRITERIA
≥18 years of age, non-insertional (2-8cm proximal to insertion) achilles tendon ruptures. Open or partial ruptures were excluded. The diagnosis was based on clinical criteria and confirmed by ultrasonography in all patients. Epidemiological data, rupture and healing risk factors, previous diagnosis of tendinopathy, pre-rupture sport activity, job information, mechanism of rupture and the time in days between lesion and surgery were collected. Patients were assessed using visual analogue scale at the 1, 3, 6 and 12-month follow-up. The achilles tendon rupture score were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected.
CONCLUSIONS
In our experience, percutaneous achilles tendon repair with absorbable sutures in patients with an acute achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively. For this reason, conservative treatment associated with an early weightbearing rehabilitation protocol should be considered a viable option for patients with achilles tendon ruptures, mainly in cooperative young patients.
Topics: Humans; Achilles Tendon; Prospective Studies; Ultrasonography; Orthopedic Procedures; Tendon Injuries; Sutures; Rupture; Suture Techniques; Treatment Outcome
PubMed: 36529423
DOI: 10.1016/j.recot.2022.12.009 -
Revista Espanola de Cirugia Ortopedica... 2023The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.
OBJECTIVE
The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.
MATERIAL AND METHODS
A prospective cohort study including patients treated for an achilles tendon rupture from January 2016 to March 2019 was conducted.
INCLUSION CRITERIA
≥18 years of age, non-insertional (2-8cm proximal to insertion) achilles tendon ruptures. Open or partial ruptures were excluded. The diagnosis was based on clinical criteria and confirmed by ultrasonography in all patients. Epidemiological data, rupture and healing risk factors, previous diagnosis of tendinopathy, pre-rupture sport activity, job information, mechanism of rupture and the time in days between lesion and surgery were collected. Patients were assessed using visual analogue scale (VAS) at the 1, 3, 6 and 12-month follow-up. The achilles tendon rupture score (ATRS) were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected.
CONCLUSIONS
In our experience, percutaneous achilles tendon repair with absorbable sutures in patients with an acute achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively. For this reason, conservative treatment associated with an early weightbearing rehabilitation protocol should be considered a viable option for patients with achilles tendon ruptures, mainly in cooperative young patients.
Topics: Humans; Achilles Tendon; Prospective Studies; Ultrasonography; Plastic Surgery Procedures; Tendon Injuries; Sutures; Rupture; Suture Techniques; Treatment Outcome
PubMed: 36096468
DOI: 10.1016/j.recot.2022.08.009 -
Danish Medical Journal Mar 2018Valid length measurements of the different segments of the Achilles tendon are needed in order to investigate if differential elongation of the Achilles tendon takes... (Comparative Study)
Comparative Study
INTRODUCTION
Valid length measurements of the different segments of the Achilles tendon are needed in order to investigate if differential elongation of the Achilles tendon takes place after rupture. The purpose of this paper was to present data concerning the accuracy and reliability of an ultrasound measurement of the free part of the Achilles tendon.
METHODS
Both legs of 19 non-injured subjects were examined by magnetic resonance imagining (MRI) and ultrasound. The length from the distal tip of the soleus muscle to the tendon insertion on the calcaneus was measured by three independent ultrasound examiners. Repeated ultrasound measurements were performed and compared with MRI measurements. Intra-rater and inter-rater reliability and the agreement between MRI and ultrasound were determined. Data were evaluated using the intraclass correlation coefficient (ICC), the standard error of the measurement (SEM) and the minimal detectable change (MDC).
RESULTS
The measurement showed excellent intra-rater reliability (ICC = 0.94 (95% confidence interval (CI): 0.91-0.96), SEM = 5 mm and MDC = 13 mm) and inter-rater reliability (ICC = 0.96 (95% CI: 0.93-0.97), SEM = 4 mm and MDC = 11 mm). On average, ultrasound measurements exceeded the MRI measurements by 2 mm (non-significant), resulting in a measurement error of 5%.
CONCLUSIONS
The ultrasound measurement of the free part of the Achilles tendon showed good reliability and accuracy. For comparison between groups of non-injured subjects, differences of > 5 mm can be detected. For repeated assessment of individual subject differences ≥ 13 mm can be detected.
FUNDING
none.
TRIAL REGISTRATION
Institutional Review Board of Zealand, Denmark, Ref. no: SJ-318.
Topics: Achilles Tendon; Adult; Denmark; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Tendon Injuries; Ultrasonography
PubMed: 29510804
DOI: No ID Found -
Revista Espanola de Cirugia Ortopedica... 2023The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.
BACKGROUND AND OBJECTIVE
The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.
MATERIAL AND METHODS
Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019).
INCLUSION CRITERIA
≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected.
RESULTS
VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries).
CONCLUSIONS
Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.
Topics: Humans; Achilles Tendon; Prospective Studies; Orthopedic Procedures; Plastic Surgery Procedures; Rupture; Tendon Injuries; Sutures; Ankle Injuries; Suture Techniques; Treatment Outcome
PubMed: 36265782
DOI: 10.1016/j.recot.2022.10.014 -
Revista Espanola de Cirugia Ortopedica... 2023The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.
BACKGROUND AND OBJECTIVE
The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.
MATERIAL AND METHODS
Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019).
INCLUSION CRITERIA
≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected.
RESULTS
VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries).
CONCLUSIONS
Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.
Topics: Humans; Achilles Tendon; Prospective Studies; Orthopedic Procedures; Plastic Surgery Procedures; Rupture; Tendon Injuries; Sutures; Ankle Injuries; Suture Techniques; Treatment Outcome
PubMed: 35809780
DOI: 10.1016/j.recot.2022.06.008 -
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