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Annals of Medicine Dec 2022Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and... (Review)
Review
Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions.KEY MESSAGEsSurgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates.Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later.Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.
Topics: Hamstring Muscles; Hamstring Tendons; Humans; Rupture; Tendon Injuries
PubMed: 35416097
DOI: 10.1080/07853890.2022.2059560 -
Journal of the American Veterinary... Mar 2003To determine hip, stifle, and tarsal joint ranges of motion (ROM) and angular velocities during swimming and walking in healthy dogs and dogs with surgically corrected...
OBJECTIVE
To determine hip, stifle, and tarsal joint ranges of motion (ROM) and angular velocities during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament (CCL) rupture.
DESIGN
Prospective clinical study.
ANIMALS
13 healthy dogs and 7 dogs with CCL rupture.
PROCEDURE
Dogs with CCL rupture were enrolled in a postoperative aquatic rehabilitation program and evaluated 21 to 35 days after surgery. Dogs were filmed while swimming in a pool and while walking at a fast (1.3 m/s) or slow (0.9 m/s) pace on a treadmill. Maximal angles of extension and flexion, ROM, and angular velocities were calculated.
RESULTS
In healthy dogs, swimming resulted in a significantly greater ROM in the hip joint than did walking, but in dogs with CCL rupture, ROM of the hip joint did not vary with swimming versus walking. For dogs in both groups, swimming resulted in significantly greater ROM of the stifle and tarsal joints than did walking, primarily because of greater joint flexion. Stifle joint ROM was significantly lower in dogs with CCL rupture than in healthy dogs, regardless of whether dogs were swimming or walking.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that following surgical management of a ruptured CCL in dogs, swimming resulted in greater ROM of the stifle and tarsal joints than did walking. This suggests that if ROM is a factor in the rate or extent of return to function in these dogs, then aquatic rehabilitation would likely result in a better overall outcome than walking alone.
Topics: Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Dog Diseases; Dogs; Female; Gait; Hindlimb; Male; Prospective Studies; Range of Motion, Articular; Rupture; Stifle; Swimming; Tarsal Joints; Walking
PubMed: 12675295
DOI: 10.2460/javma.2003.222.739 -
Knee Surgery, Sports Traumatology,... Dec 2020Achilles tendon rupture (ATR) is a common injury. The knowledge of seasonal factors´ impact is incomplete, but may provide means for preventive approaches for Achilles...
PURPOSE
Achilles tendon rupture (ATR) is a common injury. The knowledge of seasonal factors´ impact is incomplete, but may provide means for preventive approaches for Achilles tendon related morbidity. The aim of this study was to investigate seasonal variations in ATR incidence in relation to injury mechanism, adverse events including risk of re-rupture, and patient-reported outcome in adults in Stockholm, Sweden.
METHODS
In total, 349 patients with unilateral acute Achilles tendon rupture, prospectively treated with standardized surgical techniques, were retrospectively assessed. Date of injury was assigned to one of the four internationally defined meteorological seasons in the northern hemisphere. Injury mechanism and the rate of adverse events; deep venous thrombosis, infection and re-rupture in relation to per-operative complications. Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score.
RESULTS
ATR incidence was significantly highest during winter and spring, and lowest during summer (p < 0.05). The most common sporting activities associated with ATR were badminton, floorball and soccer (> 50%). The rate of soccer-related ATR was highest during summer (p < 0.05). Patients sustaining an ATR during summer, compared to other seasons, exhibited more per-operative complications (p < 0.05), a significantly higher risk of re-rupture (p < 0.05) and a lower rate of good outcome (n.s.). The risk of other adverse events after ATR did not differ between the seasons.
CONCLUSION
Winter and spring are the high risk seasons for sports-related ATR and the risk sports are badminton, soccer and floorball. The reason for the higher risk of re-rupture after ATR repair during summer should be further investigated.
LEVEL OF EVIDENCE
III.
Topics: Achilles Tendon; Adult; Athletic Injuries; Bacterial Infections; Female; Humans; Incidence; Male; Patient Reported Outcome Measures; Reinjuries; Retrospective Studies; Risk Factors; Rupture; Seasons; Sweden; Venous Thrombosis
PubMed: 32313989
DOI: 10.1007/s00167-020-05982-x -
Lakartidningen
Review
Topics: Achilles Tendon; Algorithms; Athletic Injuries; Humans; Male; Middle Aged; Precision Medicine; Rupture; Sex Factors
PubMed: 25325135
DOI: No ID Found -
Ugeskrift For Laeger Nov 2015Treatment of acute Achilles tendon rupture in Denmark has changed from being predominantly operative to being non-operative treatment over the past five years. However,... (Review)
Review
Treatment of acute Achilles tendon rupture in Denmark has changed from being predominantly operative to being non-operative treatment over the past five years. However, no clear evidence is found in the literature in favour of one treatment modality over another. Non-operative treatment leads to an increased risk of re-rupture and operative treatment to an increased risk of other complications such as adhesions, infection and nerve injury. When a non-operative treatment protocol is chosen it is paramount that sufficient expertise is present to guide the treatment and rehabilitation.
Topics: Achilles Tendon; Acute Disease; Clinical Decision-Making; Critical Pathways; Denmark; Humans; Rupture; Tendon Injuries; Treatment Outcome; Wound Healing
PubMed: 26573949
DOI: No ID Found -
International Journal of Molecular... Oct 2017A balance between matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) is required to maintain tendon homeostasis. Variation in this balance over time might...
A balance between matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) is required to maintain tendon homeostasis. Variation in this balance over time might impact on the success of tendon healing. This study aimed to analyze structural changes and the expression profile of MMPs and TIMPs in human Achilles tendons at different time-points after rupture. Biopsies from 37 patients with acute Achilles tendon rupture were taken at surgery and grouped according to time after rupture: early (2-4 days), middle (5-6 days), and late (≥7 days), and intact Achilles tendons served as control. The histological score increased from the early to the late time-point after rupture, indicating the progression towards a more degenerative status. In comparison to intact tendons, qRT-PCR analysis revealed a significantly increased expression of MMP-1, -2, -13, TIMP-1, COL1A1, and COL3A1 in ruptured tendons, whereas TIMP-3 decreased. Comparing the changes over time post rupture, the expression of MMP-9, -13, and COL1A1 significantly increased, whereas MMP-3 and -10 expression decreased. TIMP expression was not significantly altered over time. MMP staining by immunohistochemistry was positive in the ruptured tendons exemplarily analyzed from early and late time-points. The study demonstrates a pivotal contribution of all investigated MMPs and TIMP-1, but a minor role of TIMP-2, -3, and -4, in the early human tendon healing process.
Topics: Achilles Tendon; Adult; Biopsy; Collagen Type I; Collagen Type I, alpha 1 Chain; Collagen Type III; Female; Gene Expression Profiling; Gene Expression Regulation; Humans; Male; Matrix Metalloproteinases; Middle Aged; Rupture; Tendon Injuries; Time Factors; Tissue Inhibitor of Metalloproteinases; Young Adult
PubMed: 29053586
DOI: 10.3390/ijms18102199 -
Knee Surgery, Sports Traumatology,... Oct 2018The aim of this study was to perform a long-term follow-up of patients treated for an Achilles tendon re-rupture, using established outcome measurements for tendon...
PURPOSE
The aim of this study was to perform a long-term follow-up of patients treated for an Achilles tendon re-rupture, using established outcome measurements for tendon structure, lower extremity function and symptoms, and to compare the results with those for the uninjured side. A secondary aim was to compare the outcome with that of patients treated for primary ruptures. The hypotheses were that patients with a re-rupture recover well, and have similar long-term outcome as primary ruptures.
METHODS
Twenty patients (4 females) with a mean (SD) age of 44 (10.9) years, ranging from 24 to 64, were included. The patients were identified by reviewing the medical records of all Achilles tendon ruptures at Sahlgrenska University Hospital and Kungsbacka Hospital, Sweden, between 2006 and 2016. All patients received standardised surgical treatment and rehabilitation. The mean (SD) follow-up was 51 (38.1) months. A test battery of validated clinical and functional tests, patient-reported outcome measurements and measurements of tendon elongation were performed at the final follow-up. This cohort was then compared with the 2-year follow-up results from a previous randomised controlled trial of patients treated for primary Achilles tendon rupture.
RESULTS
There were deficits on the injured side compared with the healthy side in terms of heel-rise height (11.9 versus 12.5 cm, p = 0.008), repetitions (28.5 versus 31.7, p = 0.004) and drop-jump height (13.2 versus 15.1 cm, p = 0.04). There was a significant difference in calf circumference (37.1 versus 38.4 cm, p =< 0.001) and ankle dorsiflexion on the injured side compared with the healthy side (35.3° versus 40.8°, p = 0.003). However, no significant differences were found in terms of tendon length 22.5 (2.5) cm on the injured side and 21.8 (2.8) cm on the healthy side. Compared with primary ruptures, the re-rupture cohort obtained significantly worse results for the Achilles tendon total rupture score, with a mean of 78 (21.2) versus 89.5 (14.6) points, (p = 0.007). The re-ruptures showed a higher mean LSI heel-rise height, 94.7% (9.3%) versus 83.5% (11.7%) (p = < 0.0001), and superior mean LSI eccentric-concentic power, 110.4% (49.8%) versus 79.3% (21%) (p = 0.001), than the primary ruptures.
CONCLUSION
The results of this study indicate that patients with an Achilles tendon re-rupture had continued symptoms and functional deficits on the injured side, after a long-term follow-up. Patients with an Achilles tendon re-rupture had worse patient-reported outcomes but similar or superior functional results compared with patients with primary ruptures.
LEVEL OF EVIDENCE
Case series, Level IV.
Topics: Achilles Tendon; Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Range of Motion, Articular; Recurrence; Rupture; Sweden; Tendon Injuries; Treatment Outcome; Young Adult
PubMed: 29691618
DOI: 10.1007/s00167-018-4952-0 -
Joint Diseases and Related Surgery 2021This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral...
OBJECTIVES
This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL).
PATIENTS AND METHODS
Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey.
RESULTS
In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088).
CONCLUSION
The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.
Topics: Adolescent; Adult; Anatomic Variation; Anterior Cruciate Ligament Injuries; Female; Humans; Knee Joint; Ligaments; Magnetic Resonance Imaging; Male; Posterior Cruciate Ligament; Retrospective Studies; Rupture; Young Adult
PubMed: 34145813
DOI: 10.52312/jdrs.2021.52 -
Kardiologia Polska 2015The rate of aortic aneurysm rupture correlates with the aneurysm's diameter, and a higher rate of rupture is observed in patients with larger aneurysms. According to the...
BACKGROUND
The rate of aortic aneurysm rupture correlates with the aneurysm's diameter, and a higher rate of rupture is observed in patients with larger aneurysms. According to the literature, contradictory results concerning the relationship between atmospheric pressure and aneurysm size have been reported.
AIM
In this paper, we assessed the influence of changes in atmospheric pressure on abdominal aneurysm ruptures in relationship to the aneurysm's size.
METHODS
The records of 223 patients with ruptured abdominal aneurysms were evaluated. All of the patients had been admitted to the department in the period 1997-2007 from the Silesia region. The atmospheric pressures on the day of the rupture and on the days both before the rupture and between the rupture events were compared. The size of the aneurysm was also considered in the analysis.
RESULTS
There were no statistically significant differences in pressure between the days of rupture and the remainder of the days within an analysed period. The highest frequency of the admission of patients with a ruptured aortic aneurysm was observed during periods of winter and spring, when the highest mean values of atmospheric pressure were observed; however, this observation was not statistically confirmed. A statistically non-significant trend towards the higher rupture of large aneurysms (> 7 cm) was observed in the cases where the pressure increased between the day before the rupture and the day of the rupture. This trend was particularly pronounced in patients suffering from hypertension (p = 0.1).
CONCLUSIONS
The results of this study do not support the hypothesis that there is a direct link between atmospheric pressure values and abdominal aortic aneurysm ruptures.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Rupture; Atmospheric Pressure; Female; Humans; Male; Middle Aged; Poland; Retrospective Studies; Seasons
PubMed: 25987398
DOI: 10.5603/KP.a2015.0092 -
The British Journal of Ophthalmology May 1999To investigate risk factors, visual outcome, and graft survival for traumatic wound rupture after penetrating keratoplasty.
AIM
To investigate risk factors, visual outcome, and graft survival for traumatic wound rupture after penetrating keratoplasty.
METHODS
A retrospective analysis of 336 patients who underwent penetrating keratoplasty from 1988 to 1995.
RESULTS
19 patients (5.7%) suffered traumatic postoperative wound rupture requiring surgical repair. They were younger (mean age 16.6 years, 95% CI 13.2-20.6) and more frequently keratoconic (p = 0.01) than other patients (mean age 28.9 years, 95% CI 26.-31.0). Mean postoperative follow up was 37.7 (SD 22.9) months and 24.5 (18.9) months for the rupture and non-rupture patients. Mean interval between keratoplasty and rupture was 18 (21) weeks. The lens was damaged and removed in 37% of ruptured eyes. For keratoconics, the probability of graft survival at 5 years was lower (p = 0.03) in the ruptured eyes (75%) than in the non-ruptured eyes (90%). Endothelial failure was a more common (p <0.05) cause of graft opacification in ruptured grafts than in intact grafts. Of the ruptured eyes, 53% achieved a final corrected acuity of at least 6/18 and 63% achieved at least 6/60 compared with 48% and 71% of the intact eyes respectively (both p >0.1). The proportion of keratoconic eyes which achieved at least 6/60 was lower (p = 0.02) in the ruptured eyes (67%) than the non-ruptured eyes (87%). Eyes with wound ruptures of 5 clock hours or greater were less likely (p <0.05) to achieve an acuity of 6/18 and were more likely (p <0.05) to have an associated lens injury.
CONCLUSIONS
Graft rupture is relatively common in African practice, particularly in young keratoconics. Visual outcome and graft survival are not significantly worse than for other grafted eyes, but are significantly worse than for other grafted keratoconic eyes.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Eye Injuries; Female; Graft Survival; Humans; Infant; Infant, Newborn; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Rupture; Vision Disorders; Visual Acuity; Wounds, Nonpenetrating
PubMed: 10216049
DOI: 10.1136/bjo.83.5.530