Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.

The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery.

Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking.

Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques.

Treatment for painful bone marrow edema by open wedge tibial osteotomy.

We evaluated the results of patients who had undergone medial open wedge proximal tibial osteotomy, with painful bone marrow edema in the medial tibial plateau. The study included 21 patients who had presented with knee pain and whose MRIs showed bone marrow edema in medial plateau. The degree of osteoarthritis was evaluated radiologically according to the Kellgren-Lawrence criteria; 6 cases were Grade 1, 11 cases were Grade 2, and 3 cases were Grade 3. Preoperative varus angle was a mean of 2.19° (0-4). The bone marrow edema was classified according to the width of the lesions extending into the joint surface subchondral area on MRI T2 sequences. Open wedge osteotomy was performed in all patients. The postoperative results were evaluated by X-ray, MRI, and WOMAC (Western Ontario and McMaster Universities) knee scores. The preoperative 2.19° varus angle was evaluated postoperatively as valgus 6.57° (4-8°) (p < 0.05). The postoperative WOMAC knee scores revealed a significant decrease in pain (p < 0.05). In conclusion, we are of the opinion that medial open wedge proximal tibial osteotomy is an effective treatment in patients who have painful bone marrow edema in medial tibia plateau.

Effects of botulinum toxin A on fracture healing in rats: an experimental study.

INTRODUCTION: Fracture healing is a complex process influenced by intrinsic and extrinsic factors. The aim of the present study was to evaluate the effects of botulinum toxin (BTX) A on fracture healing. MATERIALS AND METHODS: Following the induction of bilateral standard closed femoral fractures and relative fixation in 18 Wistar albino rats, 8 IU of BTX A were injected into the right femoral region. After 28 days, all of the rats were sacrificed, the diameter of the callus was measured, and fracture healing was assessed by biomechanical and histopathologic evaluation. RESULTS: While an increase in biomechanical and histopathologic healing was noted on the side injected with BTX A, a decrease in callus diameter was observed. CONCLUSION: Botulinum toxin A administration increases the healing power in a relatively fixated fracture and decreases the callus diameter, just as if rigid fixation had been performed. The beneficial effect of BTX A on fracture healing might be associated with increased fixation rigidity.

Evaluation of contact characteristics of a patient-specific artificial dysplastic hip joint.

This study addresses the results of the experimental measurements for the contact surface areas and contact pressure distributions of a dysplastic hip joint. The hip joint consists of pelvis, proximal femur and artificial cartilages for both acetabulum and femoral head. The dysplastic hip joint is modeled in three dimensional (3D) form using the computerized tomography (CT) images obtained in vivo of an adult female patient. The modeled hip joint components are manufactured as a non-natural dysplastic hip joint using different materials and manufacturing processes. The dysplastic hip joint produced is subjected to compression forces experimentally to measure the contact surface area and contact pressure distributions between the femoral head and acetabulum using the pressure sensitive Fuji film. Different types of specific fixtures and molds are designed and manufactured to produce the dysplastic hip joint components and perform the experimental studies. The measured results using a non-natural dysplastic hip joint are compared with relevant results reported in current literature considering the peak and mean contact pressure values. Therefore, the obtained results showed that the non-natural dysplastic hip models can be generated and replaced to determine the contact characteristics for an elusive cadaveric model. In conclusion, the artificial models might be useful to understand the contact pressure distributions and potential changes in surface pressure contours and their effects on the stress distributions.

Anterior knee dislocation with ipsilateral open tibial shaft fracture: a 5-year clinical follow-up of a professional athlete.

Traumatic dislocation of the knee joint is an uncommon complex, multiple ligamentous injury resulting from a high-energy trauma. Significant lack of functions can be seen because of both early and late complications of these injuries such as popliteal artery disruption, peroneal nerve injury, persistent instability and posttraumatic arthritis. Therefore, the emergency surgery is necessary due to possibility of neurovascular compromise and limb loss. Controversies over operative versus closed immobilization of traumatic complex, multiple ligamentous knee injury are still debated. We report a case of traumatic anterior dislocation of the right knee with an ipsilateral tibial shaft fracture in association with right popliteal artery occlusion of a professional athlete who was returned to his sports activity by surgical treated tibia fracture and conservative treatment of the knee dislocation.

The short- and long- term effects of estrogen deficiency on apoptosis in musculoskeletal tissues: an experimental animal model study.

BACKGROUND: Estrogen is the major sex steroid affecting the growth, remodeling, and homeostasis of the female skeleton. Estrogen loss in postmenopausal women leads to osteoporosis. The aim of this study was to evaluate the early and long- term effects of estrogen loss on bones, tendons, muscles, and menisci in ovariectomized rats.  METHODS: Fifteen rats were randomized into three groups of five animals each. The first group was the control group with no additional surgical procedure, but the rest (groups 2 and 3) were bilaterally ovariectomized . All animals in the group 2 were sacrificed at 14th week to evaluate the short- term effect, and all of other animals in the groups 1 and 3 were sacrificed at 28th week to analyze the long- term effect of estrogen loss in the ovariectomized group and to control with the group 1. Quadriceps muscles, Achilles tendons, menisci, and femur cortical bones from both lower extremities were taken. The amount of apoptosis was measured. RESULTS: There was a significant increase in cell apoptosis in bones, muscles, and tendons with insignificant increase in cell apoptosis in menisci at early and late periods in rats with ovariectomies than the control.  CONCLUSION: The results indicated that estrogen loss after ovariectomy does not only affect bones; it may also increase cell apoptosis in different tissues such as muscles, tendons, and menisci.

Bilateral congenital vertical talus with severe lower extremity external rotational deformity: treated by reverse Ponseti technique.

Congenital vertical talus, also known as congenital convex pes valgus, is a complex, rare, foot deformity that is resistant to conservative treatment. We report a case of bilateral congenital vertical talus with severe lower extremity external rotational deformity that was treated by means of a method of serial manipulations and casts. Although the initial manipulation and casting before surgical treatment is the current concept of idiopathic congenital vertical talus, a good result can be obtained by a well-organized conservative treatment with the help of patient compliance, so routine surgical release of the Achilles tendon may not be necessary in all cases.