Early ankle motion after triple bundle technique repair vs. casting for acute Achilles tendon rupture.

The purpose of our study is to evaluate the triple bundle technique for acute Achilles tendon rupture repair followed by early (at 14 days) postoperative ankle range of motion compared to nonoperative treatment with delayed ankle range of motion. We retrospectively reviewed 73 patients with an acute Achilles tendon rupture treated with either a plantar flexed cast or surgical repair. We found operative treatment reduces immobilization time, allows safe early return to weight-bearing, and diminishes risk of rerupture compared to nonoperative treatment. However, at an average follow-up of greater than 3.5 years, there was no statistical difference in AOFAS hindfoot scores, strength, or patient satisfaction between the two groups. Significant complications were higher in the nonoperative group manifested by three reruptures (7.7%) vs. one deep wound dehiscence in the operative group (3%).

Achilles tendon rupture repair: biomechanical comparison of the triple bundle technique versus the Krakow locking loop technique.

This study was designed to compare the tensile strength of ruptured Achilles tendons repaired using either the triple bundle technique or the Krakow locking loop technique. Eight pairs of fresh frozen cadaveric Achilles tendons were harvested. A simulated "Achilles tendon rupture" was created 4 cm from the calcaneal insertion in all sixteen tendons by transversely cutting the tendon with a scalpel. One Achilles tendon "rupture" of a pair was repaired using the triple bundle technique, while the other tendon of the pair was repaired using the Krakow locking loop technique. Then, using a servohydraulic testing machine, each tendon was tested to failure in tension at a displacement rate of 2.54 cm/sec. The average rupture load for the triple bundle technique was 453 N (range 397 n 549 N), while the average rupture load for the Krakow locking loop technique was 161 N (range 121 n 216 N). This difference in averages represents a statistically significant superiority of 2.8 to 1 (p < 0.001) in favor of the triple bundle technique.

Ultrasonography for the evaluation of forearm interosseous membrane disruption in a cadaver model.

Recognition of interosseous membrane disruption associated with radial head injury and Essex-Lopresti injury is important, especially if radial head excision is contemplated. Because a widely accepted method to diagnose interosseous membrane disruption does not exist, we evaluated the accuracy of ultrasonography to diagnose this injury in a cadaver model. Nine pairs of cadaver forearms were randomized into 2 groups. The central third of the interosseous membrane of forearms of group 1 was cut, whereas it was visualized but not cut in group 2. A dynamic ultrasound examination was performed to determine interosseous membrane integrity, and static images were made. The static images were evaluated by 2 other radiologists and interpretations were recorded. One radiologist incorrectly interpreted 1 pair of forearms; the other 2 radiologists were 100% accurate. The accuracy of ultrasonography in detecting interosseous injuries was 96% with our methods.