Реферат
Se deben tener consideraciones especiales cuando se realizan reparaciones quirúrgicas del tendón de Aquiles. Su anatomía e irrigación particular plantean desafíos únicos para el manejo, y tener comprensión profunda de estas características es crucial para escoger el tratamiento adecuado y lograr resultados exitosos. El objetivo de este trabajo es analizar la eficiencia de la reparación quirúrgica de la rotura aguda del tendón de Aquiles con técnica de Dresden, entre el 2015 y el 2021. Se realizó un estudio de tipo analítico, observacional, longitudinal y prospectiva. El análisis del aspecto estadístico fue a través de estadística descriptiva y asociación de las variables. Se incluyeron 34 pacientes con un promedio de 42 años, la mayoría de sexo masculino. Al aplicar las escalas VISA-A se obtuvo un promedio de 12 puntos, 67,5 puntos a los 6 meses y 80,5 puntos a los 12 meses. En la encuesta SF-12 a los 6 meses se obtuvo un promedio de 68,5 puntos y 80 puntos a los 12 meses; un paciente presentó rechazo de la sutura y 6 afirmaron algún grado de edema residual aun al año de la cirugía. La reparación quirúrgica con técnica de Dresden mejora la funcionabilidad del tendón de malos resultados a regulares y buenos resultados al año de seguimiento. El 68% de la población estudiada afirmó que se encuentran satisfechos con la cirugía(AU)
Special considerations must be made when performing surgical repairs of the Achilles tendon. Its particular anatomy and blood supply pose unique management challenges, and a thorough understanding of these characteristics is crucial to choosing the right treatment and achieving successful results. The objective of this work is to analyze the efficiency of the surgical repair of the acute rupture of the Achilles tendon with the Dresden technique, between 2015 and 2021. An analytical, observational, longitudinal and prospective study was carried out. The analysis of the statistical aspect was through descriptive statistics and association of the variables. 34 patients with an average age of 42 years were included, most of them male. When applying the VISA-A scales, an average of 12 points was obtained, 67,5 points at 6 months and 80,5 points at 12 months. In the SF-12 survey at 6 months an average of 68,5 points and 80 points at 12 months were obtained; One patient presented rejection of the suture and 6 reported some degree of residual edema even one year after surgery. Surgical repair with the Dresden technique improves the functionality of the tendon from poor to regular results and good results after a year of follow-up. 68% of the population studied stated that they are satisfied with the surgery(AU)
Тема - темы
Male , Female , Adolescent , Adult , Achilles Tendon/surgery , Surgical Procedures, Operative , General Surgery , SuturesРеферат
INTRODUÇÃO: Sobrepeso e obesidade afetam variáveis de marcha tais como cadência, comprimento do degrau e comprimento dos passos junto com a deterioração do tendão de Aquiles. A rígida rosca do tendão de Aquiles reduz a tensão e aumenta a estabilidade da articulação e pode ser empregada como suporte externo durante o treinamento da marcha para modificar os parâmetros da marcha. OBJETIVO: Descobrir se o taping modifica os padrões de marcha com o aumento do peso. MÉTODOS E MATERIAIS: Foram recrutados 40 sujeitos (20 acima do peso e 20 obesos) cujo comprimento dos degraus, comprimento dos passos e cadência foram medidos antes e depois da fita rígida do tendão de Aquiles. Cada pessoa completou o teste de caminhada de 10 metros usando o aplicativo Gait Analyzer. RESULTADOS: O teste Shapiro-Wilk é usado para avaliar a normalidade dos dados. O Wilcoxon Signed Rank Test e o Mann-Whitney U Test são usados para diferenças dentro e entre grupos. As diferenças dentro do grupo foram significativas nos parâmetros de marcha p <0,05 (Passo comprimento p<0,001, Stride comprimento p<0,001 e cadência p=0,009). Os parâmetros de marcha não diferiram estatisticamente entre os grupos. CONCLUSÃO: A aplicação de fita rígida no tendão de Aquiles tem um efeito semelhante nos parâmetros da marcha em indivíduos com excesso de peso e obesos. Após a aplicação da fita adesiva, verificou-se uma diferença significativa em termos de comprimento da passada, comprimento do passo e cadência na população estudada antes e depois da aplicação da fita adesiva para Aquiles. Isto implica que, independentemente do peso corporal, a intervenção com fita adesiva afeta a mecânica da marcha de forma comparável e destina-se a evitar movimentos articulares excessivos, a fornecer informações proprioceptivas durante as atividades e a diminuir o desconforto.
INTRODUCTION: Overweight and obesity affect gait variables such as cadence, step length, stride length, and Achilles tendon deterioration. Rigid Achilles tendon Taping reduces stress and enhances joint stability and can be employed as external support during gait training to modify gait parameters. OBJECTIVE: To find out whether taping modifies gait patterns with increasing weight. METHODS AND MATERIALS: 40 subjects were recruited (20 overweight and 20 obese) whose step length, stride length, and cadence were measured before and after rigid Achilles tendon taping. Each person completed the 10-meter walk test using Gait Analyzer application. RESULTS: The Shapiro-Wilk test is used to assess the normality of the data. Wilcoxon Signed Rank Test is used for within-group differences. Within-group differences were significant in gait parameters p <0.05 (Step length p<0.001, Stride length p<0.001 and cadence p=0.009). CONCLUSION: Rigid Achilles tendon taping have a similar effect on gait parameters in overweight and obese individuals. After taping, there was a significant difference in terms of stride length, step length and cadence in the study population before and after Achilles taping. This implies that regardless of body weight, the tape intervention affects gait mechanics in a comparable way and is intended to prevent excessive joint motion, provide proprioceptive input during activities, and lessen discomfort.
Тема - темы
Achilles Tendon , Adult , ObesityРеферат
INTRODUÇÃO: O taping do Tendão de Aquiles afeta os parâmetros da marcha em adultos com sobrepeso e obesos? O comprimento dos passos, o comprimento das passadas e a cadência são todos mais curtos nestes indivíduos, com maiores índices queda. OBJETIVO: Saber o efeito do taping do Tendão de Aquiles nos parâmetros de marcha em indivíduos obesos e com sobrepeso. MÉTODOS: Um ensaio clínico será realizado em um ambulatório de fisioterapia. Um total de quarenta participantes com Índice de Massa Corporal (IMC) maior que 25 serão recrutados pelo método de amostragem por conveniência. Cada grupo terá 20 participantes, com idade entre 18 e 35 anos, sobrepeso com IMC>25 a 29,9 e obesidade com IMC>30. Ambos os grupos caminharão por 10 metros e um minuto usando um analisador de marcha, e ambos os grupos terão taping nos Tendões de Aquiles. A variável preditora será o taping do Tendão de Aquiles e as variáveis de resultado serão o comprimento do passo, o comprimento da passada e a cadência, que serão medidos antes e imediatamente após a bandagem. O software SPSS 20.0 será utilizado para análise estatística, com nível de significância de p<0.05. PERSPECTIVAS: A conclusão do ensaio clínico fornecerá informações sobre o impacto da bandagem do Tendão de Aquiles na marcha em indivíduos com sobrepeso ou obesos. Além disso, poderia potencialmente demonstrar que a bandagem pode reduzir o risco de quedas e, assim, impactar positivamente na qualidade de vida.
INTRODUCTION: Does Achilles Tendon taping affect gait parameters in overweight and obese adults? Step length, stride length, and cadence are all shorter in these individuals, with increased fall ratios. OBJECTIVE: To know the effect of Achilles Tendon taping on gait parameters in overweight and obese individuals. METHODS: A clinical trial will be conducted in a physical therapy outpatient clinic. A total of forty participants with a Body Mass Index (BMI) greater than 25 will be recruited by convenience sampling method. Each group will have 20 participants, aged between 18 and 35 years old, overweight with BMI>25 to 29.9, and obese with BMI>30. Both groups will walk for 10 meters and one minute using a gait analyzer and both groups will have taping on the Achilles Tendons. The predictor variable will be the taping of the Achilles Tendon, and the outcome variables will be step length, stride length, and cadence, which will be measured before and immediately after taping. SPSS 20.0 software will be used for statistical analysis with a significance level of p<0.05. PERSPECTIVES: Completion of the clinical trial will provide information on the impact of Achilles Tendon taping on gait in overweight or obese individuals. In addition, it could potentially demonstrate that taping can reduce the risk of falls and thus positively impact the quality of life.
Тема - темы
Achilles Tendon , Adult , ObesityРеферат
OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.
Тема - темы
Male , Humans , Female , Adolescent , Young Adult , Adult , Middle Aged , Achilles Tendon/injuries , Retrospective Studies , Treatment Outcome , Tendon Injuries/surgery , Rupture/surgery , Sutures , Acute Disease , Suture TechniquesРеферат
BACKGROUND@#Hair follicles are easily accessible and contain stem cells with different developmental origins, including mesenchymal stem cells (MSCs), that consequently reveal the potential of human hair follicle (hHF)-derived MSCs in repair and regeneration. However, the role of hHF-MSCs in Achilles tendinopathy (AT) remains unclear. The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits.@*METHODS@#First, we extracted and characterized hHF-MSCs. Then, a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo . Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT, and quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT. Furthermore, statistical analyses were performed using independent sample t test, one-way analysis of variance (ANOVA), and one-way repeated measures multivariate ANOVA as appropriate.@*RESULTS@#Flow cytometry, a trilineage-induced differentiation test, confirmed that hHF-derived stem cells were derived from MSCs. The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy, as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased. Moreover, collagen I and III were upregulated in rabbit AT treated with hHF-MSCs (compared with AT group; P < 0.05). Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration, possibly through Tenascin-C (TNC) upregulation and matrix metalloproteinase (MMP)-9 downregulation.@*CONCLUSIONS@#hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III. Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber, possibly because of upregulation of TNC and downregulation of MMP-9, thus suggesting that hHF-MSCs are more promising for AT.
Тема - темы
Animals , Humans , Rabbits , Hair Follicle , Achilles Tendon/pathology , Tendinopathy/pathology , Proteomics , Collagen Type I , Mesenchymal Stem CellsРеферат
OBJECTIVE@#To compare clinical efficacy of platelet-rich plasma (PRP) and extracorporeal shock wave in treating chronic insertional Achilles tendinopathy.@*METHODS@#From February 2019 to August 2021, 42 patients with chronic insertional Achilles tendinopathy were selected and divided into PRP group(20 patients, 28 feet) and shock wave group (22 patients, 29 feet). In PRP group, there were 12 males and 8 females, aged 47.00(28.00, 50.75) years old, and the courses of disease ranged 7.00(6.00, 7.00) months;PRP injection was performed in the Achilles tendon stop area of the affected side. In shock wave group, there were 16 males and 6 females, aged 42.00(35.75, 47.25) years old;and the courses of disease was 7.00(6.00, 8.00) months;shock wave was performed in Achilles tendon stop area of the affected side and triceps surae area. Visual analogue scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) were applied to evaluate clnical effect before treatment, 1, 3 and 6 months after treatment, and satisfaction of patients was investigated.@*RESULTS@#VAS and VISA-A score in both groups were significantly improved at 1, 3 and 6 months after treatment than before treatment (P<0.05), VAS and VISA-A score in PRP group at 6 months after treatment were significantly higher than those at 1 and 3 months after treatment, and VAS and VISA-A score in shock wave group were lower than those at 1 and 3 months after treatment (P<0.05). There was no significant difference in VAS and VISA-A score between two groups before treatment, 1 and 3 months after treatment(P>0.05), while VAS and VISA-A score in PRP group were better than those in shock wave group at 6 months after treatment(P<0.05), and the satisfaction survey in PRP group was better than that in shock wave group(P<0.05).@*CONCLUSION@#PRP injection has a good clinical effect on chronic insertional Achilles tendinopathy with high patient satisfaction, and medium-and long-term effect of PRP injection for the treatment of chronic insertional Achilles tendinopathy is better than that of extracorporeal divergent shock wave.
Тема - темы
Male , Female , Humans , Middle Aged , Achilles Tendon , Tendinopathy/therapy , Treatment Outcome , Exercise Therapy , Platelet-Rich PlasmaРеферат
OBJECTIVE@#To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.@*METHODS@#A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.@*RESULTS@#The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).@*CONCLUSION@#In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
Тема - темы
Humans , Blood Loss, Surgical , Retrospective Studies , Neurosurgical Procedures , Achilles Tendon/surgery , Tendon Injuries/surgery , Ankle Injuries , Surgical Wound , SuturesРеферат
OBJECTIVE@#To explore clinical efficacy of Locking loop stitch with suture-bridge technique in repair of acute closed distal Achilles tendon rupture by using suture anchors.@*METHODS@#From July 2019 to March 2021, 20 patients with acute closed distal Achilles tendon rupture were treated by minimally invasive suture anchor locking suture bridging repair technique. Among them, including 18 males and 2 females, aged from 19 to 52 years old with an average of(40.0±9.0) years old. Complications were observed, and recovery of ankle function was evaluated by American Orthopaedic Foot & Ankle Society(AOFAS) ankle and hindfoot function scoring system before operation and 1 year after operation.@*RESULTS@#All patients followed up from 6 to 18 months with an average of (12.0±3.2) months. The incisions were healed at stageⅠwithout infection and skin necrosis occurred;no gastrocnemius nerve injury and deep vein thrombosis of the lower extremities occurred;and no heel pain and Achilles tendon re-rupture occurred. AOFAS scores of ankle and hindfoot increased from(59.0±4.3) before opertaion to(95.1±2.6) at 1 year after operation (t=-32.1, P<0.05).@*CONCLUSION@#The effect of locking suture bridging with suture anchor nails to repair acute distal Achilles tendon rupture is definite, and it could reduce incidence of complications such as Achilles tendon re-rupture, nerve injury, and skin necrosis, which has advantages of small surgical trauma, reliable anastomosis method and good functional recovery, and is an ideal method for treating acute closed distal Achilles tendon rupture.
Тема - темы
Female , Male , Humans , Young Adult , Adult , Middle Aged , Suture Anchors , Achilles Tendon/surgery , Ankle Injuries , Tendon Injuries/surgery , NecrosisРеферат
PURPOSE@#Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function.@*METHODS@#In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference.@*RESULTS@#AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period.@*CONCLUSION@#Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.
Тема - темы
Humans , Achilles Tendon/surgery , Retrospective Studies , Treatment Outcome , Elasticity , Tendon Injuries/surgery , Rupture/surgeryРеферат
Performing flexibility training in an exercise program is important to improve range of motion (ROM). Tendons have a profound impact on the general function of the musculoskeletal system, influence the limitation of ROM, and its structure and mechanical properties can benefit from stretching protocols. The systematic use of lower limbs in locomotion caused the Achilles tendon to become the largest and strongest tendon in the human body. Therefore, understanding the best prescription and frequency of flexibility exercise leads to changes in tendon properties is essential for an appropriate and effective exercise routine. Thus, the aim of this review was to organize and discuss publications about the implications of triceps surae stretching in ROM, as well as its influence on tendon properties. Acute studies show that continuous stretching times between five and 10 minutes cause decreased tendon stiffness, which is not seen in fractionated stretching times less than five minutes. Chronic studies, in turn, also don't present significant results in stiffness with fractionated times and studies with continuous times were not found. Thus, it is not possible to know if a continuous stretching time (longer than one minute) or a total time longer than five minutes but fractionated, can influence the tendon stiffness. (AU)
A realização de treino de flexibilidade como rotina em um programa de exercícios é importante para melhorar amplitude de movimento (ADM). Os tendões têm um impacto profundo na função geral do sistema musculoesquelético, influenciam na limitação da ADM, e sua estrutura e propriedades mecânicas podem se beneficiar de protocolos de alongamento. O uso sistemático dos membros inferiores na locomoção fez com que o tendão de Aquiles se tornasse o maior e mais forte tendão do corpo humano. Portanto, entender qual a melhor prescrição e frequência de exercício de flexibilidade para que ocasione alterações nas propriedades tendíneas é essencial para uma rotina de exercícios adequada e eficaz. Sendo assim, o objetivo dessa revisão de literatura foi organizar e discutir publicações sobre as implicações do alongamento do tríceps sural na ADM, bem como sua influência nas propriedades tendíneas. Estudos agudos mostram que tempos contínuos entre cinco e 10 minutos de alongamento estático causam diminuição da rigidez tendínea, o que não é visto em tempos intervalados inferiores a cinco minutos. Os estudos crônicos, por sua vez, também não apresentam resultados significativos na rigidez com protocolos de alongamento intervalados e estudos com protocolos contínuos não foram encontrados. Dessa forma, não é possível saber se um tempo contínuo de alongamento (superior a um minuto) ou um tempo superior a cinco minutos, intervalado, podem influenciar na rigidez tendínea. (AU)
Тема - темы
Humans , Male , Female , Achilles Tendon , Biomechanical Phenomena , Range of Motion, Articular , Exercise , Pliability , Human Body , Lower Extremity , Muscle Stretching Exercises , Locomotion , Movement , Muscle Rigidity , Musculoskeletal SystemРеферат
OBJECTIVE@#To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance.@*METHODS@#From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.@*RESULTS@#Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).@*CONCLUSION@#The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.
Тема - темы
Adult , Female , Humans , Male , Achilles Tendon/surgery , Retrospective Studies , Rupture/surgery , Suture Techniques , Tendon Injuries/surgery , Treatment OutcomeРеферат
OBJECTIVE@#To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects.@*METHODS@#From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up.@*RESULTS@#All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.
Тема - темы
Adult , Female , Humans , Male , Achilles Tendon/surgery , Fascia Lata , Retrospective Studies , Rupture , Treatment OutcomeРеферат
OBJECTIVE@#To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture.@*METHODS@#The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture.@*RESULTS@#All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05).@*CONCLUSION@#The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.
Тема - темы
Adult , Female , Humans , Male , Middle Aged , Young Adult , Achilles Tendon/surgery , Aponeurosis , Cicatrix , Retrospective Studies , Rupture/surgery , Sutures , Treatment OutcomeРеферат
Introducción: El tendón de Aquiles es el tendón más grande y fuerte del organismo. Es también de los más frecuentes en sufrir rotura. Tradicionalmente se ha realizado cirugía convencional de sutura de los cabos. En la actualidad crecieron en popularidad las técnicas de mini abordaje y percutáneas. Todas con riesgos y beneficios. El objetivo de la presentación en analizar resultados funcionales en la reparación de Aquiles con técnica mini invasiva de diseño propio. Material y Métodos: Se revisaron retrospectivamente 23 cirugías de reparación del tendón de Aquiles agudas con técnica propio mini invasiva. Resultados: Los resultados funcionales según es Score ATRS fueron de 87 puntos promedio. Discusión: Existe en la literatura médica buenos resultados en la reparación del tendón de Aquiles con distintas técnicas. Conclusión: Los beneficios de la técnica es que la misma es segura, reproducible, reduce complicaciones y permite movilización precoz
Introduction: The Achilles tendon is the largest and strongest tendon in the body. It is also one of the most frequent to suffer rupture. Traditionally, conventional suture surgery has been performed on the ends. At present, the mini-approach and percutaneous techniques have grown in popularity. All with risks and benefits. The objective of the presentation is to analyze functional results in Achilles repair with a mini-invasive technique of our own design. Material and Methods: Twenty-three acute Achilles tendon repair surgeries with their own mini-invasive technique were retrospectively reviewed. Results: The functional results according to the ATRS Score were 87 average points. Discussion: There are good results in the medical literature in the repair of the Achilles tendon with different techniques. Conclusion: The benefits of the technique is that it is safe, reproducible, reduces complications and allows early mobilization.
Тема - темы
Rupture , Achilles Tendon/surgery , Ankle InjuriesРеферат
Introducción: Las técnicas mínimamente invasivas son las preferidas para tratar las roturas agudas del tendón de Aquiles. Representan una opción para evitar las complicaciones tegumentarias, y la lesión del nervio sural es uno de sus principales problemas. El objetivo de este estudio fue comprobar la utilidad de la ecografía para prevenir la lesión del nervio sural durante la reparación del tendón de Aquiles con técnicas percutáneas. materiales y métodos: Estudio en 12 piezas cadavéricas. Se recreó una lesión en el tendón de Aquiles 5 cm proximales de su inserción distal. En uno de los miembros del cadáver, se identificó el nervio sural o su vena satélite mediante ecografía. Se reparó el nervio sural por vía percutánea con dos agujas proximales y dos agujas distales a la lesión, y se representó el recorrido del nervio sural. En el miembro contralateral, no se identificó el nervio sural mediante ecografía. Se efectuó la reparación percutánea de las lesiones mediante la técnica de Ma y Griffith. Resultados: En el grupo ecográfico, no se identificaron lesiones del nervio sural. En el grupo de control, se observaron dos lesiones del nervio sural (p = 0,6). En todos los casos, la identificación del nervio sural mediante ecografía fue correcta. Conclusión: La asistencia ecográfica en el tratamiento percutáneo de las lesiones del tendón de Aquiles es un método eficaz y confiable para evitar las lesiones del nervio sural. Nivel de Evidencia: III
Introduction: Minimally invasive techniques are preferred to treat acute Achilles tendon ruptures. They represent an option to avoid integumentary complications, and sural nerve injury is one of its main problems. This study aims to verify the usefulness of ultrasound in preventing sural nerve injury during Achilles repair with percutaneous techniques. materials and methods: Study in 12 cadaveric pieces. We recreated an injury at the level of the Achilles tendon, 5 cm proximally to its distal insertion. In one of the cadaver limbs, the sural nerve and/or its satellite vein were identified by ultrasonography. We repaired the sural nerve percutaneously with two needles at the proximal level and two needles at the distal level of the lesion and represented the path of the sural nerve. In the contralateral limb, the sural nerve was not identified by ultrasound. We performed the percutaneous repair of the injuries using the Ma & Griffith technique. Results: In the ultrasound group, no sural nerve injuries were identified. In the control group, two sural nerve injuries were observed (p=0.6). In all cases, the identification of the sural nerve by ultrasound was correct. Conclusion: Ultrasound assistance in the percutaneous treatment of Achilles tendon injuries is an effective and reliable method to prevent sural nerve injuries. Level of Evidence: III
Тема - темы
Achilles Tendon/surgery , Achilles Tendon/injuries , Sural Nerve/injuries , Ultrasonography , Minimally Invasive Surgical Procedures , Ankle Joint/surgeryРеферат
Abstract Objective Sound experimental data suggest that oxidative stress plays an important role in the pathogenesis of tendinopathies. However, this hypothesis in humans remains speculative given that clinical data are lacking to confirm it. Recently, a new methodology has allowed to quantify the oxidative stress in vivo by measuring the concentration of hydroperoxides of organic compounds, which have been utilized as an oxidative stressrelated marker in several pathologic and physiologic conditions. Given the reliability of this test and the lack of information in subjects with tendinopathies, the aim of the present study was to assess the oxidative stress status in elite professional soccer players with and without ultrasonographic features of tendon damage. Methods In 73 elite players, blood metabolic parameters were evaluated and oxidative stress was measured by means of a specific test (expressed as U-Carr units). Therefore, an ultrasonographic evaluation of the Achilles and patellar tendons was performed. Results No significant relationships were observed between metabolic parameters and oxidative stress biomarkers. The Achilles and patellar tendons showed a normal echographic pattern in 58 athletes, and sonographic abnormalities in 15. The athletes with ultrasonographic alterations, compared to those with normal US picture, showed significantly higher U-Carr levels (p = 0.000), body mass index (BMI) values (p = 0.03) and were older (p = 0.005). The difference in U-Carr values among the subjects remained significant also after adjustment for age and BMI. Conclusion The results of the present study support the hypothesis that oxidative substances, also increasedat systemicand notonlyat local level, mayfavor tendon damage. Level of Evidence IV (pilot study).
Resumo Objetivo Dados experimentais ultrassonográficos sugerem que o estresse oxidativo desempenha um papel importante na patogênese das tendinopatias. No entanto, essa hipótese permanece especulativa em humanos, dado que faltam dados clínicos para comprová-la. Recentemente, uma nova metodologia permitiu quantificar o estresse oxidativo in vivo medindo a concentração de hidroperóxidos de compostos orgânicos, que tem sido utilizada como um marcador relacionado ao estresse oxidativo em várias condições patológicas e fisiológicas. Dada a confiabilidade desse teste e a falta de informação em sujeitos com tendinopatias, o objetivo do presente estudo foi avaliar o status de estresse oxidativo em jogadores profissionais de elite com e sem características ultrassonográficas de dano tendinoso. Métodos Em 73 jogadores de elite foram avaliados parâmetros metabólicos e o estresse oxidativo foi medido por meio de um teste específico (expresso como unidades U-Carr). Por isso, foi realizada uma avaliação ultrassonográfica dos tendões de Aquiles e patelar. Resultados Não foram observadas relações significativas entre parâmetros metabólicos e biomarcadores de estresse oxidativo. Os tendões de Aquiles e patelar mostraram um padrão ecográfico normal em 58 atletas, e anormalidades ultrassonográficas em 15. Os atletas com alterações, em comparação com aqueles com quadro normal, apresentaram níveis significativamente mais elevados de U-Carr (p = 0,000), índice de massa corporal (IMC) (p = 0,03) e eram mais velhos (p = 0,005). A diferença nos valores de U-Carr entre os sujeitos permaneceu significativa também após ajuste por idade e IMC. Conclusão Os resultados deste estudo corroboram a hipótese de que as substâncias oxidativas, também aumentadas a nível sistêmico e não apenas a nível local, podem favorecer danos no tendão. Nível de Evidência IV (estudo piloto).
Тема - темы
Humans , Achilles Tendon/injuries , Achilles Tendon/diagnostic imaging , Ultrasonography , Patellar Ligament/diagnostic imaging , Oxidative Stress , Athletes , FootballРеферат
PURPOSE@#To observe the changes of gait behavior and the expression of wound healing factors of transforming growth factor-β1 (TGF-β1), TGF-β3 and cAMP response element binding protein-1 (CREB-1) during the healing of Achilles tendon in a rat model, and to investigate whether gait analysis can be used to evaluate the tendon healing.@*METHODS@#Achilles tendon of 40 healthy male Sprague-Dawley rats were transected and sutured to establish the Achilles tendon injury (ATI) model. They were randomly divided into 4 groups based on the observational time point at 1, 2, 4 and 6 weeks after injury (n = 10 for each group). Before modeling, 9 rats were randomly selected for CatWalk gait analysis, which contained step cycle, single stance time and average speed. Data were recorded as the normal controls. After then, ATI models were established in the left hind limbs of the all 40 rats (ATI group), while the right hind limbs were only cut and sutured without injury of the Achilles tendon (sham operation group). At 1, 2, 4 and 6 weeks after injury, the gait behavior of the corresponding group of rats (n = 9) as observed and recorded by CatWalk platform. After then, the rats were sacrificed and Achilles tendon of both limbs was harvested. The tendon healing was observed by gross anatomy and histological examination, and the protein and mRNA expression of TGF-β1, TGF-β3, CREB-1 were observed by immunohistochemistry and qPCR. The results of tendon gross grading were analyzed by Wilcoxon rank sum test, and other data were analyzed by one-way analysis of variance among multiple groups.@*RESULTS@#Compared with normal controls, all gait indexes (step cycle, single stance time and average speed) were greatly affected following ATI, which however improved with time. The step cycle was significantly lower at 1, 2 and 4 weeks after ATI (compared with normal controls, all p 0.05). The single stance time of the ATI group was significantly shorter at 1 and 2 weeks after operation ((0.078 ± 0.010) s at 1 week, (0.078 ± 0.020) s at 2 weeks, all p < 0.001) and revealed no significant difference at 4 weeks (p = 0.120). The average speed of ATI group at 1, 2, 4, 6 weeks was significantly lower than that in the normal control group (all p < 0.001). Gross observation showed that the grade of local scar adhesion in ATI group increased significantly at 2, 4 and 6 weeks, compared with the sham operation group (all p < 0.001). Extensive adhesion was formed at 6 weeks after ATI. The results of HE staining showed that the number of fibroblast increased gradually and arranged more orderly in ATI group at 1, 2 and 4 weeks (all p < 0.001), and decreased at 6 weeks, but it was still significantly higher than that of the sham operation group (p < 0.001). Immunohistochemistry showed that the positive expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at 4 time points (all p < 0.05), which reached the peak at 2 weeks after operation and decreased at 4 weeks (p = 0.002, p < 0.001, p = 0.041, respectively). The results of qPCR suggested that the mRNA expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at all-time points (all p < 0.05), which reached the peak at 2 weeks after operation, decreased at 4 weeks, and significantly decreased at 6 weeks (all p < 0.001).@*CONCLUSION@#Gait behavior indexes are associated with Achilles tendon healing. The study gives an insight of TGF-β1, TGF-β3, CREB-1 changes in the coursing of Achilles tendon healing and these cytokines may be able to be used to regulate the Achilles tendon healing.
Тема - темы
Animals , Male , Rats , Achilles Tendon , CREB-Binding Protein , Gait Analysis , Rats, Sprague-Dawley , Transforming Growth Factor beta1/genetics , Transforming Growth Factor beta3 , Wound HealingРеферат
OBJECTIVE@#To explore the abnormal manifestations and clinical features of patients with gout according to the location of crystal deposits: in articulars or in tendons.@*METHODS@#A total of 105 patients with gout who were continuously treated in the Department of Rheumatology and Immunology of Peking University People's Hospital from June 2019 to December 2019 were selected and their knees, ankles, toes and painful joints and tendons were examined by high-frequency ultrasound. Then we grouped them according to the presence or absence of sodium urate crystals and the location of the crystals, collected their clinical data, and analyzed the clinical characteristics.@*RESULTS@#Among the 105 patients, 25 patients had no crystal deposits in the joints or tendons (as the non-crystal group), 43 patients had intra-articular crystals (as the joint group), and 37 patients had intra-tendon crystals with or without intra-articular crystals (as the tendon group). Among them, the most involved part of sodium urate crystals deposited in the joints was the metatarsophalangeal joint (29 cases, 67.4%), followed by knee joints (10 cases, 23.2%), ankle joints (9 cases, 20.9%). The most involved part of sodium urate crystals deposited in the tendon was the quadriceps tendon (16 cases, 43.2%), followed by the Achilles tendon (13 cases, 35.1%), the patellar tendon (12 cases, 32.4%), and the three heads of brachii tendons (5 cases, 13.5%). The three groups were compared using multi-sample analysis of variance/multi-sample rank sum test. Age, age of first increase in uric acid (UA), serum glucose (Glu) level and C reactive protein (CRP) were all significantly different. After multiple comparisons, compared with the non-crystal group, age, the age of first increase in uric acid, and CRP were significantly higher in the tendon group. There was no significant difference between the non-crystal group and the joint group. There was no significant difference between the tendon group and the joint group.@*CONCLUSION@#In patients with gout, it is common for ultrasound to find crystals deposited in joints or tendons. The most commonly affected parts include the metatarsophalangeal joint, knee joint, ankle joint, quadriceps tendon, Achilles tendon, patellar tendon, and triceps tendon. There were significant differences among the three groups in age, age of first increase in uric acid, CRP and blood glucose, and the proportion of urinary calculi in patients with crystal deposits was significantly higher than those without crystal deposits.
Тема - темы
Humans , Achilles Tendon , Gout , Knee Joint , Metatarsophalangeal Joint/diagnostic imaging , Uric AcidРеферат
Introducción: Las técnicas quirúrgicas modernas buscan rehabilitar en forma temprana para una recuperación en menor tiempo. Las técnicas mínimamente invasivas son una opción para lograrlo. Objetivo: Evaluar la capacidad de comenzar una rehabilitación y la carga de peso en el posoperatorio inmediato utilizando una técnica mínimamente invasiva sin nudos y la evolución a los 6 meses de la cirugía. materiales y métodos: Se realizaron 10 reparaciones quirúrgicas de lesiones agudas del tendón de Aquiles con una técnica mínimamente invasiva sin nudo. Se utilizó el sistema combinado (PARS SpeedBridgeTM original. A las 48 h se permitió la carga completa de forma progresiva, según tolerancia. Se evaluó el resultado final a los 6 meses utilizando el puntaje ATRS. Resultados: En promedio los pacientes tardaron 14 días en deambular sin muletas. Todos comenzaron la rehabilitación con movilidad activa y pasiva del tobillo durante la primera semana posoperatoria. El puntaje ATRS promedio fue de 79 (rango 60-90). Conclusión: Esta técnica ha demostrado ser una excelente opción quirúrgica en las lesiones agudas del tendón de Aquiles de media sustancia, pero no fue posible comenzar con la carga de peso inmediata debido al dolor o temor del paciente, pero sí con la rehabilitación dentro de la primera semana posquirúrgica. Nivel de Evidencia: IV
Introduction: Modern surgical techniques seek to rehabilitate early for recovery in less time. Minimally invasive techniques are one option to accomplish this. Objective: To evaluate the ability to start rehabilitation and weight bearing in the immediate post-operative period and the evolution at 6 months postoperative using a minimally invasive knotless technique. materials and methods: 10 surgical repairs of acute Achilles tendon injuries were performed with a minimally invasive technique. The original Arthrex combination system (PARS - SpeedBridgeTM) was used. After 48 hours, weight bearing was progressively allowed according to tolerance. The final outcome at 6 months was evaluated using the ATRS score. Results: On average, patients took 14 days to walk without crutches. All began rehabilitation with active and passive ankle range of motion during the first postoperative week. The average ATRS score was 79 points (between 60 and 90 points). Conclusion: This technique has proven to be an excellent surgical option in acute midsubstance Achilles tendon injuries. The patients were able to start rehabilitation within the first postoperative week, whereas immediate weight bearing was not possible, due to the patients Ì pain or fear. Level of Evidence: IV
Тема - темы
Adult , Rehabilitation , Achilles Tendon/surgery , Acute Disease , Ankle Injuries , Minimally Invasive Surgical ProceduresРеферат
ABSTRACT Purpose: Histologically evaluate the effects of low frequency electrical stimulation in the treatment of Achilles tendon injuries in rats. Methods: Thirty-four rats underwent Achilles tendon tenotomy and tenorrhaphy. They were randomly allocated in two groups. Half of the sample constituted the experiment group, whose lesions were stimulated with 2 Hz, nonpolarized current and 1 mA, for 14 days. The other animals formed the control group. They were evaluated at 2, 4 and 6 weeks. The histological study was carried out, the collagen density and the wound maturity index were measured. Results: The healing score was higher in the group stimulated at the 6th week (p = 0.018). The density collagen 1 was higher in the group treated at the three times (p = 0.004) and that collagen 3 was higher in the group treated at 6 weeks (p = 0.004). Together, collagen 1 and 3 were higher in the group stimulated at 4 and 6 weeks (p = 0.009, p = 0.004). The maturity index was higher in this group at the three moments (p = 0.017 p = 0.004 and p = 0.009). Conclusion: Low frequency electric stimulation improved healing and increased the quantity of collagen.