RESUMO
PURPOSE: To investigate early structural and mechanical predictors of plantarflexor muscle strength and the magnitude of Achilles tendon (AT) nonuniform displacement at 6 and 12 months after AT rupture. METHODS: Thirty-five participants (28 males and 7 females; mean ± SD age 41.7 ± 11.1 years) were assessed for isometric plantarflexion maximal voluntary contraction (MVC) and AT nonuniformity at 6 and 12 months after rupture. Structural and mechanical AT and plantarflexor muscle properties were measured at 2 months. Limb asymmetry index (LSI) was calculated for all variables. Multiple linear regression was used with the 6 and 12 month MVC LSI and 12 month AT nonuniformity LSI as dependent variables and AT and plantarflexor muscle properties at 2 months as independent variables. The level of pre- and post-injury sports participation was inquired using Tegner score at 2 and 12 months (scale 0-10, 10 = best possible score). Subjective perception of recovery was assessed with Achilles tendon total rupture score (ATRS) at 12 months (scale 0-100, 100=best possible score). RESULTS: Achilles tendon resting angle (ATRA) symmetry at 2 months predicted MVC symmetry at 6 and 12 months after rupture (ß = 2.530, 95% CI 1.041-4.018, adjusted R2 = 0.416, p = 0.002; ß = 1.659, 95% CI 0.330-2.988, adjusted R2 = 0.418, p = 0.016, respectively). At 12 months, participants had recovered their pre-injury level of sports participation (Tegner 6 ± 2 points). The median (IQR) ATRS score was 92 (7) points at 12 months. CONCLUSION: Greater asymmetry of ATRA in the early recovery phase may be a predictor of plantarflexor muscle strength deficits up to 1 year after rupture. TRIAL REGISTRATION: This research is a part of "nonoperative treatment of Achilles tendon rupture in Central Finland: a prospective cohort study" that has been registered in ClinicalTrials.gov (NCT03704532).
Assuntos
Tendão do Calcâneo , Força Muscular , Recuperação de Função Fisiológica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tendão do Calcâneo/lesões , Seguimentos , Contração Isométrica , Força Muscular/fisiologia , Músculo Esquelético/lesões , Músculo Esquelético/fisiologia , Estudos Prospectivos , Ruptura/terapia , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/reabilitaçãoRESUMO
BACKGROUND AND PURPOSE: The aim of our study was to assess the regional variations in Achilles tendon rupture incidence and treatment methods in Finland during the period 1997-2019. METHODS: The Finnish National Hospital Discharge Register (NHDR) and the Finnish Register of Primary Health Care Visits (PHCR) were searched to identify all adult patients diagnosed with Achilles tendon rupture during our study period. The population-based annual incidence and incidences of surgically and non-surgically treated Achilles tendon ruptures were calculated for each hospital district. RESULTS: Achilles tendon rupture incidence increased from 17.3 per 105 person-years in 1997 to 32.3 per 105 in 2019. The mean incidence of Achilles tendon ruptures ranged from 26.4 per 105 (North Savo) to 37.2 per 105 (Central Ostrobothnia). The incidence of Achilles tendon ruptures increased in all areas. The proportion of non-surgical treatment of Achilles tendon ruptures ranged in 1997 from 7% (Vaasa) to 67% (Åland) and in 2019 from 73% (Southwest Finland) to 100% (East Savo, Kainuu, Länsi-Pohja, Åland). During the study period, a shift towards non-surgical treatment was evident in all hospital districts. CONCLUSION: Regional variations in Achilles tendon rupture incidence exist in Finland; however, the incidence increased in all areas during the follow-up period. More Achilles tendon rupture patients are currently being treated non-surgically throughout the country.
Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Humanos , Finlândia/epidemiologia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Incidência , Ruptura/epidemiologia , Ruptura/cirurgia , Ruptura/terapia , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/terapia , Idoso , Sistema de Registros , Adulto JovemRESUMO
INTRODUCTION: Achilles tendon ruptures (ATRs) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. METHODS: The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. RESULTS: From February 2009 to August 2023, 556 patients presented with an ATR. Of these, 37 (6.7 â%) patients were diagnosed with a MT tear. At final follow-up, at 12 months following injury, the MT group reported an Achilles tendon total rupture score (ATRS) of mean (standard deviation (SD)) of 83.6 (3.5) (95 â% confidence interval (CI) 81.8, 85.4) and median (inter-quartile range (IQR)) ATRS of 86 points (78-95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59-95) (p â= â0.673). Functional evaluation, however, revealed statistically significant differences in mean (SD) heel-rise height index MT group 79 â% (25) (95%CI 65.9, 92.1) and MS group 59 â% (13) (95%CI 51.9, 67.1) (p â= â0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. CONCLUSIONS: When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. LEVEL OF EVIDENCE: IV.
Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/lesões , Calcanhar , Estudos Retrospectivos , Resultado do Tratamento , Recuperação de Função Fisiológica , Ruptura/terapia , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/cirurgiaRESUMO
Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment 1. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner 2. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.
Assuntos
Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Humanos , Ligamento Cruzado Posterior/lesões , Ligamento Cruzado Posterior/cirurgia , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/terapia , Reconstrução do Ligamento Cruzado Posterior/métodos , Ruptura/terapia , Ruptura/cirurgiaRESUMO
CASE: A 19-year-old female athlete experienced calf pain during sport. A complete Achilles tendon rupture was diagnosed 4 weeks after injury. Ultrasound revealed discontinuity of the Achilles tendon with 2.0 cm of diastasis, persisting in plantarflexion. Plantarflexion immobilization was initiated, and progressive dorsiflexion was used until 10 weeks from injury. At 1 year from injury, ankle magnetic resonance imaging revealed a contiguous tendon, the patient was pain-free, and had returned to high-level athletics with equivalent sport performance relative to her preoperative status. CONCLUSION: Certain Achilles tendon ruptures in young people may be treated nonoperatively with good clinical outcomes, even if diagnosis and immobilization are delayed and tendon diastasis persists in maximum plantarflexion.
Assuntos
Tendão do Calcâneo , Traumatismos do Tornozelo , Traumatismos dos Tendões , Feminino , Adolescente , Humanos , Adulto Jovem , Adulto , Tendão do Calcâneo/cirurgia , Diagnóstico Tardio , Ruptura/terapia , Ruptura/cirurgia , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/cirurgia , AtletasRESUMO
The authors report a case of simultaneous bilateral rupture of the patellar ligament resulting of low-energy trauma in a patient with chronic renal failure.
Os autores apresentam um caso de uma ruptura bilateral simultânea do ligamento patelar decorrente de trauma de baixa energia em paciente portador de insuficiência renal crônica.
Assuntos
Humanos , Masculino , Idoso , Joelho , Ligamento Patelar/cirurgia , Ligamento Patelar/lesões , Ruptura/terapiaRESUMO
The aim of this study was to compare the efficacy of somatostatin versus endoscopic sclerotherapy in the management of digestive bleeding caused by rupture of esophageal varices. Forty patients were evaluated; 21 were randomly assigned to receive somatostatin (initial 250 micrograms followed by a 48-hour continuous infusion of 250 micrograms/h and 250 micrograms 6/6 h bolus in the first 24 hours) and 19 to receive endoscopic sclerotherapy with ethanolamine oleate 5 per cent. The patients were evaluated after 48 hours and after 7 days of treatment. Both groups of patients were similar in sex, age, gravity of the hemorrhage and liver dysfunction. Therapeutic failure occurred in 26.3 per cent and 35.7 per cent in the group of endoscopic sclerotherapy (48 h and 7 days respectively), and in 23.8 per cent and 21.4 per cent in the group of somatostatin. The need of blood transfusion (3.38 U in the group of endoscopic sclerotherapy and 2.42 U in the group of somatostatin) and the mortality rate (31.6 per cent in the group of endoscopic sclerotherapy and 28.6 per cent in the group of somatostatin) were also similar (P > 0.05). The authors conclude that somatostatin is as effective as endoscopic sclerotherapy and that it should be considered in the treatment of acute esophageal variceal bleeding
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hemorragia Gastrointestinal/terapia , Escleroterapia , Somatostatina/uso terapêutico , Varizes Esofágicas e Gástricas/terapia , Vasodilatadores/uso terapêutico , Idoso de 80 Anos ou mais , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/terapia , Estudos Prospectivos , Distribuição Aleatória , Ruptura/terapia , Resultado do Tratamento , Varizes Esofágicas e Gástricas/complicaçõesRESUMO
Entre mayo 2003 y mayo 2006 cuatro pacientes que habian sufrido ruptura del mecanismo extensor después de una artroplastia total de rodilla fueron sometidos a reconstrucción tardía usando aloinjertos liofilizados de tendón de Aquiles. El promedio de edad era de 70,75 (70-72) años. Por lo menos 3 cirugías anteriores en promedio. Todos los pacientes alcanzaron un alivio del dolor con un promedio de seguimiento de 16,75 (3-38) meses. Dos pacientes presentaron en el post operatorio retardo para la extensión de 10 (50 por ciento) y dos de -40° (50 por ciento), comparando al promedio preoperatorio de -65° por ciento. La deambulación apoyando todo el peso fue posible en todos los pacientes; sin embargo dos pacientes usaban bastón (50 por ciento) y dos andadera (50 por ciento).
Assuntos
Humanos , Masculino , Feminino , Idoso , Artroplastia do Joelho/métodos , Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Transplante Homólogo/métodos , Ortopedia , Ruptura/terapia , TraumatologiaRESUMO
La lesión traumática cerrada de los cuerpos cavernoso o fractura de pene o fractura de cujerpoas cavernosos, es una patología urológica de urgencia y poco frecuente. Presentamos nuestra experiencia en el diagnóstico, tratamiento quirúrgico y evaluación alejada de 6 pacientes intervenidos en el hospital de Clínicas "José de San Martín". El tiempo entre la Lesión y la consulta varió entre 2 y 10 horas. Todos los pacientes fueron intervenidos quirúrgicamente y se realizó evacuación del hematoma, control de la hemostasis y reparación de la lesión. En ningún caso se presentó lesión de uretra. El seguimiento se realizó durante 6 a 46 meses. Los resultados a largo plazo fueron satisfactorios ya que todos los pacientes mostraron una restituición anatómica y funcional completa
Assuntos
Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Seguimentos , Ruptura/diagnóstico , Ruptura/cirurgia , Ruptura/terapiaRESUMO
No período de 15 anos, 18.095 pacientes foram cadastrados na clínica privada, Centro Médico Esportivo Sao Francisco da Penitência e no Serviço Médico do Fluminense Football Clube. Observamos que, entre os 18.095 pacientes tratados, 10.719 (59,23 por cento) foram diagnosticados com lesoes esportivas e 2.670 (24 por cento), portadores de lesoes musculares. Apresentamos os meios de diagnóstico, que sao baseados na observaçao clínica evolutiva de atletas de alto nível, com minucioso registro diário e na escolha de exames complementares para orientaçao do tratamento conservador ou cirúrgico.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Traumatismos em Atletas/terapia , Músculos/lesões , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Cãibra Muscular/terapia , Contratura/terapia , Contusões/terapia , Prognóstico , Recidiva , Ruptura/terapia , Traumatismos dos Tendões/cirurgiaRESUMO
Foi realizado trabalho de avaliaçäo do tratamento conservador em 189 ombros de 171 pacientes portadores de pinçamento subacromial e ruptura do manguito rotador, divididos em grupos I e II, respectivamente. Procurou-se caracterizar o grupo de estudo quanto aos dados de anamnese, exame fisico e tempo de tratamento, correlacionando-os com o resultado final. Encontraram-se 80,1 por cento e 75 por cento de resultados satisfatorios no grupo I ao fim de um e dois anos, respectivamente. No grupo II, 42,9 por cento e 21,5 por cento. O fator limitante na avaliaçäo dos resultados foi o abandono do tratamento.