Early satisfactory results of percutaneous repair in neglected achilles tendon rupture.

PURPOSE: This investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes. METHODS: This is a retrospective review of a cohort of patients (n = 24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 and 2019. Included patients were adults with closed injuries, presented 4-10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference. RESULTS: The mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P < 0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P < 0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis. CONCLUSION: Percutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.

Congenital segmental tibial dysplasia and late onset pseudarthrosis of the tibia.

Background: Congenital pseudarthrosis of the tibia represents a continuum of dysplasia. Most cases develop pseudarthrosis during the first two years of life. Only a few cases with tibial dysplasia present after the age of two years, with or without pseudarthrosis. This under-reported form of Congenital segmental Tibial Dysplasia (CSTD) was investigated to evaluate its distinctive features and possibly predict the disease progression. Methods: Of the 46 cases presented to our institute over a 20-year period, 17 patients had CSTD. 13 patients developed pseudarthrosis after the age of two years, the average follow up period was four years. Four patients did not break their tibiae until the time of last follow up. Radiological criteria were evaluated by plain x-rays. Results: According to the radiological criteria, late-presenting CSTD was divided into resolving CSTD (R-CSTD), and pre-pseudarthrosis-CSTD (P-CSTD). In all cases of the R-CSTD group, the tibia had a canalized medullary cavity with anterolateral bowing and segmental cortical sclerosis. While in the P-CSTD group, there was anterolateral bowing, segmental cortical sclerosis, and any of the following: 1) medullary obliteration, 2) cystic changes, 3) hour-glass appearance, 4) Impending fracture, and 5) progressive deformity. Conclusion: A simple classification of prognostic value has been proposed for cases that did not sustain a fracture until after the age of two years. This differentiation would assist in decision making, and in preoperative counseling for patients. Level of evidence: IV, Retrospective case series.