Achilles tendon disorders: An overview of diagnosis and conservative treatment.

ABSTRACT: Achilles tendon-related pain affects up to 6% of the US population during their lifetime and is commonly encountered by primary care providers. An accurate diagnosis and early conservative management can improve patient quality of life and reduce unnecessary surgical consultations, saving healthcare dollars. Achilles tendon pathologies can be categorized into acute (pain lasting less than 6 weeks), chronic (pain lasting more than 6 weeks), and acute on chronic (worsening of pain with preexisting chronic Achilles tendon pathology). This article describes the diagnosis, conservative management, indications for imaging, and indications for surgical referral for acute and chronic Achilles tendon rupture, Achilles tendinitis, gastrocnemius strain, plantaris rupture, insertional Achilles tendinopathy, Haglund deformity, and noninsertional Achilles tendinopathy.

Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair.

INTRODUCTION: Little is known about the factors affecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcome instruments and the impact of patient resilience on postoperative outcomes. This is the first study to investigate the impact of resilience on the outcomes of lateral ligament repair. METHODS: Retrospectively, 173 patients undergoing Brostrom-Gould at single institution from January 2013 to June 2020 were identified. Patient characteristics, participation in athletic activities, surgical variables, and complications were recorded. Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference v1.1 (PI), Physical Function v1.2 (PF), and the Foot Ankle Ability Measure (FAAM) were collected. The Brief Resilience Scale was used to quantify resilience. A linear regression model was constructed to evaluate the independent effect of resilience on each PROMIS and FAAM outcome instrument. Variables were included in the regression model based on an a priori significance threshold of P <0.05 in bivariate analysis. RESULTS: Resilience's independent effect on outcome measures was as follows: PROMIS PF (unstandardized ß 8.2, 95% confidence interval [CI] 3.9 to 12.6), PROMIS PI (unstandardized ß -4.8, 95% CI -7.9 to -1.7), FAAM Activities of Daily Living (unstandardized ß 16.6, 95% CI 8.7 to 24.6), and FAAM Sports (unstandardized ß 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcome metrics including PROMIS PF (unstandardized ß 9.4, 95% CI 2.8 to 16.0), PROMIS PI (unstandardized ß -5.3, 95% CI -10.0 to -0.582), and FAAM Sport scores (unstandardized ß 34.4, 95% CI 15.4 to 53.4). CONCLUSIONS: Resilience and patient participation in athletic activities are independent predictors of improved postoperative functional outcomes as measured by PROMIS and FAAM instruments at intermediate term follow-up. Resilient patients and athletes reported markedly higher PF and less pain burden postoperatively. Preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.

BACHD Mice Recapitulate the Striatal Parvalbuminergic Interneuron Loss Found in Huntington's Disease.

Huntington's disease (HD) is a dominantly inherited, adult-onset neurodegenerative disease characterized by motor, psychiatric, and cognitive abnormalities. Neurodegeneration is prominently observed in the striatum where GABAergic medium spiny neurons (MSN) are the most affected neuronal population. Interestingly, recent reports of pathological changes in HD patient striatal tissue have identified a significant reduction in the number of parvalbumin-expressing interneurons which becomes more robust in tissues of higher disease grade. Analysis of other interneuron populations, including somatostatin, calretinin, and cholinergic, did not reveal significant neurodegeneration. Electrophysiological experiments in BACHD mice have identified significant changes in the properties of parvalbumin and somatostatin expressing interneurons in the striatum. Furthermore, their interactions with MSNs are altered as the mHTT expressing mouse models age with increased input onto MSNs from striatal somatostatin and parvalbumin-expressing neurons. In order to determine whether BACHD mice recapitulate the alterations in striatal interneuron number as observed in HD patients, we analyzed the number of striatal parvalbumin, somatostatin, calretinin, and choline acetyltransferase positive cells in symptomatic 12-14 month-old mice by immunofluorescent labeling. We observed a significant decrease in the number of parvalbumin-expressing interneurons as well as a decrease in the area and perimeter of these cells. No significant changes were observed for somatostatin, calretinin, or cholinergic interneuron numbers while a significant decrease was observed for the area of cholinergic interneurons. Thus, the BACHD mice recapitulate the degenerative phenotype observed in the parvalbumin interneurons in HD patient striata without affecting the number of other interneuron populations in the striatum.