Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice.

INTRODUCTION: This biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program. METHODS: 19 patients (16M:3F) were enrolled and prospectively assessed using Achilles Repair Scores (ARS)/Achilles Tendon Rupture Scores (ATRS) (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length. RESULTS: Both ATRS and ARS improved between short- and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. Three patients failed the SMART protocol requiring surgical fixation. DISCUSSION: The SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.

Foot injuries, playing surface and shoe design: Should we be thinking more about injury prevention.

The increasing use of artificial pitches has occurred in a multitude of sports at both professional and amateur levels. Artificial turf has become an extremely attractive option as it is felt to encourage a faster, safer and more entertaining play. However these pitches are not without controversy among sporting professionals and in the media. Foot and ankle injury in sport remains incredibly common and a significant burden on health professionals, but what impact do the new artificial surfaces have on these injuries. This review article aims to establish whether artificial turf has an impact on injury rates in the foot and ankle.

How I Use a Three-Dimensional Approach to Correct Hallux Valgus with a Distal Metatarsal Osteotomy.

The role of uniplanar osteotomy in correction of multiplanar deformity in hallux valgus is a developing and promising concept. Careful consideration should be given to the literature when considering the concept of preexisting pronation of the metatarsal. Recent weight-bearing computed tomography studies contradict the existing literature and state that there is little or no rotation of the metatarsal; therefore, a multiplanar osteotomy should aim to correct the rotation caused by soft tissue imbalance at the tarsometatarsal and metatarsophalangeal joints rather than in the metatarsal itself. A minimally invasive technique used by the senior author to achieve this correction is reported.

Do magnetic growing rods have lower complication rates compared with conventional growing rods?

BACKGROUND CONTEXT: The main advantage cited for the use of the magnetic controlled growing rod (MCGR) system over the conventional growing rod (CGR) in early-onset scoliosis is avoiding repeated invasive surgical procedures for lengthening, thus reducing, complications. PURPOSE: The study aimed to evaluate the complications of the MCGR system against the CGR system in our center. STUDY DESIGN/SETTING: This is a retrospective case control series. PATIENT SAMPLE: The sample includes patients with early-onset scoliosis treated with MCGR or CGR. OUTCOME MEASURES: Complications and unplanned return to theater were the outcome measures. RESULTS: Of the 37 patients (MCGR, N=10; CGR, N=27) in our cohort, 28 patients (76%) had at least one complication. Taking into account the follow-up period, MCGR had a higher complication rate than CGR group (0.32 complication per patient per year vs. 0.15 complication per patient per year). The use of MCGR was associated with a lower risk of deep infection (odds ratio [OR]: 0.22; p=.22) and superficial infection (OR: 0.07, p=.017) but increased risk of metalwork problems (OR: 4.67; p=.045) and unplanned return to theater (OR: 2.92; p=.05) compared with CGR. CONCLUSIONS: Although MCGR has a lower rate of both deep and superficial infections when compared with CGR, it does not completely avoid repeated invasive surgical procedures as previously suggested. It does have a significant increased risk of metalwork problems and unplanned return to theater.

Magnetic controlled growing rods for early-onset scoliosis: a 4-year follow-up.

BACKGROUND CONTEXT: There have been no studies with medium-term follow-up of magnetic controlled growing rods (MCGRs). PURPOSE: This study aimed to report our single center experience of a magnetic growing rod system with an average of 4 years' follow-up. STUDY DESIGN/SETTING: A retrospective case series was carried out. PATIENT SAMPLE: The sample comprised patients with early-onset scoliosis treated with magnetic controlled growth rods who were operated in 2011. OUTCOME MEASURES: Cobb angle, spinal growth rate, complications, and revision were the outcome measures. METHODS: Clinical case notes and radiographs were reviewed. RESULTS: There were 8 patients (5 dual-rod construct, 3 single-rod construct) who had a minimum of 44 months' follow-up and average of 48 months (44-55 months). Mean age at surgery was 8.2 years (range 3-10). Mean preoperative Cobb angle was 60° (34-94), whereas mean postoperative Cobb angle was 42° (32-63). The average number of extensions was 13.8 (range: 12-20). There were 6 patients (75%) who required 8 revision surgeries: rod problems (N=4), proximal screw pull-out (N=3), and development of proximal junction kyphosis (N=1). All three patients who had single-rod construct underwent revision procedure. Currently, four patients (50%) still have the magnetic rods in situ. The mean duration of MCGR in the patient in the removed group was 39 months (range: 34-46). CONCLUSIONS: Medium-term results of MCGR are not as promising as previously reported early results. Hence, MCGRs should be used with caution. Single-rod constructs should definitely be avoided. The role of MCGRs in revision cases still remains unknown.