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1.
Sports Med Arthrosc Rev ; 29(3): 154-157, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398118

RESUMO

Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time. Surgical advances in operative techniques, modern instrumentation and biological enhancements collectively improve healing rates of meniscal repair. However, failed repair is not without consequences and can negative impact patient outcomes. Therefore, it is imperative for surgeons to have a thorough understanding of the vascular zones and biomechanical classifications of meniscal tears in order to best determine the most appropriate treatment.


Assuntos
Lesões do Menisco Tibial , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Humanos , Imageamento por Ressonância Magnética , Meniscectomia/métodos , Meniscos Tibiais/irrigação sanguínea , Meniscos Tibiais/cirurgia , Modalidades de Fisioterapia , Ruptura/classificação , Ruptura/diagnóstico por imagem , Ruptura/patologia , Ruptura/terapia , Lesões do Menisco Tibial/classificação , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/patologia , Lesões do Menisco Tibial/terapia , Cicatrização
2.
Isr Med Assoc J ; 23(8): 510-515, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392629

RESUMO

BACKGROUND: In recent years, treatment for Achilles tendon rupture (ATR) went through radical changes: from the conservative non-weight bearing approach to a functional protocol. This functional protocol allows complete weight bearing after only 2 weeks by placing the foot in a plastic boot in tapered down equines and using interchangeable wedges under the heel. This change of approach has dramatically lowered the rate of re-rupture. OBJECTIVES: To describe our preliminary results with this functional protocol and to assess outcome measures in the functional conservative treatment. METHODS: The study comprised 15 people who were evaluated clinically and by sonograph. We measured calf circumference, ankle joint range of motion (ROM), and single-leg heel-rise test (SLHRT). In addition, standard scoring methods (Achilles Tendon Rupture Score and Physical Activity Scale) were examined. RESULTS: In our cohort 14 people successfully gained SLHRT. The mean Achilles Tendon Rupture Score functional questionnaire and Physical Activity Scale physical activity questionnaire score was 85.6 of 100, and 4.7 of 6, respectively. There were no significant differences in ankle ROM compared to the uninjured limb. There was statistically significant reduction in the calf circumference and soleus muscle thickness sonographically. CONCLUSIONS: It seems that the conservative functional treatment of ATR demonstrates good functional outcomes, with the patients returning to close to normal activity, although noted muscle wasting and weakness. This protocol presents a true alternative to surgery and should be considered for most non-insertional Achilles tendon tears.


Assuntos
Tendão do Calcâneo , Articulação do Tornozelo/fisiopatologia , Tratamento Conservador/métodos , Traumatismos dos Tendões , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/lesões , Tendão do Calcâneo/fisiopatologia , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Ruptura/diagnóstico por imagem , Ruptura/prevenção & controle , Ruptura/terapia , Prevenção Secundária/métodos , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/terapia , Ultrassonografia/métodos
3.
Knee ; 30: 35-40, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33836302

RESUMO

In this article we report a case of stiff, neglected extreme recurvatum knee deformity in a 17-year-old female. This is the first reported case in the literature of an acquired ligamentous stiff extreme knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection. Μodified Judet quadricepsplasty combined with Ilizarov external hinged frame fixation was implemented. This dual technique can be considered as a rational approach for such an extreme deformity as it stabilizes, progressively corrects, and prevents recurrence. A patellar tendon rupture caused by the increasing tension of the extensor mechanism following the correction was treated successfully using a cadaveric Achilles tendon allograft.


Assuntos
Anestesia/efeitos adversos , Toxinas Botulínicas/efeitos adversos , Joelho/fisiopatologia , Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Tendão do Calcâneo/transplante , Adolescente , Toxinas Botulínicas/administração & dosagem , Feminino , Humanos , Técnica de Ilizarov , Joelho/diagnóstico por imagem , Ligamento Patelar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/etiologia , Ruptura/terapia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Transplante Homólogo/métodos
4.
J Hand Surg Asian Pac Vol ; 26(2): 274-279, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33928866

RESUMO

Closed traumatic rupture of forearm flexor muscles has been reported rarely. Previous reports have included ruptures of the flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, flexor carpi radialis, pronator quadratus and the palmaris longus. We report a patient with a closed traumatic rupture through the muscle belly of the flexor carpi ulnaris and summarise the published literature on ruptures involving the forearm flexor muscles. Overall, conservative treatment can result in excellent outcomes. Early surgical intervention is recommended in patients with nerve involvement and compartment syndrome and delayed reconstruction may be considered for patients with functional deficits.


Assuntos
Traumatismos do Antebraço/terapia , Músculo Esquelético/lesões , Ruptura/terapia , Adulto , Terapia por Exercício , Traumatismos do Antebraço/diagnóstico por imagem , Humanos , Imobilização , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/diagnóstico por imagem , Traumatismos Ocupacionais/terapia , Ruptura/diagnóstico por imagem , Contenções
5.
J Zoo Wildl Med ; 52(1): 117-125, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33827168

RESUMO

The objective of this pilot study was to examine the histologic effects associated with three known sclerosing agents and their ability to induce fibrosis in the subcutaneous space between the cervicocephalic air sac and skin. In the future, these drugs may prove useful in treating birds experiencing cervicocephalic diverticula rupture. The agents used were 1% polidocanol, absolute ethanol, and doxycycline hyclate. Twelve healthy adult chickens (Gallus gallus domesticus) were used in this study. The chickens were randomly allocated into three groups denoting day of euthanasia (day 4, 7, or 14). On day 0, all agents were injected (0.2 ml) subcutaneously, in a four-point grid fashion, in both the cervical and pectoral region of each bird. After euthanasia, the skin and subcutaneous tissues corresponding to the injection sites were harvested for histologic assessment. Tissue sections were assessed for fibrosis and lymphocytic and histiocytic inflammation. A scoring system was established to rank sclerosing agents by fibrosing and inflammatory ability. In the cervical region of chickens, 1% polidocanol induced the greatest inflammatory changes by day 7. Data suggest that doxycycline hyclate may produce the greatest cutaneous and subcutaneous fibrosis overall among all groups of birds. No adverse reactions were associated with any injection. Sterile saline produced the least amount of inflammation when assessed with the scoring system. Further investigation is needed to determine the safety of injections of larger volume with these chemicals and whether these findings can be extrapolated to birds with disease.


Assuntos
Sacos Aéreos/patologia , Galinhas , Doxiciclina/farmacologia , Etanol/farmacologia , Polidocanol/farmacologia , Animais , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Etanol/administração & dosagem , Fibrose/induzido quimicamente , Fibrose/veterinária , Histiócitos , Inflamação/induzido quimicamente , Inflamação/veterinária , Linfócitos , Projetos Piloto , Polidocanol/administração & dosagem , Doenças das Aves Domésticas/terapia , Ruptura/terapia , Ruptura/veterinária , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/uso terapêutico , Pele/efeitos dos fármacos , Pele/patologia
6.
Clin Podiatr Med Surg ; 38(2): 201-226, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33745652

RESUMO

There is an ever-evolving debate about the best treatment option for Achilles tendon ruptures. There was a relative consensus that operative treatment yielded the best outcomes. Much of this is based on results in athletic populations. Conservative treatment was considered only for the elderly and those with very inactive lifestyles. There has been an evolution, however, with more surgeons utilizing an aggressive functional rehabilitation with conservative management. Surgical intervention still is the treatment of choice for elite-level athletes. The treatment of choice for patient populations other than elite athletes remains an individual choice between patient and physician.


Assuntos
Tendão do Calcâneo/lesões , Ruptura/diagnóstico , Ruptura/terapia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/terapia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Tratamento Conservador , Humanos , Incidência , Procedimentos Cirúrgicos Minimamente Invasivos , Exame Físico , Complicações Pós-Operatórias
7.
BMJ Case Rep ; 14(2)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597165

RESUMO

Placement of a double-lumen tube to achieve one lung ventilation is an aerosol-generating procedure. Performing it on a patient with COVID-19 will put healthcare workers at high risk of contracting the disease. We herein report a case of its use in a patient with traumatic diaphragmatic rupture, who was also suspected to have COVID-19. This article aims to highlight the issues, it presented and ways to address them as well as the perioperative impact of personal protective equipment.


Assuntos
COVID-19/prevenção & controle , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação Monopulmonar/normas , Equipamento de Proteção Individual/normas , Acidentes de Trânsito , Adulto , COVID-19/diagnóstico , COVID-19/transmissão , Diafragma/lesões , Diafragma/cirurgia , Humanos , Masculino , Ventilação Monopulmonar/instrumentação , Guias de Prática Clínica como Assunto , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Ruptura/etiologia , Ruptura/terapia
8.
Scand J Med Sci Sports ; 31(5): 1069-1077, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33464638

RESUMO

The purpose of this study was investigate tendon displacement patterns in non-surgically treated patients 14 months after acute Achilles tendon rupture (ATR) and to classify patients into groups based on their Achilles tendon (AT) displacement patterns. Twenty patients were tested. Sagittal images of AT were acquired using B-mode ultrasonography during ramp contractions at a torque level corresponding to 30% of the maximal isometric plantarflexion torque of the uninjured limb. A speckle tracking algorithm was used to track proximal-distal movement of the tendon tissue at 6 antero-posterior locations. Two-way repeated measures ANOVA for peak tendon displacement was performed. K-means clustering was used to classify patients according to AT displacement patterns. The difference in peak relative displacement across locations was larger in the uninjured (1.29 ± 0.87 mm) than the injured limb (0.69 ± 0.68 mm), with a mean difference (95% CI) of 0.60 mm (0.14-1.05 mm, P < .001) between limbs. For the uninjured limb, cluster analysis formed 3 groups, while 2 groups were formed for the injured limb. The three distinct patterns of AT displacement during isometric plantarflexion in the uninjured limb may arise from subject-specific anatomical variations of AT sub-tendons, while the two patterns in the injured limb may reflect differential recovery after ATR with non-surgical treatment. Subject-specific tendon characteristics are a vital determinant of stress distribution across the tendon. Changes in stress distribution may lead to variation in the location and magnitude of peak displacement within the free AT. Quantifying internal tendon displacement patterns after ATR provides new insights into AT recovery.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/fisiopatologia , Contração Isométrica , Ruptura/fisiopatologia , Tendão do Calcâneo/diagnóstico por imagem , Adulto , Algoritmos , Fenômenos Biomecânicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Ruptura/diagnóstico por imagem , Ruptura/terapia , Torque , Ultrassonografia
9.
Knee Surg Sports Traumatol Arthrosc ; 29(5): 1617-1626, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33386883

RESUMO

PURPOSE: Studies have shown that elongation of the injured Achilles tendon after acute Achilles tendon rupture (ATR) is negatively associated with clinical outcomes. The difference between operative and non-operative treatment on the length of the Achilles tendon is only sparsely investigated. The aim of the study was to investigate if the operative and non-operative treatment of ATR had different effects on tendon elongation. METHODS: The study was performed as a registry study in the Danish Achilles tendon database (DADB). The primary outcome of the study was an indirect measure of Achilles tendon length: the Achilles tendon resting angle (ATRA) at 1-year follow-up. The variable of interest was treatment (operative or non-operative). RESULTS: From August 2015 to January 2019, 438 patients (154 operatively treated and 284 non-operatively treated) were registered with full baseline data and had their ATRA correctly registered at 1-year follow-up in DADB. The analysis did not show a clinically relevant nor statistically significant difference in ATRA between operative and non-operatively treated patients at 1-year follow-up (mean difference - 1.2°; 95% CI - 2.5; 0.1; n.s) after adjustment for potential confounders. CONCLUSION: There were neither clinically relevant nor statistically significant differences in terms of the ATRA at 1-year follow-up between the operative and non-operatively treated patients. This finding suggests that operative treatment does not lead to a clinically relevant reduction in tendon elongation compared to non-operative treatment and it should therefore not be used as an argument in the choice of treatment. LEVEL OF EVIDENCE: Level III.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Ruptura/patologia , Ruptura/terapia , Tendão do Calcâneo/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/cirurgia , Resultado do Tratamento
10.
Arch Orthop Trauma Surg ; 141(5): 751-760, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367375

RESUMO

INTRODUCTION: The acute Achilles tendon rupture (AATR) is a common injury of great importance in an increasingly active society. When early functional treatment is established, recent literature shows comparable rates of re-rupture in conservative and surgical treatments of AATR. However, there is no study comparing the outcome using a dynamometer. The aim of this study is to evaluate the results of patients with AATR treated conservatively and surgically using a dynamometer. In addition, the data are compared to evaluation of the Achilles tendon with ultrasound. MATERIALS AND METHODS: Between 2012 and 2015, 90 patients (mean age 41 years, male-to-female ratio 81:9) with AATR were enrolled in a prospective, randomized, and monocentric study. Thirty patients were assigned to each of the three different treatment groups. Group OPEN received a conventional open suture of the Achilles tendon, group MIN received a minimally invasive suture and patients in group CONS were treated conservatively. Follow-up treatment was the same for all patients regardless of the group they were assigned to. Plantar flexion force was assessed using a dynamometer (Biodex® System 3 Pro, Biodex Medical Systems). Further evaluation included a physical test and ultrasound of the Achilles tendon. RESULTS: Sixty-nine patients were available for a 24-month follow-up. In each of the OPEN and MIN groups, there was one re-rupture. In the CONS group, there were two re-ruptures. A positive correlation between the Biodex® dynamometer measurement and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AH) could be found in all groups. Nevertheless, there were no significant differences between the treatment groups after 2 years. On sonography, all patients showed isolated structure loosening and a significantly thickened cross-sectional area compared with the non-injured opposite side, without differences between the groups. There was no correlation between the Biodex® measurement and sonographic outcome. CONCLUSION: At 24-month follow-up, no significant difference can be found in patients with AATR treated operatively or conservatively. It is, therefore, important to inform patients with AATR regarding the respective advantages and disadvantages of the individual treatment strategies. LEVEL OF EVIDENCE: Randomized controlled trial; level 1.


Assuntos
Tendão do Calcâneo , Tratamento Conservador , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Ortopédicos , Ruptura/terapia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos
12.
Clin Sports Med ; 39(4): 877-891, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892973

RESUMO

Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture.


Assuntos
Tendão do Calcâneo/lesões , Traumatismos do Tornozelo/terapia , Traumatismos em Atletas/terapia , Procedimentos Ortopédicos/métodos , Volta ao Esporte , Ruptura/terapia , Tendinopatia/terapia , Tendão do Calcâneo/cirurgia , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Tratamento Conservador/métodos , Humanos , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/fisiopatologia , Tendinopatia/diagnóstico , Tendinopatia/etiologia , Tendinopatia/fisiopatologia , Resultado do Tratamento
13.
Acta Orthop Traumatol Turc ; 54(4): 438-444, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32812877

RESUMO

OBJECTIVE: The aim of this study was to compare the effects of local administrations of platelet-rich plasma (PRP) with autologous conditioned serum (ACS) on Achilles tendon healing in a rat model. METHODS: In this study, 40 male Sprague-Dawley rats, aged 12 months and weighing 350 to 400 g were used. The rats were divided into three groups (n=10 in each group): a control group and two treatment groups (PRP vs ACS). A standardized procedure was applied for the complete rupture and repair of the Achilles tendon in each group. The PRP group received one dose of PRP on the operative area, and ACS group received ACS at 24, 48, and 72 hours after the surgery. The control group received no injection. Animals were sacrificed 30 days after the operation, and tendon healing in each group was assessed histopathologically based on Bonar's semi-quantitative score and Movin's semi-quantitative grading scale. For the biomechanical analyses, unoperated Achilles tendons of all rats in the control and ACS groups were also harvested, and pulling tests were applied to the specimen to measure the longitudinal axis strength. The highest force value among the data obtained was defined as the maximum strength value (Fmax). RESULTS: The mean Bonar's score was significantly lower in the PRP group (3.8±0.8) than in the ACS (4.8±0.45) and control groups (5.2±0.837) (p=0.0028). The mean Movin's score was significantly lower in the PRP group (7.80±1.49) than in the ACS (9.8±1) and control groups (11.2±2.4) (p=0.029). The ratio of type I collagen was significantly higher in the PRP group (60±6) than in the ACS (52±4.5) and control groups (42±9) (p=0.005). Biomechanical results obtained from operated sites were comparable in terms of Fmax among groups (PRP, 33.93±2.61; ACS, 35.24±3.26; control, 35.69±3.62) (p=0.674). Similarly, the results obtained from unoperated sites were comparable among groups (PRP, 47.71±1.21; ACS, 48.14±2; control, 49.14.69±1.88) (p=0.395). CONCLUSION: In terms of histopathological results, PRP seems to be more effective than ACS for Achilles tendon healing in rats.


Assuntos
Tendão do Calcâneo , Plasma Rico em Plaquetas/fisiologia , Ruptura/terapia , Soro/fisiologia , Cicatrização/fisiologia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/fisiopatologia , Animais , Fenômenos Biomecânicos , Modelos Animais de Doenças , Injeções Intralesionais/métodos , Masculino , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
14.
Wilderness Environ Med ; 31(3): 327-331, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32709490

RESUMO

The case of a 42-y-old rock climber who sustained a complete, isolated rupture of the short head of the biceps brachii muscle after falling onto his upper arm while bouldering is presented. This is the first description of this rare injury after a climbing accident. Moreover, there is no definitive consensus on whether and when surgical intervention is necessary in such a case. We performed a direct end-to-end suture of the muscle belly through an open surgical approach. Postoperatively, we performed a detailed follow-up, including clinical examinations and sonography and magnetic resonance imaging to check the integrity of the suture. After 6 mo, our patient had regained a full range of motion without functional complaints or pain. Concerning the sports-specific outcome, we only found a slight decrease in rock-climbing abilities (Union Internationale des Associations d'Alpinisme Scale of Difficulty grade VII+ postsurgery compared to VIII preinjury). In conclusion, we suggest that early surgical reapproximation of the muscle belly might be the best treatment option for this severe but rare injury in athletes.


Assuntos
Acidentes por Quedas , Montanhismo , Músculo Esquelético/lesões , Ruptura/terapia , Adulto , Humanos , Masculino , Volta ao Esporte , Ruptura/etiologia , Resultado do Tratamento
15.
Am J Sports Med ; 48(9): 2268-2276, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32485112

RESUMO

BACKGROUND: An acute Achilles tendon rupture (ATR) is a long-lasting and devastating injury. Possible biological augmentation to promote and strengthen tendon healing after an ATR would be desirable. PURPOSE: To determine whether the application of a platelet-rich plasma (PRP) injection in nonsurgically treated ATRs may promote healing and thereby improve functional outcomes. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 40 men (aged 18-60 years) with an ATR incurred within 72 hours were included, and 38 were followed for 12 months. All patients were treated with an orthosis with 3 wedges for 8 weeks; full weightbearing from day 1 was allowed, combined with either 4 PRP or 4 placebo injections (a few drops of saline, <0.5 mL, under the skin) 14 days apart. All patients received the same instructions on an exercise program starting from week 9. Outcomes included the self-reported Achilles tendon Total Rupture Score (ATRS) as well as heel-rise work, heel-rise height, tendon elongation, calf circumference, and ankle dorsiflexion range of motion. RESULTS: The mean ATRS score improved in both groups at all time points (P < .001), but there was no difference between the groups at any time points (12 months: 90.1 points in PRP group and 88.8 points in placebo group). No differences in all functional outcomes at any time points were seen between the groups. At 12 months, the injured leg did not reach normal functional values compared with the uninjured leg. CONCLUSION: The application of PRP in nonsurgically treated ATRs did not appear to show any superior clinical and functional improvement. REGISTRATION: NCT02417922 (ClinicalTrials.gov identifier).


Assuntos
Tendão do Calcâneo/lesões , Plasma Rico em Plaquetas , Ruptura/terapia , Traumatismos dos Tendões/terapia , Adolescente , Adulto , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
16.
BMC Musculoskelet Disord ; 21(1): 358, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513228

RESUMO

BACKGROUND: While numerous clinical studies have compared the surgical and non-surgical treatment of acute Achilles tendon rupture (ATR), there are no studies that have performed a non-inferiority analysis between treatments. METHODS: Data from patients who were included in five randomised controlled trials from two different centres in Sweden were used. Outcomes at 1 year after ATR consisted of the patient-reported Achilles tendon Total Rupture Score (ATRS) and the functional heel-rise tests reported as the limb symmetry index (LSI). The non-inferiority statistical 10% margin was calculated as a reflection of a clinically acceptable disadvantage in ATRS and heel-rise outcome when comparing treatments. RESULTS: A total of 422 patients (350 males and 72 females) aged between 18 and 71 years, with a mean age of 40.6 (standard deviation 8.6), were included. A total of 363 (86%) patients were treated surgically. The ATRS (difference (Δ) = - 0.253 [95% confidence interval (CI); - 5.673;5.785] p = 0.36) and LSI of heel-rise height (difference = 1.43 [95% CI; - 2.43;5.59] p = 0.81), total work (difference = 0.686 [95% CI; - 4.520;6.253] p = 0.67), concentric power (difference = 2.93 [95% CI; - 6.38;11.90] p = 0.063) and repetitions (difference = - 1.30 [95% CI; - 6.32;4.13] p = 0.24) resulted in non-inferiority within a Δ - 10% margin for patients treated non-surgically. CONCLUSION: The non-surgical treatment of Achilles tendon ruptures is not inferior compared with that of surgery in terms of 1-year patient-reported and functional outcomes.


Assuntos
Tendão do Calcâneo/lesões , Calcanhar/fisiopatologia , Ruptura/terapia , Traumatismos dos Tendões/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Suécia , Adulto Jovem
17.
Schweiz Arch Tierheilkd ; 162(6): 345-364, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32489180

RESUMO

INTRODUCTION: Cranial cruciate ligament rupture is one of the most important diseases in canine orthopedics. Despite the frequent occurrence of the disease and the extensive literature available, there is still controversy about the best treatment method. The aim of this review article is to present a new, more specific approach to treatment selection in dogs with cranial cruciate ligament rupture. Patients are divided into different groups and particular treatment methods are then recommended according to group membership. In order to develop the treatment recommendations, the patient groups were initially defined based on criteria that are important for treatment selection, such as type of cranial cruciate ligament rupture, chronicity, degree of instability, size and weight of the patient, stage of osteoarthritis, the presence of bone deformities, concurrent medial patellar luxation or rotational instability. A detailed literature search was conducted through MEDLINE/PUBMED; CAB Abstracts, Google -Scholar and in conference proceedings abstracts from 1990-2019. Based on the available literature, treatment recommendations were developed for each patient group. These patient group-specific recommendations based on best available evidence are intended to simplify the decision-making process for treatment selection in dogs with cranial cruciate ligament disease.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/patologia , Doenças do Cão/terapia , Ruptura/veterinária , Animais , Lesões do Ligamento Cruzado Anterior/terapia , Cães , Ruptura/terapia
18.
Clin Sports Med ; 39(3): 565-574, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446575

RESUMO

Medial ulnar collateral ligament (MUCL) insufficiency is becoming common in younger, nonprofessional athletes. In contrast to elite athletes who develop valgus extension overload syndrome and associated chronic pathologic changes in the MUCL, younger patients present with sprains and partial tears that can often be managed non-operatively with successful outcome and rapid return to play. In the younger throwing athlete with medial-sided elbow pain, a hinged elbow brace and rehabilitation of dysfunctional muscles often lead to successful recovery and return to play within 1-2 months. In more severe injuries, direct repair of the partial tear with or without added internal bracing supplementation allows restoration of stability with a return to play with 4 to 6 months.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Ligamento Colateral Ulnar/lesões , Ruptura/diagnóstico , Ruptura/terapia , Entorses e Distensões/diagnóstico , Entorses e Distensões/terapia , Traumatismos em Atletas/cirurgia , Braquetes , Ligamento Colateral Ulnar/cirurgia , Humanos , Volta ao Esporte , Ruptura/cirurgia , Entorses e Distensões/cirurgia , Reconstrução do Ligamento Colateral Ulnar/métodos
19.
Clin Sports Med ; 39(3): 673-685, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446583

RESUMO

Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Ruptura/diagnóstico por imagem , Ruptura/terapia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/terapia , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/cirurgia , Humanos , Imageamento por Ressonância Magnética , Músculo Esquelético/lesões , Radiografia , Fatores de Risco , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia
20.
Knee Surg Sports Traumatol Arthrosc ; 28(12): 3994-4002, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32350575

RESUMO

PURPOSE: Studies suggest that women have worse treatment outcome than men after acute Achilles tendon rupture (ATR). The aim of this study was to investigate if sex and age affect treatment outcome after ATR. METHODS: The study was performed as a registry study in the Danish Achilles tendon Database. The primary outcome was change in the Achilles tendon Total Rupture Score (ATRS) from baseline to 4 months, 1 year and 2 years follow-up. Variables of interest were sex and age group (< 40 years, 40-65 years and > 65 years). RESULTS: Data were collected from April 2012 to March 2018. Five-hundred and sixteen patients (416 men, 100 women) were included in the study population. At baseline, women scored 4.3 points lower in ATRS compared to men. No statistically significant difference between the sexes regarding change in ATRS were found. Women scored statistically significantly less in absolute ATRS at 1 year follow-up (mean difference 9.4; 95% CI 3.8, 14.9; P = 0.03). Patients older than 65 years scored statistically significantly more in ATRS change compared to patients between 40-65 years (mean difference 12.8; 95% CI 6.1-19.5; P < 0.001). CONCLUSION: This study did not show a statistically significant or clinically relevant difference between the sexes in ATRS change from baseline to follow-up. The mean difference in ATRS change between patients older than 65 years and patients between 40-65 years was clinically relevant with better outcome for patients older than 65 years. When comparing ATRS between groups with an unequal sex distribution, the findings of a baseline difference and a difference in absolute ATRS at 1 year follow-up between the sexes, advocate for reporting of sex-specific data or for use of change in ATRS from baseline to follow-up instead of absolute ATRS. LEVEL OF EVIDENCE: Level III.


Assuntos
Tendão do Calcâneo/lesões , Ruptura/terapia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Volta ao Esporte , Retorno ao Trabalho , Fatores Sexuais , Resultado do Tratamento
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