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Objectives: Acute rupture of achilles tendon is a commonly occurring injury affecting mostly the young individuals involved in sports activities. Operative management is most often employed to treat such injuries. This study was aimed to evaluate the functional outcome in patients with acute tendo achilles tear managed by open repair using a suture anchor. Methods: This was a prospective study conducted between September 2018 to August 2020 on patients who underwent suture anchor repair for acute tendo achilles tear. All patients were followed up for at least 9 months. The patients were clinically evaluated and AOFAS score was used to assess their functional outcome. Results: In a total of 38 patients, 28 (73.7%) patients showed Excellent and 7 (18.4%) patients had Good results whereas 1 (2.6%) had Fair and 2 (5.3%) patients demonstrated Poor surgical result at the final follow-up. 89.5% patients did not have any complication. The average AOFAS score was 90.97 ± 10.24. Conclusion: Operative treatment with suture anchor in acute tendo achilles tear has a high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results and is also a safe, simple and accepted surgical technique.

Objectives: Acute rupture of achilles tendon is a commonly occurring injury affecting mostly the young individuals involved in sports activities. Operative management is most often employed to treat such injuries. This study was aimed to evaluate the functional outcome in patients with acute tendo achilles tear managed by open repair using a suture anchor. Methods: This was a prospective study conducted between September 2018 to August 2020 on patients who underwent suture anchor repair for acute tendo achilles tear. All patients were followed up for at least 9 months. The patients were clinically evaluated and AOFAS score was used to assess their functional outcome. Results: In a total of 38 patients, 28 (73.7%) patients showed Excellent and 7 (18.4%) patients had Good results whereas 1 (2.6%) had Fair and 2 (5.3%) patients demonstrated Poor surgical result at the final follow-up. 89.5% patients did not have any complication. The average AOFAS score was 90.97 ± 10.24. Conclusion: Operative treatment with suture anchor in acute tendo achilles tear has a high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results and is also a safe, simple and accepted surgical technique. [ABSTRACT FROM AUTHOR]

To determine the influence of gap distance and its location on clinical and radiological outcomes in patients with acute rupture of Tendo-Achilles (TA) treated non-operatively with functional rehabilitation. Twenty-six patients with acute complete TA rupture underwent ultrasound (US) scanning within a week of their injury. The measurements taken included the distance of the rupture from the enthesis and the gap distance between the tendon edges in varying degrees of ankle and knee positions. All patients were managed non-operatively in functional weight-bearing orthoses. Nineteen patients were then followed up at a mean of 6.1 years (range 5.8–6.5) to assess their clinical and radiological outcomes. The outcomes included ultrasound assessment of tendon healing, Achilles Tendon Rupture Score (ATRS) and modified Leppilahti Score (mLS). In the initial ultrasound, the mean distance of the rupture from the enthesis was 52 mm (range: 40–76). The mean gap distance with the foot plantigrade was 11.4 mm, which reduced to 4.8 mm with the foot in equinus. At final follow up, no re-ruptures had occurred. The mean ATRS and mLS were 86 and 71 respectively. There was a significant correlation between the distance of the rupture from the enthesis with the MLS total score (p = 0.02), mLS Fatigue domain score (p = 0.03), and the ATRS domains of strength (p = 0.04) and fatigue (p = 0.02). There was no significant correlation between the measured gap distance with respect to the mLS, ATRS or individual ATRS domain scores. Also, there was no significant difference in ATRS and mLS outcomes when comparing tendons with respect to healed tissue appearance and fibre orientation on ultrasound. The initial gap distance had no relationship with any of the measured clinical outcomes at the final follow up. The distance of the gap from the enthesis, however, may carry a greater prognostic value following non-operative treatment of Achilles tendon injuries. [ABSTRACT FROM AUTHOR]

The necessity of quick surgical treatment of acute ruptured cerebral aneurysms was demonstrated in large studies by the ISAT and ISUIA, which also proved the advantage of the endovascular method over the surgical one. Ballonassistence is widely used in treatment of aneurysms with wide neck and unfavorable vascular anatomy, but the radicality of the treatment is insufficient. The aim of this study was to demonstrate the efficacy and safety of stent-assisted embolization of «acute» cerebral aneurysms. Material and methods. A retrospective analysis of the treatment of 234 patients with «acute» cerebral aneurysms was carried out. Results. Only coils were used in 40.6 % of cases (n = 95), balloon-assistance, in 40.2 % of cases (n = 94), and stent-assistance, in 19.2 % of cases (n = 45). There were 11.5 % (n = 27) clinically significant complications. Total aneurysm occlusion (Raymond-Roy I) was achieved in 187 cases (79.9 %); the radicality at the control examination was 67.1 % (157 patients). Discussion. The radicality of the treatment with stents was slightly higher then with balloons and coils at the end of operation (84.4 %, n = 38 and 78.8 %, n = 149, p > 0.05), but it was significantly higher at the control examination (80.0 %, n = 36 and 60.8 %, n = 115, respectively, p

Surgical repair of acute mid-substance Achilles tendon ruptures is performed in active patients, but the postoperative rehabilitation program is often based on the experience of the surgeon or therapist, rather than on evidence-based protocols. The aim of the study is to establish an evidence-based protocol for rehabilitation. This study is a consensus statement. The "GAIT" study group (German, American, and Italian Tendon), an informal collection of 4 experienced foot and ankle surgeons, met to address the question of what items they felt were important relative to rehabilitate a surgically repaired Achilles tendon acute rupture. Thirty-three statements were formulated. A value of 100% agreement by all the members was set to produce a proposed consensus statement. A value of 80% consensus was set to produce "strong recommendation." A systematic review of the literature was also performed. The GAIT group reach 100% agreement on the average postoperative non-weightbearing for 2.3 weeks, the foot in plantarflexion for the first 4 weeks, avoiding ROM exercises beyond neutral, and both stretching and eccentric exercise, not started before 12 weeks. Concentric bilateral heel raises should be performed after 6 weeks, and the average return to initiate sports, was 24.4 weeks. The use of a 1/8th-1/4th inch heel cushions in daily shoes after 8 weeks, the use of an antigravity treadmill for rehabilitation, and the return to sports based on heel raise repetitions is strongly recommended. Given lack of established verified protocols, the recommendations by our experienced panel should be considered. These proposed consensus statements could be used as a basis for larger controlled trials, and develop best practices. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference. Methods A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management. Demographic data was collected to include: practice setting, years from residency graduation, and completion of fellowship. Correlations analyzed between demographics and treatment preferences. Results Sixty-two surgeons responded. 62% of respondents selected surgical intervention. Of these, 59% chose a traditional open technique. 50% of respondents were general orthopaedic. There was a correlation between fellowship training and operative management (P = 0.042). Within the operative management group there was no statistical difference (P > 0.05) in need for further imaging, technique used, post-operative immobilization, length of immobilization, weight-bearing protocol, and time to release to running. The majority of non-operative responders would splint/cast in plantarflexion or CAM boot with heel lift for

Background: Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. Purpose: To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results: The AOFAS score (P =.669), Achilles Tendon Total Rupture Score (P =.753), and length of incision (P =.305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P <.001). The maximum height of the SLHR (P =.042) and the number of SLHRs (P =.043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s (P =.185) and 120 deg/s (P =.271). There was no significant difference in the occurrence of postoperative complications between the groups (P =.093). Conclusion: The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair. [ABSTRACT FROM AUTHOR]

Background: Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference.Methods: A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management. Demographic data was collected to include: practice setting, years from residency graduation, and completion of fellowship. Correlations analyzed between demographics and treatment preferences.Results: Sixty-two surgeons responded. 62% of respondents selected surgical intervention. Of these, 59% chose a traditional open technique. 50% of respondents were general orthopaedic. There was a correlation between fellowship training and operative management (P = 0.042). Within the operative management group there was no statistical difference (P > 0.05) in need for further imaging, technique used, post-operative immobilization, length of immobilization, weight-bearing protocol, and time to release to running. The majority of non-operative responders would splint/cast in plantarflexion or CAM boot with heel lift for < 3 weeks (50%) and keep non-weight bearing for < 4 weeks (63%). Only 38% of respondents would use DVT chemoprophylaxis.Conclusion: When provided with a hypothetic case of an acute Achilles tendon rupture, queried Army orthopaedic surgeons would more often treat with a surgical procedure. This difference in treatment is secondary to training, fellowship or other. This propensity of surgical management, likely stems from the highly active population and the desire to return to duty. [ABSTRACT FROM AUTHOR]

Mini-open techniques using special devices, introduced to preclude the complications of open and percutaneous techniques, have limited usefulness because of the need for the devices and the weak strength of the repair. We developed a mini-open technique using a ring forceps. This technique is easy to use and increases the strength of the repair with crossed sutures. Twenty-six consecutive patients were treated using a mini-open technique using a ring forceps for acute Achilles tendon rupture. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) were evaluated at the last follow-up. The active range of motion of ankle joint and maximum calf circumference (MCC) were measured and compared with the uninjured side at the last follow-up, as well as hopping and single-limb heel-rise (SLHR) tests and isokinetic tests for ankle plantarflexion. AOFAS score and ATRS were 92.2 ± 9.4 and 89.9 ± 10.9, respectively, at the last follow-up. The MCC (p =.035) and maximum height of SLHR (p =.001) were significantly different between uninvolved and involved legs. No significant differences in mean peak torques for plantarflexion at angular speeds of 30°/s (60.9 ± 23.6 vs 50.8 ± 20.4 Nm/kg; p =.299) and 120°/s (31.6 ± 16 vs 29.6 ± 17.7 Nm/kg; p =.776) were observed between uninvolved and involved legs. The mini-open technique using a ring forceps for acute Achilles tendon rupture showed satisfactory clinical outcomes and favorable functional outcomes without complications. [ABSTRACT FROM AUTHOR]

Introduction: Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleus-Achilles tendon-calcaneus complex using a free ipsilateral semitendinosus graft, and clinical outcomes of a case series of 28 consecutive patients. Our hypothesis was that this is a safe technique, and patients can return to pre-injury occupation and athletic activities.Patients and Methods: A total of 28 patients (mean age 46 years) underwent minimally invasive reconstruction using a free ipsilateral semitendinosus graft for acute insertional rupture of tendo Achillis. The procedure required two small incisions along the course of the Achilles tendon, and one posteromedial incision at level of the ipsilateral knee to harvest the semitendinosus tendon. Patients were assessed at minimum 2 years (range, 2-2.5 years) following the index procedure.Results: The median Achilles tendon Rupture Score (ATRS) at the latest follow-up was 88. Two patients developed a superficial wound infection. All patients returned to their preinjury occupation, whilst 22 out of 28 patients (79%), returned to their preinjury level of physical activity at a mean of 6.7 months after surgery, reporting good or excellent overall satisfaction in 88.5% of cases.Conclusion: This minimally invasive technique was safe, and allowed most of patients to return to preinjury daily and sport activities within 9 months from surgery. [ABSTRACT FROM AUTHOR]

Fatih Karaaslan,1 Musa Uğur Mermerkaya,1 Alper Çıraklı,2 Sinan Karaoğlu,3 Fuat Duygulu21Department of Orthopaedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey; 2Department of Orthopaedics and Traumatology, Kayseri Training Hospital, Kayseri, Turkey; 3Department of Orthopaedics and Traumatology, Memorial Kayseri Hospital, Kayseri, TurkeyIntroduction: Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared.Material and methods: A prospective assessment was made of 16 patients (eight surgical, eight conservative) and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal–Wallis and Mann–Whitney U-tests were used for the evaluation of data.Results: Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P

Reasons for the development of chronic tendon pathologies are still under debate and more basic knowledge is needed about the different diseases. The aim of the present study was therefore to characterize different acute and chronic Achilles tendon disorders. Achilles tendon samples from patients with chronic tendinopathy (n = 7), chronic ruptures (n = 6), acute ruptures (n = 13), and intact tendons (n = 4) were analyzed. The histological score investigating pathological changes was significantly increased in tendinopathy and chronic ruptures compared to acute ruptures. Inflammatory infiltration was detected by immunohistochemistry in all tendon pathology groups, but was significantly lower in tendinopathy compared to chronic ruptures. Quantitative real-time PCR (qRT-PCR) analysis revealed significantly altered expression of genes related to collagens and matrix modeling/remodeling (matrix metalloproteinases, tissue inhibitors of metalloproteinases) in tendinopathy and chronic ruptures compared to intact tendons and/or acute ruptures. In all three tendon pathology groups markers of inflammation (interleukin (IL) 1β, tumor necrosis factor α, IL6, IL10, IL33, soluble ST2, transforming growth factor β1, cyclooxygenase 2), inflammatory cells (cluster of differentaition (CD) 3, CD68, CD80, CD206), fat metabolism (fatty acid binding protein 4, peroxisome proliferator-activated receptor γ, CCAAT/enhancer-binding protein α, adiponectin), and innervation (protein gene product 9.5, growth associated protein 43, macrophage migration inhibitory factor) were detectable, but only in acute ruptures significantly regulated compared to intact tendons. The study gives an insight into structural and molecular changes of pathological processes in tendons and might be used to identify targets for future therapy of tendon pathologies. [ABSTRACT FROM AUTHOR]

Tibialis anterior tendon rupture is a relatively rare injury, with diverse etiologies, that can cause significant deficits in the functionality of the ankle. These injuries are sometimes diagnosed too late, being in many occasions the alteration in walking the symptom that makes the patient go to the doctor. The six weeks will mark the limit between acute and chronic injury, requiring different therapeutic approaches, along with other parameters such as age, functional demand or concomitant pathologies. Objective: To present two cases of acute rupture, with different etiology, the surgical technique used and the final results. Material and methods: We present two cases of acute rupture of the tibialis anterior tendon in the critical hipovascular area, a male and a female, with posttraumatic and spontaneous etiology, respectively, in which tendon reinsertion was performed on the tarsal scaphoid with a biothenodesis screw, followed by immobilization with permission to walk at three weeks and subsequent physiotherapy. Results: In both cases a satisfactory final functional result was obtained, with a significant improvement in the AOFAS score, returning to their work and sports activities at 3 and 4 months of surgery respectively, with a follow-up of 7.5 years and 10 months. Discussion: This technique, within the variety described in the medical literature, has provided us excellent results, restoring the functionality of the anterior tibialis tendon and being reproducible for its simplicity, providing a high degree of safety when performing an early physiotherapy. [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the clinical outcomes after surgical repair of patellar tendon rupture (PTR) and compare the evolution of 2 types of rupture (acute and chronic) after the same rehabilitation protocol. Methods This was a prospective cohort study of patients with PTR treated between January 2006 and January 2014 in the department of trauma surgery, Ibn Rochd university hospital, Casablanca. Results We evaluated 25 patients (21 men) after a median follow-up of 75 months (range 29–120). The mean age was 34.7 ± 8.59 years. Overall, 17 patients had acute rupture and 8 chronic rupture. Fifteen healthy volunteers (13 men) were recruited as a control group. Mean Knee Society Score (KSS) knee score was significantly higher after than before surgery (82.28 ± 12.297 vs 20.64 ± 7.6; P < 0.0001) as was KSS function score (88.40 ± 17.483 vs 23.40 ± 8.98; P < 0.0001). Pain measured on a visual analog scale was significantly lower after than before surgery (1.96 ± 1.24 vs 6.60 ± 1.26; P < 0.0001). ROM and KSS knee and function scores were significantly lower on the operated than non-operated side after surgery. For both types of PTR, only knee extensor muscle strength was significantly lower on the operated than non-operated side and as compared with healthy volunteer knees. Conclusions Surgical repair of PTR with reinforcement and an early rehabilitation program demonstrate good results after a long follow-up. However, chronic PTR may need longer or a different rehabilitation protocol of the knee-extensor apparatus. [ABSTRACT FROM AUTHOR]

Copyright of Sport-Orthopadie - Sport-Traumatologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

One of the most important goals of the treatment of sports injuries is athletes’ early return to normal sporting activities. Time when the athletes will return to normal sporting activities, after Achilles tendon acute rupture, depends on the level of sports involvement. Average time of return to sport is usually between 5-6 months after rupture. Patients, who are treated using postoperative functional cast, can expect an average return to their sport a month earlier than those who after surgery used solid cast immobilization. The most important signs that indicate possible slow rehabilitation process are the pain and swelling after activity and late recovery of the tissue.

Reasons for the development of chronic tendon pathologies are still under debate and more basic knowledge is needed about the different diseases. The aim of the present study was therefore to characterize different acute and chronic Achilles tendon disorders. Achilles tendon samples from patients with chronic tendinopathy (n = 7), chronic ruptures (n = 6), acute ruptures (n = 13), and intact tendons (n = 4) were analyzed. The histological score investigating pathological changes was significantly increased in tendinopathy and chronic ruptures compared to acute ruptures. Inflammatory infiltration was detected by immunohistochemistry in all tendon pathology groups, but was significantly lower in tendinopathy compared to chronic ruptures. Quantitative real-time PCR (qRT-PCR) analysis revealed significantly altered expression of genes related to collagens and matrix modeling/remodeling (matrix metalloproteinases, tissue inhibitors of metalloproteinases) in tendinopathy and chronic ruptures compared to intact tendons and/or acute ruptures. In all three tendon pathology groups markers of inflammation (interleukin (IL) 1β, tumor necrosis factor α, IL6, IL10, IL33, soluble ST2, transforming growth factor β1, cyclooxygenase 2), inflammatory cells (cluster of differentaition (CD) 3, CD68, CD80, CD206), fat metabolism (fatty acid binding protein 4, peroxisome proliferator-activated receptor γ, CCAAT/enhancer-binding protein α, adiponectin), and innervation (protein gene product 9.5, growth associated protein 43, macrophage migration inhibitory factor) were detectable, but only in acute ruptures significantly regulated compared to intact tendons. The study gives an insight into structural and molecular changes of pathological processes in tendons and might be used to identify targets for future therapy of tendon pathologies.

Various minimally invasive repair techniques have been performed for acute Achilles tendon rupture. Despite this, it is difficult to use these techniques in common practice because of the necessity of special instruments. We propose a novel minimal invasive technique using sponge holding forceps, which are commonly used in the operating room for the acute Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to compare the functional and clinical outcomes of absorbable and nonabsorbable sutures on patients with achilles tendon rupture. The study analyzed the medical outcomes of 48 patients that were divided into two groups based on the suture type. It concludes that the use of absorbable suture in the Achilles tendon repair was associated with lower incidence of surgical reaction as compared to nonabsorbable suture.

Acute rupture of flexor tendons following distal radius fracture is very rare. We experienced four cases of acute rupture of flexor tendons that were treated surgically. Injured tendons included flexor pollicis longus, flexor carpi radialis, palmaris longus and third flexor digitorum profundus. A severely displaced fracture with a volar spike of the distal radius was detected on plain radiographs in all cases. Ruptures of flexor pollicis longus and third flexor digitorum profundus were diagnosed on preoperative examination but ruptures of other tendons were identified during the operation. Repairs of fractures and ruptured tendons were performed simultaneously and good functional outcomes were achieved. [ABSTRACT FROM AUTHOR]

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures. [ABSTRACT FROM AUTHOR]

Achilles tendon rupture is a common sports-related injury, with the incidence of acute ruptures continuing to increase. Achilles ruptures can be missed, or presentation may be delayed. Clinical tests assist diagnosis, with the Thompson and Matles tests being the most sensitive and specific. Ultrasound provides a valuable adjunct for diagnosing acute Achilles tendon ruptures. Traditionally, operative management has led to lower re-rupture rates than conservative treatment, but surgery increases the risk of complications such as adhesions and wound infection. More recently, however, non-operative treatment consisting of early mobilisation and rehabilitation, produces comparable re-rupture rates and functional outcomes to surgery. Percutaneous surgery may reduce the risk of operative complications, but needs to be more widely practised. In the present review we discuss the anatomy, aetiology, mechanism of injury, clinical assessment and investigations for diagnosing acute Achilles tendon ruptures. The debate regarding operative versus non-operative management is also considered. [ABSTRACT FROM PUBLISHER]

The article discusses a study which analyzed the functional and clinical outcome of patients with standard open and minimally invasive repair using the Achillon suture system at mid-term follow-up. The study included 40 patients who were operated for acute Achilles tendon rupture treatment between February 2004 and May 2007. It found that minimally invasive repair with the Achillon suture system offered safe, reliable and practical treatment with low risk of complications.

Rupture of the tibialis posterior tendon may occur during a trauma in pronation-external rotation of the foot or, less commonly, during a direct trauma of the ankle. When an isolated fracture of the medial malleolus is present, it is more likely that a direct trauma has occurred. A 36-year-old man with a non-displaced medial malleolar fracture was evaluated. Repair of the tendon and reduction of the fracture were performed. Twenty-four months after the operation, the fracture was completely healed, the patient was asymptomatic, he had a normal ankle range of motion, and the function and strength of the tibialis posterior tendon were equal to those on the contralateral side. Early surgical repair of the tibialis posterior tendon combined with malleolar fracture reduction is recommended to avoid progression to a plano-valgus foot. [ABSTRACT FROM AUTHOR]

We prospectively analyzed the functional and clinical results of patients who underwent a single end-to-end suture and an augmented tendon repair with plantaris tendon at middle-term follow-up. From January 2003 to May 2005, 30 consecutive patients were operated on for the treatment of acute Achilles’ tendon rupture by means of 2 different methods. No cases required adjunctive procedures to allow for acceptable end-to-end apposition. All ruptures were acute and repairable. The patients were divided into 2 groups. In group 1, augmentation with plantaris tendon was performed in addition to the Krakow end-to-end suturing technique in 16 patients, and in group 2, only the Krakow end-to-end suturing technique was used in 14 patients. The average age of the patients was 40.6 years. Patients in the study groups were followed up at a mean of 17.8 months after surgery. At the end of the follow-up, functional and subjective outcome scores were evaluated. The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores were 96.7 in group 1 and 98.8 in group 2. Although there was a numerical increase in group 2, no significant difference was determined between the 2 study groups statistically. The surgical outcome concerning local tenderness, skin adhesion scar, and tendon thickness was better in group 2 than in group 1 without a statistical significance. Although functional outcomes of both treatment groups were the same, the end-to-end suturing technique provided a safer and more reliable treatment with a low risk of complications in the treatment of acute Achilles’ tendon ruptures compared with the plantaris tendon augmentation technique. [Copyright &y& Elsevier]

Objective: To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates. Methods: Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57±19 years, range 20–85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n=18), Talent (n=4), Corvita (n=1), and Vanguard (n=1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique. Results: Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively. Conclusions: Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodelling. [Copyright &y& Elsevier]

Copyright of European Journal of Orthopaedic Surgery & Traumatology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tibialis anterior tendon rupture is a relatively rare injury, with diverse etiologies, that can cause significant deficits in the functionality of the ankle. These injuries are sometimes diagnosed too late, being in many occasions the alteration in walking the symptom that makes the patient go to the doctor. The six weeks will mark the limit between acute and chronic injury, requiring different therapeutic approaches, along with other parameters such as age, functional demand or concomitant pathologies., Objective: To present two cases of acute rupture, with different etiology, the surgical technique used and the final results., Material and Methods: We present two cases of acute rupture of the tibialis anterior tendon in the critical hipovascular area, a male and a female, with posttraumatic and spontaneous etiology, respectively, in which tendon reinsertion was performed on the tarsal scaphoid with a biothenodesis screw, followed by immobilization with permission to walk at three weeks and subsequent physiotherapy., Results: In both cases a satisfactory final functional result was obtained, with a significant improvement in the AOFAS score, returning to their work and sports activities at 3 and 4 months of surgery respectively, with a follow-up of 7.5 years and 10 months., Discussion: This technique, within the variety described in the medical literature, has provided us excellent results, restoring the functionality of the anterior tibialis tendon and being reproducible for its simplicity, providing a high degree of safety when performing an early physiotherapy.

Achilles tendon injuries can be serious injuries requiring either operative or nonoperative management. For appropriate surgical candidates, operative intervention may provide lower rerupture rates and adequate end-to-end tendon healing. Our preference is an open Achilles tendon repair, specifically a limited open technique using the PARS device (Arthrex, Naples, FL). Postoperatively, we use functional rehabilitation and early range of motion. Although the current literature remains controversial regarding operative versus nonoperative management, the authors have obtained satisfactory results in appropriately chosen surgical candidates., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction Patellar tendon rupture is an uncommon injury requiring immediate repair to restablish knee extensor continuity and to allow early motion. The aim of this study was to evaluate the clinical outcomes of surgical repair of patellar tendon rupture and compare the evolution of two groups (acute and chronic ruptures). Materials and methods This was a retrospective study of 25 cases operated for patellar tendon rupture and followed in our department. Functional knee evaluation and quality of life were performed. Results There were 21 men and 4 women. The average age was 33.60 years. The ruptures were fresh in 17 cases and neglected in 8 cases. There was a significant difference between the range of motion, IKS knee and IKS function when the injured leg was compared to the non-injured leg. In comparison between group with acute rupture and the other with chronic rupture, no significant difference was found in IKS knee, IKS function, SF 12 PCS, SF 12 MCS, pain score and satisfaction. Only the ROM of the knee was significantly different between two groups. Discussion/conclusion Patellar tendon ruptures are usually complete and long-term follow-up results indicate excellent function with early repairs. Direct repair of the rupture with cerclage stabilization demonstrates good intermediate to long-term results. [ABSTRACT FROM AUTHOR]

Introduction: Acute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory., Methods: A retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6 ± 9.9 years (range, 23-81 years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1 months (range, 3-24 months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3 years (range, 19-229 months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction., Results: Thirty-one knees were assessed at a mean 7.1 months. Mean knee flexion was 128.5° ± 7.5° (range, 85°-150°), extension -1° (range, -15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57-1.29). Twenty-three knees were further assessed at a mean 9.3 years. Mean Lysholm score was 93.7 points (range, 61-100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level., Conclusion: Patellar tendon rupture has good prognosis if diagnosis and surgical treatment is early., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.