Achilles tendon ruptures

Pedowitz, David I.; Kirwan, Greg

doi:10.1007/s12178-013-9185-8

Cited by 68 publications

(32 citation statements)

References 88 publications

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“…Five out of six patients needed a small size split thickness skin graft at the donor site after a mean time of 7.1 days (range 7-9) of vacuum therapy to improve the granulation tissue and reduce the cosmetic impact on the forearm. DASH score values relating to the donor extremity resulted with a mean value of 8.0 points (range [3][4][5][6][7][8][9][10][11][12][13][14][15] with no significant functional impairment complained by patients. The MRI study at 8 months FU showed a nearly normal shape of the reconstructed tendon without interruptions, and the fusion between the two segments of FCR reaching in size the original Achilles tendon (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of acute Achilles tendon ruptures is increasing, probably following the arising diffusion of high demanding sports among inadequately trained middle-aged persons. [1][2][3] The open surgical repair of the tendon represents the gold standard; however, it is associated with significant rates of complications. 4 The most common complication is the wound dehiscence, which may be followed by infection, skin necrosis, exposure, and eventually necrosis of Achilles tendon.…”

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confidence: 99%

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Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis

et al. 2015

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Background: Wound dehiscence, infection, and necrosis of tendon and overlying skin are severe complications after open repairs of Achilles tendon. A simultaneous reconstruction should be provided in a single stage operation. We evaluated the outcomes of one of the possible options: the radial forearm free flap with Flexor Carpi Radialis (FCR) tendon. Methods: Between 2006 and 2014, six patients affected by infection and necrosis after Achilles tendon open repair underwent multi-tissutal reconstruction by a composite radial forearm free flap including a vascularized FCR tendon. The mean skin and tendon defect was respectively 9.8 cm 3 4.7 cm and 6.5 cm. After reconstruction, patients underwent clinical examination, including the Achilles Tendon Total Rupture Score (ATRS) questionnaire, DASH score, MRI study, and a computer-assisted gait analysis. Results: All flaps survived and no complications were recorded. Full weightbearing was allowed within 2 months after surgery. The mean follow-up was 36.2 months (range 12-96). MRI showed an optimal reconstruction of the tendon. Range of motion was minimally reduced if compared to the contralateral side. Gait analysis showed the recovery of a nearly symmetrical stance phase, time to heel off, and step length of the gate. ATRS and DASH score improved to a mean value of 85.2 (range 83-88) and 8.0 (range 3-15) respectively. Conclusions: This procedure provided an anatomical reconstruction of the Achilles tendon and skin achieving good and objective functional results; donor site morbidity was limited to the sacrifice of the radial artery, which, in our opinion, is a minor drawback if compared to the quality of the results. V C 2015 Wiley Periodicals, Inc. Microsurgery 35:608-614, 2015.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis

et al. 2015

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“…Patients typically refer to a “snap” followed by immediate onset of pain in the back of their lower leg and ankle. A functional limitation is usually experienced while walking and pointing the injured foot downward or while standing on the toes on the affected side 11 , 12 . Local swelling and a palpable defect proximal to the calcaneal insertion of the Achilles tendon may be detected on physical examination 11 , 12 ; dynamic clinical tests, such as the calf squeeze test, are also helpful 13 – 15 …”

Section: B‐mode Evaluation Of Achilles Tendons After Complete Rupturementioning

confidence: 99%

Sonography of the Achilles Tendon After Complete Rupture Repair

Gitto

Draghi

Bortolotto

et al. 2016

J of Ultrasound Medicine

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This review aims to provide the radiologist with simple and systematic guidelines for evaluation of the Achilles tendon after complete rupture repair. Currently, there is a plethora of nonsurgical and surgical treatments, but sonographic examination has shown no significant differences between them. A systematic analysis of several parameters (morphologic characteristics, structure, color Doppler vascularization, and mobility) should be undertaken. Morphologically, the repaired tendon is larger, wider, or both. The loss of the fibrillary structure, inhomogeneity, and the surgical material in the context of the tendon are "normal" aspects after a repaired rupture. The presence of fluid collections when affecting greater than 50% of the surface of the tendon and extensive calcifications should be considered pathologic aspects. In the immediate postoperative period, there is the absence of vascularization detectable by color Doppler imaging. During the first 3 months, there is an increase in intratendinous vascularization with hypervascularization. From 3 to 6 months, stabilization and regression of the vascularization occur. Beyond the first 6 months, the hypervascularization is pathologic. The pattern of motion is, generally, reduced considerably more often in surgically treated tendons than in non-surgically treated ones. Elastography generally shows a hard appearance, with only a relatively heterogeneous pattern. In conclusion, a treated tendon will never regain a normal sonographic appearance, and the operator must distinguish between normal posttreatment changes and real pathologic characteristics.

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“…While not all injuries require surgical intervention, many classes of these injuries, such as rotator cuff and Achilles tendon tears, together account for more than 100,000 surgeries per year in the USA (Pedowitz and Kirwan, 2013; Vitale et al , 2007) and can show wide ranges of re-failure rates based on patient demographics (Galatz et al , 2006). Generally, tendon and ligament defects display poor intrinsic healing properties, requiring surgical intervention and result in fibrous scar tissue formation with misaligned extracellular matrix (ECM) and inferior mechanical properties, leading to high rates of injury recurrence (James et al , 2008; Liu et al , 2008; Xu and Murrell, 2008).…”

Section: Introductionmentioning

confidence: 99%

Clinical use of stem cells in orthopaedics

2017

eCM

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Orthopaedic injuries, particularly those involving ligaments and tendons, are some of the most commonly treated ailments in the United States and are associated with both high costs and poor outcomes. Regenerative medicine strategies for tendon injuries could be enhanced by three-dimensional biomaterials that can promote cell alignment and pro-tenogenic differentiation of patient-derived MSCs. We have previously described a collagen-glycosaminoglycan (CG) scaffold possessing aligned structural features able to promote bone marrow MSC differentiation towards a tenogenic lineage, in the absence of growth factor supplementation. We aimed to employ a bioreactor to enhance MSC tenogenic differentiation within the aligned CG scaffold via cyclic tensile strain (CTS), and further to evaluate the relative effects of strain cycle duration and extended application of repeated cycles of CTS on MSC response. Human MSCs were cultured in CG scaffolds for up to 6 d under static (unloaded) or cyclic tensile strain (1 Hz) for 10 min every 6 h. Time-dependent activation of ERK 1/2 and p38 mechanotransduction pathways was observed within each 6 h strain cycle. MSCs remained viable throughout the experiment and application of CTS robustly upregulated the expression of tendon-specific extracellular matrix proteins and phenotypic markers. Simultaneously, CTS promoted increased phosphorylation of Smad 2/3, suggesting a link between tensile stimulation and TGF-β family growth factor production. Together, we demonstrated the design, fabrication and validation of a high-throughput tensile stimulation bioreactor to increase MSC tenogenic differentiation in porous CG scaffolds.

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Achilles tendon ruptures

Cited by 68 publications

References 88 publications

Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis

Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis

Sonography of the Achilles Tendon After Complete Rupture Repair

Clinical use of stem cells in orthopaedics

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