Neglected Achilles Tendon Ruptures

Cottom, James M.; Sisovsky, Charles

doi:10.1016/j.cpm.2020.12.010

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Suppose an Achilles´ tendon rupture (ATR) is left untreated due to missed or delayed diagnosis or unavailable treatment facilities. In that case, the lack of plantar flexion force will result in impaired gait and disabilities 224 . Postoperative rehabilitation may play a key role in patient satisfaction after treatment of acute ATRs Nerve injuries after surgical treatment of ATRs are limited to partial or complete injury to the sural nerve leading to (permanent or temporary) heel-numbness or sensory loss on the heel and the dorsolateral part of the foot, respectively.…”

Section: Treatment Optionsmentioning

confidence: 99%

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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Aufwerber and co-workers (2021) compared gait patterns between patients allowed to weight-bear immediately in an orthosis with patients deferring weight-bearing in a cast for two weeks followed by four weeks of weight-bearing in an orthosis. They found that immediate weight-bearing did not result in a more symmetrical gait pattern than deferring weight-bearing the first two weeks postoperatively 79 .

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Section: Treatment Optionsmentioning

confidence: 99%

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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“…This study is clinically relevant, since it documents a new association between socioeconomic deprivation status and ATR, which has important implications for health service planning and resource allocation, particularly as socioceconomic deprivation status is known to exhibit marked geographic variation [34]. Furthermore, it has previously been reported that ATR are frequently misdiagnosed or missed on presentation [14, 40] and chronic injuries are often associated with poor outcomes and present a treatment challenge to clinicians [10, 37]. A better understanding of the epidemiology and nature of these injuries will increase clinician awareness and reduce the risk of missed injuries.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture

Maempel

Clement

Mackenzie

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients. Methods A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was deined using governmental population data and SEDS was deined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses. Results There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18 years) was 18.75/100,000 per year (range 16.56-23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35-1.89; p < 0.001). When adjusting for confounding factors, least deprived patients were more likely to be > 50 years old (OR 1.97; 95%CI 1.24-3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11-2.67; p = 0.02) and in the spring (OR 1.65, 95%CI 1.01-2.70; p = 0.045) and to give a history of preceding tendinitis (OR 4.04, 95%CI 1.49-10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23-0.87; p = 0.02) and to be obese (OR 0.25-0.41, 95%CI 0.07-0.90; p ≤ 0.03). Conclusions The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Signiicant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries. Level of Evidence Prognostic Study Level III.

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“…Patients with severe ligament and tendon injuries often undergo autograft or allograft tendon transplantation [4,8,12,15,23]. However, concerns about potential viral, bacterial, and fungal contamination of implanted allografts have arisen [3,7].…”

Section: Discussionmentioning

confidence: 99%

Can the Sterilization Protocol Be Improved to Enhance the Healing of Allograft Tendons? An In Vivo Study in Rabbit Tendons

Zhang,

Xu,

Zhao

et al. 2024

Clin Orthop Relat Res

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Background Peracetic acid and irradiation are common sterilization methods for allograft tendons; however, under some conditions, both methods adversely affect the fiber arrangement and ultimate load of the tendon. An in vitro study showed that low-dose peracetic acid combined with irradiation may be less detrimental to allograft tendon structure and properties, possibly because the breakdown of peracetic acid can lead to an enlargement of the interstitial spaces and an increase in porosity. Questions/purposes Using a rabbit Achilles tendon model, we asked: What is the effect of peracetic acid-ethanol combined irradiation on (1) the histopathology and fiber diameter of the allograft tendon, (2) tensile creep and load-to-failure biomechanical properties of allograft tendons, and (3) healing of the treated tendon in vivo compared with fresh-frozen allograft and peracetic acid-ethanol sterilization at 4 and 8 weeks? Methods The Achilles tendons used in this study were sourced from euthanized 10-week-old male New Zealand White rabbits previously used for ophthalmic experiments. All allografts were divided into three groups: fresh-frozen group (control group, n = 20), peracetic acid-ethanol sterilization group (n =20), and peracetic acid-ethanol combined irradiation group (n = 20). The sterilization protocols were performed per a predetermined plan. In the peracetic acid-ethanol sterilization group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (1% peracetic acid for 30 minutes). In the peracetic acid-ethanol combined irradiation group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (0.2% peracetic acid for 30 minutes) and were subjected to 15 kGy gamma irradiation. Thirty 10-week-old male New Zealand White rabbits received bilateral Achilles tendon allografts surgically. Tendon samples from each group were harvested at 4 weeks (n = 30) and 8 weeks (n = 30) postoperatively. For each timepoint, eight tissues were used for histologic staining and electron microscopy, 15 tissues were used for biomechanical testing, and seven tissues were used for hydroxyproline assay and quantitative polymerase chain reaction. Histopathology was determined qualitatively by hematoxylin and eosin and Masson staining, while fiber diameter was measured quantitatively by transmission electron microscopy. Biomechanical properties were measured using cyclic loading tests and load-to-failure tests. The healing outcome was quantitatively judged through healing-related genes and proteins. Results At 4 weeks and 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group visually demonstrated the best continuity and minimal peripheral adhesions. Histologic staining showed that tendon fibers in the peracetic acid-ethanol combined irradiation group maintained consistent alignment without notable disruptions or discontinuities, and there was a qualitatively observed increase in the number of infiltrating cells compared with the control group at the 4-week timepoint (444 ± 49 /mm2 versus 256 ± 43 /mm2, mean difference 188 /mm2 [95% confidence interval 96 to 281]; p < 0.001). At 8 weeks postoperatively, the tendon fiber diameter in the peracetic acid-ethanol combined irradiation groups was similar to that of the control group (0.23 ± 0.04 µm versus 0.21 ± 0.03 µm, mean difference 0.02 µm [95% CI -0.04 to 0.08]; p = 0.56). At 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group exhibited better properties in terms of both ultimate load (129 ± 15 N versus 89 ± 20 N, mean difference 40 N [95% CI 7 to 73]; p = 0.02) and energy absorption density (17 ± 6 kJ/m2 versus 8 ± 4 kJ/m2, mean difference 8 kJ/m2 [95% CI 0.7 to 16]; p = 0.004) compared with the control group. Gene expression analysis revealed higher expression levels of COL1A1 (2.1 ± 0.8 versus 1.0 ± 0, mean difference 1.1 [95% CI 0.1 to 2.1]; p = 0.003) and MMP13 (2.0 ± 0.8 versus 1.0 ± 0, mean difference 1.0 [95% CI 0.4 to 1.6]; p = 0.03) in the peracetic acid-ethanol combined irradiation group than in the control group. There was a higher amount of collagen Type I in tendons treated with peracetic acid-ethanol combined irradiation than in the control group (0.36 ± 0.03 versus 0.31 ± 0.04, mean difference 0.05 [95% CI 0.01 to 0.09]; p = 0.02). Conclusion Treatment with peracetic acid-ethanol combined irradiation did not have any discernible adverse effect on the histology, fiber diameter, enzymatic resistance, collagen content, or biomechanical strength of the allograft tendons compared with the control group. Peracetic acid-ethanol combined irradiation treatment had a positive impact on remodeling of the extracellular matrix and realignment of collagen fibers. Clinical Relevance This sterilization method could be helpful to expand the scope and frequency with which allogeneic materials are applied. The long-term healing effect and strength of allograft tendons must be tested before clinical use, and it is necessary to conduct comparative studies on autografts and synthetic materials that are currently widely used clinically.

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Neglected Achilles Tendon Ruptures

Cited by 6 publications

References 22 publications

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture

Can the Sterilization Protocol Be Improved to Enhance the Healing of Allograft Tendons? An In Vivo Study in Rabbit Tendons

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