scholarly journals Nonsurgical treatment and early return to activity leads to improved Achilles tendon fatigue mechanics and functional outcomes during early healing in an animal model

2016 ◽  
Vol 34 (12) ◽  
pp. 2172-2180 ◽  
Author(s):  
Benjamin R. Freedman ◽  
Joshua A. Gordon ◽  
Pankti R. Bhatt ◽  
Adam M. Pardes ◽  
Stephen J. Thomas ◽  
...  
Keyword(s):  
Animal Model ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Nonsurgical Treatment ◽  
Early Return ◽  
Early Healing ◽  
Return To Activity

Functional Outcomes Following Nonsurgical Treatment for Advanced-Stage Laryngeal Carcinoma

2003 ◽  
Vol 113 (4) ◽  
pp. 720-728 ◽  
Author(s):  
Robert J. Meleca ◽  
James Paul Dworkin ◽  
Danny T. Kewson ◽  
Robert J. Stachler ◽  
Samuel L. Hill
Keyword(s):  
Laryngeal Carcinoma ◽  
Functional Outcomes ◽  
Nonsurgical Treatment ◽  
Advanced Stage

scholarly journals Outcomes following treatment of the infected Achilles tendon

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Mark Bowers ◽  
Norman Turner ◽  
Daniel Ryssman
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Functional Results ◽  
Therapy Program ◽  
Tendon Surgery ◽  
Extensive Debridement ◽  
Eradication Of Infection ◽  
Secondary Closure ◽  
Ability Measure

Category: Sports Introduction/Purpose: Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat. Our purpose was to evaluate clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon. Methods: We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture specific intravenous antibiotics for three to six weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale. Results: All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal”. Conclusion: Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture specific IV antibiotics.

scholarly journals Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian D. Steginsky ◽  
Mallory Suhling ◽  
Eric Giza ◽  
Christopher D. Kreulen ◽  
B. Dale Sharpe ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Distal Stump ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

Retrospective Analysis of Mini-Open Repair Versus Open Repair for Acute Achilles Tendon Ruptures

2012 ◽  
Vol 6 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Erin E. Klein ◽  
Lowell Weil ◽  
Jeffrey R. Baker ◽  
Lowell Scott Weil ◽  
Wenjay Sung ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Surgical Intervention ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Tendon Ruptures ◽  
Return To Activity ◽  
Mini Open

Purpose: Debate exists over optimal treatment for acute Achilles tendon ruptures. Recent literature suggests the mini-open technique may provide the reliability of the open repair with the decreased complication rate of non-operative treatment. This retrospective review compares acute tendon ruptures treated with one of two techniques: open repair (TO) or mini-open repair (MOA). Methods & Results: Records were reviewed and 34 patients were found to meet the inclusion criteria for open or mini-open repair of an acute Achilles tendon rupture with follow up of at least 12 months. TO (n=16) and MOA (n=18) had no statistically significant differences in age at time of injury [TO: 41 + 2.5 years (range 20 – 68); MOA: 46 + 2.5 years (range 33 – 73)] or time between injury and surgical repair [TO: 15 + 2 days (range 2 – 30); MOA: 15 + 2 days (range 2 – 30)]. Post-operative VISA-A scores were 82 + 10 (range 42 – 98) and 92 + 5 (range 66 – 100) for TO and MOA, respectively. Significant differences were found in the time between surgical intervention and beginning of rehabilitation [TO: Post op day 37 + 5 (range 21 – 46); MOA: Post op day 19 + 2 (range 7 – 32)] and the time between surgical intervention and full return to activity [TO: Post op month 7 + 1 (range 4 – 11); MOA: Post op month 5 + 0.6 (range 4 – 11)]. Conclusion: These results suggest that the mini-open repair provides acceptable surgical outcomes while optimizing patient function after Achilles tendon repair. Level of Evidence: Therapeutic, Level III: Retrospective Comparative

Functional Outcomes Of Primary Open Repair With Augmentation And Without Augmentation In Achilles Tendon Rupture

2016 ◽  
Vol 48 ◽  
pp. 446
Author(s):  
YILMAZ ERGISI ◽  
GULCAN HARPUT ◽  
BURAK ULUSOY ◽  
HAKAN SELEK ◽  
HAMZA OZER ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Rupture ◽  
Open Repair ◽  
Achilles Tendon Rupture

Experimental Animal Model to Study Muscle and Tendon Adaptations to Chronic Loading

1998 ◽  
Vol 02 (04) ◽  
pp. 283-288 ◽  
Author(s):  
J. M. Archambault ◽  
T. J. Koh ◽  
W. Herzog ◽  
D. A. Hart
Keyword(s):  
Animal Model ◽  
Achilles Tendon ◽  
Short Communication ◽  
Angular Position ◽  
Force Transducer ◽  
Triceps Surae ◽  
Experimental Setup ◽  
Cyclic Loads ◽  
Transverse Axis ◽  
Tendon Force

The purpose of this short communication is to present an animal model that: (1) allows for controlled, quantifiable loading of muscle and tendon; and (2) can be used to evaluate the response of musculo-skeletal tissues to chronic loading. A loading apparatus was used to move the rabbit foot through any desired angular position and velocity, while continuously measuring moments about the transverse axis of the ankle. A stimulator was triggered at a pre-set location in the range of motion to produce a contraction of the triceps surae and plantaris muscles. Muscle forces measured with an Achilles tendon force transducer were found to correlate well with externally measured ankle extensor moments. The experimental setup was used to provide cyclic loads to the triceps surae and plantaris muscles and Achilles tendon of 16 rabbits for three loading sessions per week over the period of one to eleven weeks. The experimental model described here is appropriate for the systematic study of the adaptation of muscle and tendon to chronic loading because of the repeatability of the setup and the quantification of tissue loads.

scholarly journals Multilevel anterior thoracic discectomies and anterior interbody fusion by using a microsurgical thoracoscopic approach

1999 ◽  
Vol 7 (5) ◽  
pp. E5 ◽  
Author(s):  
Curtis A. Dickman ◽  
Camilla A. Mican
Keyword(s):  
Interbody Fusion ◽  
Kyphotic Deformity ◽  
Operative Techniques ◽  
Thoracoscopic Approach ◽  
Compression Fractures ◽  
Anterior Interbody Fusion ◽  
Early Return ◽  
Microsurgical Approach ◽  
Return To Activity ◽  
Length Of Hospitalization

A video-assisted thoracoscopic microsurgical approach was performed to treat a myelopathic patient with a severe kyphotic deformity caused by chronic nonunion of compression fractures of T7-9 vertebrae. The kyphotic deformity was treated by combined operative procedures. First, an anterior release was performed using a thoracoscopic technique, sectioning the anterior longitudinal ligament and performing multilevel thoracic discectomies. Next, a posterior reduction and internal fixation of the deformity was achieved using hook-rod instrumentation. Finally, bone graft harvested during the posterior approach was used for interbody fusion via a thoracoscopic approach. Microsurgical thoracoscopic techniques potentially can be used in a variety of spinal surgeries. Compared to transthoracic and posterolateral approaches, this technique presents distinct advantages to treatment of anterior spinal pathology. The small incisions made into the intercostal spaces without retracting the ribs may reduce postoperative pain, shorten the length of hospitalization, and allow early return to activity. The operative techniques used in this case are described in detail. This report demonstrates that thoracoscopic discectomies and interbody fusion are technically feasible and can be effectively performed with acceptable results.

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