Background:Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We...

https://journals.sagepub.com/doi/pdf/10.1177/10711007211038594

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture:

The Krackow technique has the advantage of high strength, though it is not minimally invasive. The “Locking Block Modified Krackow” (LBMK) peri-tendon fixation technique was designed for minimally invasive surgery. This study aimed to compare the biomechanics of LBMK with Kessler and Percutaneous Achilles Repair System (PARS) techniques using a simulated early rehabilitation program. Thirty-fresh bovine Achilles tendon specimens were randomly assigned to the LBMK, Kessler, and PARS groups (n = 10). In LBMK group, the main suture configuration was the LBMK technique, and the transverse suture was used as the secondary suture configuration. The Kessler group employed three suture configurations, two sagittal, one coronal plane. In the PARS group, two transverse and one locking sutures were placed at either end of the tendon. Each repaired specimen underwent two cyclic loading protocols (20–100 N, 20–190 N), 500 cycles, followed by measurement of the gap between the tendon ends. All specimens underwent a load-to-failure test at a 25 mm/s stretching rate. After the first loading cycle, the average gaps of the LBMK, Kessler and PARS groups were 0.76 ± 0.44 mm, 1.80 ± 0.82 mm, and 2.66 ± 1.04 mm, respectively. The LBMK group had a significantly reduced gap than the other groups (p < 0.01). The LBMK group gaps were all within 2 mm. The Kessler and PARS groups had six, and two specimens within 2 mm, respectively. After the second loading cycle, the average end gaps of the LBMK, Kessler, and PARS groups were 3.68 ± 1.08 mm, 5.70 ± 0.89 mm and 7.59 ± 1.26 mm, respectively. The LBMK group had a significantly reduced average gap than the other groups (p < 0.01). The maximum load-to-failure was highest 732.8 ± 138 N in the LBMK than the other groups (p < 0.01). The biomechanical strength of the LBMK suture was significantly greater than Kessler and PARS. The reduced gap in the LBMK group suggests superior resistance to gap formation, which may occur during early postoperative rehabilitation.

A biomechanical comparison of Achilles tendon suture repair techniques: Locking Block Modified Krackow, Kessler, and Percutaneous Achilles Repair System with the early rehabilitation program in vitro bovine model.

Tendinopathy has a high incidence in athletes and the aging population. It can cause pain and movement disorders, and is one of the most difficult problems in orthopedics. Animal models of tendinopathy provide potentially efficient and effective means to develop understanding of human tendinopathy and its underlying pathological mechanisms and treatments. The selection of preclinical models is essential to ensure the successful translation of effective and innovative treatments into clinical practice. Large animals can be used in both micro- and macro-level research owing to their similarity to humans in size, structure, and function. This article reviews the application of large animal models in tendinopathy regarding injuries to four tendons: rotator cuff, patellar ligament, Achilles tendon, and flexor tendon. The advantages and disadvantages of studying tendinopathy with large animal models are summarized. It is hoped that, with further development of animal models of tendinopathy, new strategies for the prevention and treatment of tendinopathy in humans will be developed.

/pdf/large-animal-models-for-the-study-of-tendinopathy-19av079s.pdf

Large animal models for the study of tendinopathy

Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p   3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. III, retrospective cohort study

/pdf/midterm-functional-performance-following-open-surgical-1nt7xxrh9j.pdf

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Objective: The present study aimed to verify the state of the art of minimally invasive percutaneous surgical treatment for Haglund syndrome. Methods: This systematic review of the literature was based on a bibliographic survey in the PubMed, Medline and Embase databases. The descriptors "Haglund syndrome", "Haglund", "Achilles", "Minimally invasive", "Percutaneous surgery" and "Osteotomy" were used, in addition to the filters "Randomized Controlled Trial", "Randomized Clinical Trial", "Meta-Analysis", "Systematic Reviews", "Reviews", and "Clinical Trial". Results: A total of 37 articles were included. The total number of patients with Haglund syndrome treated in the included studies was 831 and 920. The mean patient age was 46.6 years (range, 28.7 to 61) and 58% were men. A higher success rate and a lower rate of complications were reported in men, and physically active patients had better treatment results. The mean success rate for minimally invasive percutaneous procedures was 83.4% (range 66 to 100%). Overall patient satisfaction was 77.5% (range 60 to 95%) and the complication rate was 6.3% (range 0 to 23%). Conclusion: Despite a lack of studies with the recommended evidence level, minimally invasive and percutaneous surgical treatments seem to be a good option for patients with Haglund syndrome when conservative treatment fails. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

/pdf/percutaneous-surgery-in-the-treatment-of-haglund-syndrome-a-244m6zbpc1.pdf

Percutaneous surgery in the treatment of Haglund syndrome: a systematic review

Background Open Giftbox repair of the Achilles tendon has good biomechanical advantages, but it is not minimally invasive. We designed a peritendon fixation technique, the “Locking Block Modified Krackow” (LBMK) technique, to meet minimally invasive needs. This study used a simulated protocol of early rehabilitation to compare the biomechanics of LBMK with those of the Giftbox technique. Methods Twenty fresh bovine Achilles tendon specimens were randomly assigned to either the LBMK group or the Giftbox group. The LBMK technique and the Giftbox technique were used as the main suture configurations, and transverse sutures were used as secondary suture configurations in both groups. Each repaired specimen was subjected to two cyclic loading protocols (20–100 N, 20–190 N). The gapping between the tendon ends was measured after each stage of loading. Finally, all specimens underwent a load-to-failure test at a stretching rate of 25 mm/s. Results After the first loading stage, the mean tendon gapping was 0.76±0.44 mm in the LBMK group and 0.86 ± 0.47 mm in the Giftbox group (p = 0.620). After the second loading test, the average gapping measures of the LBMK and Giftbox groups were 3.8 ± 1.9 mm and 4.2 ± 2.2 mm, respectively (p = 0.466). Finally, the catastrophic load to failure was 732.8 ± 138 N in the LBMK group and 645.5 ± 121 N in the Giftbox group. The difference was statistically significant (p = 0.023). Conclusion Both the LBMK and Giftbox techniques meet the requirements of early rehabilitation, but the suture strength in the LBMK group was significantly higher than that in the Giftbox group.

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique.

BACKGROUND
The medial plantar artery perforator (MPAP) flap is widely used to reconstruct the weight-bearing area of the foot. Traditionally, its donor site is closed using a skin graft, which is associated with several complications, including walking disability. This study aimed to examine our experience with using a super-thin anterolateral thigh (ALT) flap to reconstruct the MPAP flap donor site.


METHODS
We examined 10 patients who underwent reconstruction of the MPAP flap donor site using a super-thin ALT flap between August 2019 and March 2021. The vascular pedicle was anastomosed to the proximal end of the medial plantar vessels or the end of the posterior tibial vessels.


RESULTS
All reconstruction flaps survived and all patients were satisfied with the aesthetic appearance. No blisters, ulcerations, hyperpigmentation, or contractures occurred. All patients gained protective sensation in the super-thin ALT flap. The average visual analog scale score for the aesthetic appearance of the reconstructed foot was 8.5 ± 0.7 (range, 8-10). All patients were able to ambulate without aids and could wear regular shoes. The average revised Foot Function Index score was 26.4 ± 4.1 (range, 22-34).


CONCLUSION
Reconstruction of the MPAP flap donor site using a super-thin ALT flap is reliable and provides satisfactory functional recovery, aesthetic appearance, and protective sensation while minimizing postoperative morbidity.

https://journals.sagepub.com/doi/pdf/10.1177/10225536231181706

Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site.

Purpose To evaluate the clinical efficacy of using free tissue flap combined with contralateral instep thick plantar skin in reconstructing complex plantar forefoot defects. Methods During the past 8 years, 15 patients, aged 25–60 years, with defects in the soft-tissue and composite bone of the forefoot were treated. Their defects were caused by trauma. These defects were all located on the plantar forefoot. The free tissue flaps transposed to reconstruct defects were anterolateral thigh flaps, groin flaps, and latissimus dorsi flaps. Flap size varied in width 4-cm and length (6–16 cm). The mean size of flaps was 80.3 cm2. The follow-up period ranged from 12 to 90 months (mean, 25.5 months). Results Partial flap loss was observed in one anterolateral thigh flap and one latissimus dorsi flap. One patient showed skin graft loss at the defect site, and the wound was re-epithelialized by changing dressings. Hyperkeratosis was not observed in any of the cases. All patients were able to walk near-normally within 2.5 months after surgery, and there was no recurrence of ulceration. Conclusion We advocate using a free tissue flap combined with contralateral instep thick plantar skin for reconstruction of moderate or large complex plantar forefoot defects.

https://journals.sagepub.com/doi/pdf/10.1177/10225536221094258

Reconstruction of complex plantar forefoot defects using free tissue flaps combined with contralateral instep thick skin grafts

Knowledge, attitude and practice of patients with ankle injury regarding osteochondral lesions of the talus: a cross-sectional study in Wuxi, China

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