Atraumatic bilateral Achilles tendon rupture: an association of systemic steroid treatment.

A case of bilateral Achilles tendon rupture associated with steroid use is reported. This case illustrates the importance of taking a thorough drug history in cases of tendon rupture. In lower limb tendon rupture all patients, especially those on steroids, should be warned of the increased risk of contralateral injury.     

Bilateral Achilles tendon rupture: an unusual occurrence.

Bilateral Achilles tendon rupture is an unusual injury. This rare entity usually occurs in patients on chronic steroid therapy or with underlying disease. Bilateral Achilles tendon rupture is extremely rare in a previously healthy individual. A case involving traumatic Achilles tendon rupture as a result of a sky diving accident is reported. Evaluation of patients with suspected Achilles tendon rupture is briefly reviewed.     

Achilles tendon rupture: surgical versus non-surgical treatment

OBJECTIVE: To ascertain the treatment method of choice for Achilles tendon rupture, which results in the most favourable functional outcome. METHODS: A comprehensive literature search was performed to retrieve relevant English language articles comparing surgical with non-surgical treatment. RESULTS: The literature search identified five prospective randomised controlled trials, three of which compare surgical with non-surgical treatment, one which compares functional early mobilisation with cast immobilisation after surgical repair and one which compares functional and cast immobilisation in non-surgical management of Achilles tendon rupture. CONCLUSION: Surgical treatment of Achilles tendon rupture is associated with a significantly lower incidence of re-rupture and therefore is the treatment method of choice. Non-surgical treatment may be acceptable for patients who refuse surgery or who are unfit for surgery. Functional early mobilisation appears to be associated with an improved functional outcome and should be considered in preference to plaster cast immobilisation where appropriate.     

Levofloxacin-associated Achilles tendon rupture

OBJECTIVE: To describe a case of levofloxacin-induced partial Achilles tendon rupture; this occurred in the presence of known risk factors and acute renal failure. CASE SUMMARY: A 79-year-old white man received levofloxacin for presumed pneumonia, developed acute renal failure in the setting of dehydration, and began having ankle pain on the 12th day of admission. Levofloxacin was discontinued, and magnetic resonance imaging revealed a 6-cm partial tear and degenerative changes. DISCUSSION: The Naranjo probability scale indicates a possible association between levofloxacin and tendon rupture because the event occurred in the setting of known risk factors such as steroid use, renal failure, older age, and male gender. CONCLUSIONS: Levofloxacin, like other fluoroquinolones, may cause Achilles tendon rupture, and this may be particularly likely with known risk factors.     

Bilateral Achilles tendon rupture: a case report

Bilateral Achilles tendon rupture is a rare injury. We present a case of a 59-year-old gentleman who sustained a bilateral Achilles tendon rupture when the tendon was subjected to normal physiological load. He was treated operatively with V-Y plasty and repair of the tendon with post-operative plaster immobilisation.     

高压氧联合超短波辅助治疗兔跟腱断裂的实验研究

目的探讨高压氧联合超短波辅助治疗跟腱断裂对跟腱愈合的影响。 方法将80只新西兰白兔切断跟腱,制造模型,均行Kessler法缝合,并石膏超踝膝固定4周后拆除。随机分为高压氧组（A组）、超短波组（B组）、高压氧联合超短波组（C组）、对照组（D组）,每组20只。A组、C组术后即刻行高压氧治疗,前3天每天2次,后4天每天1次,共治疗7 d。B组、C组术后每天给予超短波治疗,共6 d,D组不予治疗。术后分别于4周、8周各组分别处死10只白兔,取跟腱组织行生物力学检测（最大拉伸长度和最大抗拉力）、HE染色和免疫组织化学染色。采用方差分析比较术后4周和8周生物力学检测结果的组间差异,并采用LSD-t检验进行组间的两两比较。 结果生物力学测试结果显示：术后4周A组、B组、C组跟腱平均最大抗拉力和平均最大拉伸长度与D组相比显著升高[最大抗拉力：（276.20±8.16）N vs（278.10±7.92）N vs（309.90±9.78）N vs（259.50±4.99）N;最大拉伸长度：（4.62±0.14）mm vs（4.67±0.16）mm vs（5.05±0.17）mm vs（4.18±0.32）mm],差异均具有统计学意义（最大抗拉力：t=5.519、6.280、14.513,P均<0.001;最大拉伸长度：t=3.934、4.136、7.563,P=0.001、<0.001、<0.001）,且C组更优于A组及B组,差异均具有统计学意义（最大抗拉力：t=8.366、7.989,P均<0.001;最大拉伸长度：t=6.164、5.190,P均<0.001）。术后8周A组、B组、C组跟腱平均最大抗拉力和平均最大拉伸长度与D组相比显著升高[最大抗拉力：（354.60±5.68）N vs（355.30±9.62）N vs（390.70±7.48）N vs（339.60±5.60）N;最大拉伸长度：（4.88±0.18）mm vs（5.10±0.16）mm vs（5.38±0.15）mm vs（4.46±0.23）mm],差异均具有统计学意义（最大抗拉力：t=5.946、4.461、17.286,P均<0.001;最大拉伸长度：t=4.578、7.327、10.628,P均<0.001）,且C组更优于A组及B组,差异均具有统计学意义（最大抗拉力：t=12.150、9.187,P均<0.001;最大拉伸长度：t=6.600、3.925,P<0.001、=0.001）。组织学观察结果：C组发现大量成纤维细胞在跟腱断端附近增生,并有少量炎性细胞。A组和B组中虽然可见大量成纤维细胞,但较C组少,且炎性细胞数量较多。D组镜下炎性细胞数量显著多于其他3组,成纤维细胞生长情况明显落后于其他3组,且排列杂乱,并见较多肉芽组织。免疫组织化学染色检查：术后可见Ⅰ型胶原纤维呈现阳性表达,且C组Ⅰ型胶原纤维表达数目最为丰富,B组略多于A组,D组最少。 结论高压氧联合超短波可促进跟腱断裂后跟腱愈合生物学性能,促进Ⅰ型胶原纤维合成。     

Spontaneous bilateral quadriceps tendon rupture

Spontaneous bilateral quadriceps tendon rupture is a rare finding in emergency departments. Thus, the pathophysiology is not well understood. Imaging for improved speed of diagnosis is rarely considered. We present a case of non-traumatic spontaneous bilateral quadriceps tendon rupture and examine current literature on the pathophysiology and imaging guidelines on the topic. The patient is a 49-year-old male that presented to the emergency department with bilateral thigh pain. He had been seen earlier with similar pain, but now presents with increased difficulty ambulating. The patient was found to have spontaneous rupture of bilateral quadriceps tendon. He was treated surgically and has been following with Orthopedic Surgery. Imaging in the emergency department included an ultrasound that showed tendon rupture. Spontaneous bilateral quadriceps tendon rupture is an uncommon finding in medicine and the emergency department. MRI remains the gold standard. However, clinical exam and ultrasound should be utilized for diagnosis of tendon rupture to hasten treatment.     

Orthopedic pitfalls in the ED: Achilles tendon rupture

Achilles tendon rupture is a relatively uncommon occurrence in a general ED population. The history can be subtle, and physical findings may not be clear-cut. Prompt diagnosis and treatment of these injuries, however, is important to improved clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This review article examines the clinical presentation, diagnostic technique, and management options applicable to the emergency physician in the treatment of Achilles tendon rupture.     

同种异体肌腱移植修复跟腱断裂☆

背景：对于跟腱断裂,临床传统修复方法是应用踝周自体肌腱移位修复,自体肌腱取材有限,供区损伤,以牺牲正常的动力和稳定结构为代价;而同种异体肌腱移植具有来源丰富,取材方便,不破坏宿主正常结构,保持其原有生物结构特性等优点。目的：评价同种异体肌腱移植修复跟腱断裂的临床效果。方法：2008年8月至2011年6月收治30例急性、陈旧性跟腱断裂患者,4例陈旧损伤有2-5 cm不等缺损,应用同种异体肌腱移植修复缺损,移植后短腿石膏固定患肢,4周后拆除石膏行功能锻炼。按Arner-lindholm疗效评定标准评价临床治疗结果。结果与结论：住院时间平均12.5 d。移植后25例获得随访,随访1-3年,未见再断裂病例。按Arner-lindholm评定标准,25例中优20例,良3例,可2例,优良率为92%。患者踝关节功能恢复正常,3例跟腱与邻近组织粘连,影响踝关节背伸,足部蹬力无明显下降。2例考虑排异反应,经对症处理痊愈。1例出现少许皮缘坏死、切口感染,扩创换药,行邻近转移皮瓣覆盖后痊愈。所有患者出院时切口均愈合。结果显示,同种异体肌腱移植修复跟腱断裂效果满意,是一种值得推荐的治疗选择。但远期疗效需要进一步观察。     

Achilles tendonopathy and tendon rupture: conservative versus surgical management

Injuries to the Achilles tendon are common in primary care. Insertional tendonitis, retrocalcaneal bursitis, and paratenonitis are acute injuries usually treated conservatively with rest, ice, anti-inflammatory measures, and physical rehabilitation. Causative factors such as improper training or biomechanical abnormalities must be corrected to prevent reoccurrence. Achilles tendinosis is a chronic condition that does not always cause clinical symptoms. When symptoms occur, they are thought to be due to microtrauma or progressive failure resulting in inflammation. Again, conservative treatment usually relieves symptoms, but treatment may be prolonged. Surgical treatment may occasionally be recommended. With rupture of the Achilles, there exists some controversy regarding the advantage of conservative versus surgical management. Treatment should be based on individual patient considerations and expectations.     

闭合性跟腱损伤的超声动态声像表现

目的:探讨闭合性跟腱损伤的超声动态声像图特征,为跟腱病变的超声鉴别诊断提供依据。方法:对35例临床疑诊为闭合性跟腱损伤患者行超声动态检查,观察足在背屈和伸运动时,跟腱有无部分损伤的声像图表现,与手术结果对照。结果:根据跟腱损伤不同的动态声像图表现,超声提示完全性跟腱撕裂9例,不完全性跟腱撕裂19例,慢性跟腱增生3例,陈旧性跟腱损伤伴粘连2例,跟腱局部肿胀2例。33例得手术病理证实,2例超声随访得到验证。结论:高频超声动态观察闭合性跟腱损伤具有一定特异性,可为跟腱病变的诊断及鉴别诊断提供依据。     

Incidence and outcome of rupture of the Achilles tendon

We determined the incidence of complete rupture of the Achilles tendon in the Maribor region (273,609 inhabitants) between 1991 and 1996. During this period, 116 ruptures were treated at Maribor Teaching Hospital. The average incidence was 7 ruptures per 100,000 inhabitants, with a peak incidence of almost 9 per 100,000. Most injuries (65%) occurred during sports activities, with soccer as the major cause of rupture. The average age of patients was 37 years with a male-to-female ratio of 18:1. All patients underwent open surgical repair of the ruptured Achilles tendon, with a minimum follow-up of two years. 19.8% of cases developed complications and in 10.4% of these the complications were major. 1.9% of patients sustained a re-rupture. The mean AOFAS score was 96 points. The patients were subjectively very satisfied with their treatment in 88% of cases. Good functional results with a return to the usual pre-injury activities were achieved in 96% of patients.     

Simultaneous bilateral rupture of the quadriceps tendon

The simultaneous, complete rupture of both quadriceps tendons is a rare event. Only 30 previous cases have been reported and the majority have had well-documented predisposing factors, such as chronic renal failure, gout, hyperparathyroidism, diabetes and obesity. We report a case which presented without any predisposing cause, and review the literature to date.     

高频超声对闭合性跟腱断裂重建术的应用价值

目的研究高频超声对闭合性跟腱损伤重建术的术前评估价值。方法30例跟腱疾病患者行高频超声检查,判断有无跟腱断裂、断裂范围（完全断裂或不完全断裂）、记录断裂部位（断端距跟骨止点的距离）、断端分离长度,并与临床及手术相对照。结果30例患者中完全断裂25例,不完全断裂5例（2例超声未检出）。损伤位置：位于跟腱ˉ跟骨连接部2例,跟腱ˉ肌腹连接部3例,跟腱中部25例（其中位于跟骨止点上方2-5 cm处24例）,断裂部位以跟腱中部居多（83%）。断端分离程度：急性跟腱断裂（20例）中,14例断端分离≤3 cm、6例断端分离＞3 cm;陈旧性跟腱断裂（10例）中,9例断端分离＞3 cm、1例断端分离≤3 cm,陈旧性跟腱断裂患者以分离长度大于3 cm为主;急性跟腱断裂与陈旧性跟腱断裂相较,差异有统计学意义（P〈0.01）。与手术对照,完全断裂患者25例,超声及临床诊断符合率均为100%;不完全断裂患者5例,超声漏诊2例,诊断符合率为60%,临床误诊1例,诊断符合率为80%。结论高频超声对闭合性跟腱断裂尤其是完全断裂诊断符合率高,可为跟腱断裂重建术提供详尽的术前信息,具有较好的临床实用价值。     

Bilateral patellar tendon rupture secondary to repeated local steroid injections.

A case is reported of bilateral patellar tendon rupture in a fit man after a fall. He had a history of repeated local steroid injections into both tendons and histology confirmed steroid-induced changes. The history of repeated local steroid administration has to be implicated as the cause of this extremely rare injury in this patient, which can also be associated with hyperparathyroidism, systemic lupus erythematosus, diabetes and rheumatoid arthritis. All doctors performing repeated local steroid injections into the patellar tendon should be aware of the possible dangers of inducing tendon rupture and should ensure that the steroids are not delivered into its substance.