Achilles tendon elongation after repair北大核心CSCD

BACKGROUND AND OBJECTIVE The Achilles tendon,while the strongest tendon in the human body,is susceptible to complete rupture,occurring most frequently in men 30to 50years of age.While the treatment for these ruptures can involve surgical or nonsurgical repair,a consensus has not been reached regarding the optimal intervention.For both interventions the length of the tendon may elongate,with this occurring within 6-12weeks after surgery.This study was designed to better understand this phenomenon.     

高频超声诊断跟腱闭合性断裂25例分析

目的评价高频超声检查在跟腱闭合性断裂诊断中的应用价值。方法对25例跟腱闭合性断裂患者进行高频超声检查,观察损伤跟腱的形态,内部结构及回声改变,并将检查结果与手术结果或MRI相对比。结果高频超声检出跟腱完全性断裂20例,与手术结果检查结果相比较,诊断准符合率为100%;检出部分断裂3例,其中2例微小跟腱断裂超声未检出,后经MRI检出,诊断准符合率为60%。结论高频超声诊断跟腱断裂是一种经济、快捷、较准确的诊断方法,并能提供动态观察,具有重要的临床诊断价值。     

超声监测跟腱断裂手术治疗后跟腱周长及断端血流动态变化的价值

目的 探讨超声监测跟腱周长及断端血流在跟腱手术治疗后恢复过程中的意义.方法 对31例跟腱断裂修补术后不同时期的患者,超声动态观察跟腱术后断端的血流变化,用轨迹测量法测量健侧和患侧跟腱多点的周长.结果 跟腱断裂后患侧跟腱周长较健侧大(P＜0.05).术后随着修复时间的延长,患侧跟腱周长有逐渐变小的趋势,但仍较同时期健侧跟腱的周长值大.跟腱术后8周,跟腱断端的血流信号由丰富逐渐减少.结论 监测跟腱术后周长及断端血流的变化可以准确跟踪跟腱术后的动态演变过程.     

Surgery for chronic Achilles tendinopathy produces worse results in women

Purpose. To report the middle term outcome in male and female patients who underwent surgery for chronic recalcitrant Achilles tendinopathy.

Methods. We tried to match each of the 58 female patients with a diagnosis of tendinopathy of the main body of the Achilles tendon with a male patient with tendinopathy of the main body of the Achilles tendon who was within two years of age at the time of operation. A match accordingly was possible for 41 female subjects.

Results. Female patients were shorter and lighter than male patients. They had similar BMI, lower calf circumference, similar side-to-side calf circumference differences, and greater subcutaneous body fat than men. Of the 41 sedentary patients, only 25 reported an excellent or good result. Of these, three had undergone a further exploration of the Achilles tendon. The remaining patients could not return to their normal levels of activity despite prolonged supervised post-operative physiotherapy, with cryotherapy, massage, ultrasound, pulsed magnetic, and laser therapy.

Conclusion. Females experience more prolonged recovery, more complications, and a greater risk of further surgery than males with recalcitrant Achilles tendinopathy.     

US in mid-portion Achilles tendon injury

Ultrasound (US) is the primary imaging technique used to evaluate pathologies affecting the tendons, as the use of high frequency probes permits a detailed study of the structure and morphology of the area also during dynamic examinations. The mid-portion of the Achilles tendon is well evaluated both in normal and pathological conditions, such as tendinosis and peritendinitis as well as partial-thickness and full-thickness tears. The role of US is essential to the diagnosis and, therefore, also to treatment planning in major disorders affecting the Achilles tendon. US furthermore allows the clinician to monitor the effectiveness of treatment over time as well as the risk of recurrent rupture after surgery.     

Mid-portion Achilles tendinopathy – current options for treatment

Purpose. To report on the present option for management of tendinopathy of the main body of the Achilles tendon.

Background. Tendinopathy of the main body of tendo Achillis affects athletic and sedentary patients. Mechanical loading is thought to be a major causative factor. However, the exact mechanical loading conditions which cause tendinopathy are poorly defined. Repetitive mechanical loading induces a non-inflammatory pathology, and repetitive microtrauma ultimately exceeds the healing response. The management of Achilles tendinopathy is primarily conservative. Although many non-operative options are available, few have been tested under controlled conditions. This review article specifically focuses on eccentric training, and on shock wave therapy. Surgical intervention can be successful in refractory cases. However, surgery does not usually completely eliminate symptoms and complications are not rare.

Conclusions. Further studies are needed to discern the optimal non-operative and surgical management of midsubstance Achilles tendinopathy.     

超声在跟腱疾病诊疗中的应用进展

跟腱是人体最粗大的肌腱,在下肢运动中有重要作用。跟腱疾病包括跟腱断裂和跟腱病。随着超声新技术的不断发展,超声在跟腱检查中广泛应用,为跟腱疾病的诊断、治疗及随访提供重要参考信息。本文就弹性成像、介入超声、超微血管成像、超声造影、三维成像等技术在跟腱疾病诊疗中的应用进展进行综述。     

中医定向透药联合功能锻炼对跟腱断裂术后患者疗效与功能恢复的影响

目的探讨中医定向透药联合功能锻炼对跟腱断裂术后患者疗效与功能恢复的影响。方法选取2016年12月至2018年12月在本院行跟腱缝合微创修补手术的新鲜闭合性跟腱断裂患者82例,将其随机等分为对照组与观察组,对照组术后行常规护理,观察组在对照组基础上行中医定向透药联合功能锻炼。比较两组患者临床疗效、足踝关节功能评分、生活质量并发症及术后并发症发生率。结果观察组患者疗效高于对照组(P<0.05);观察组AOFAS,ALS评分均高于对照组(P<0.05);并发症发生率低于对照组(P<0.05)。结论跟腱断裂术后行中医定向透药联合功能锻炼可促进踝关节功能恢复,提高临床疗效,降低术后并发症发生率。     

Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up

ObjectiveTo analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT).MethodsThis retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores.ResultsThirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT.ConclusionSurgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.     

低场强核磁共振在跟腱外伤中的应用

目的:探讨核磁共振成像技术(MRI)在跟腱外伤中的诊断价值。材料与方法:回顾性分析我院于2007年7月至2010年9月期间收治的19例经手术证实的外伤性跟腱损伤患者的临床资料,归纳其MRI表现特征。结果:跟腱完全性损伤的患者8例,其MRI表现特征为跟腱肌腱不完全增粗,形态不规则,肌腱束连续性完全中断,肌腱内T1WI、T2WI上呈混杂性信号。跟腱部分性损伤11例,MRI表现特征为肌腱增粗,肌腱内T1WI、T2WI上呈局限性高信号,肌腱束内毛糙、不规则。手术病理证实9例完全性损伤,10例部分性损伤。结论:MRI能清晰显示跟腱形态及其内部结构,准确判断跟腱损伤的性质、范围,有利于临床诊治。     

The ruptured Achilles tendon: operative and non-operative treatment options

The Achilles tendon is the strongest and thickest tendon in the human body. Like any other tendon in the body, however, it is susceptible to rupture. Many surgeons advocate early operative repair of the ruptured Achilles tendon, citing decreased re-rupture rates and improved functional outcome. Waiting for surgical repair for longer than one month may lead to inferior functional results postoperatively. Non-operative treatment has higher re-rupture rates as compared to surgically repaired tendons, but may be the treatment of choice in some patients. While for many years, patients were rigidly immobilized in a non-weightbearing cast for 6–8 weeks postoperatively, newer studies have shown excellent results with early weightbearing, and this is quickly becoming the standard of care amongst many physicians.     

低场MRI在跟腱损伤中的应用价值

目的 探讨低场MRI在跟腱损伤诊断及术后随访中的应用价值.方法 15例跟腱损伤患者经低场四肢专用磁共振多序列检查,其中7例行缝补术后随访,分析其低场MRI表现,并与5例正常跟腱比较.结果 5例正常跟腱矢状面各序列显示呈条带状均匀低信号.1例利器切割伤显示跟腱下段大部分中断,断面整齐.5例部分撕裂显示跟腱增粗,内部信号不均匀,部分纤维束连续.9例完全性撕裂均显示跟腱连续性完全中断,2例表现为肌腱普遍增粗、形态不规则,T1WI 、T2WI上信号弥漫增高,7例表现为肌腱局部增粗、断裂,断端回缩呈＂杵＂状改变或扭曲,T1WI 、T2WI上中断处呈高信号.7例术后随访显示高信号强度逐渐下降.结论 低场磁共振能够明确地显示跟腱损伤的部位、程度及形态、信号改变,在跟腱损伤的诊断和术后随访方面能提供重要价值.     

Mechanical properties of the human Achilles tendon, in vivo

Background

Ultrasonography has been widely applied for in vivo measurements of tendon mechanical properties. Assessments of human Achilles tendon mechanical properties have received great interest. Achilles tendon injuries predominantly occur in the tendon region between the Achilles-soleus myotendinous junction and Achilles-calcaneus osteotendinous junction i.e. in the free Achilles tendon. However, there has been no adequate ultrasound based method for quantifying the mechanical properties of the free human Achilles tendon. This study aimed to: 1) examine the mechanical properties of the free human Achilles tendon in vivo by the use of ultrasonography and 2) assess the between-day reproducibility of these measurements.

Methods

Ten male subjects had the Achilles tendon moment arm length, Achilles tendon cross sectional area and free Achilles tendon length determined. All subjects performed isometric plantarflexion ramp contractions to assess between-day reproducibility on two separate days. Simultaneous ultrasonography based measurements of Achilles-soleus myotendinous junction and Achilles-calcaneus osteotendinous junction displacement together with Achilles tendon force estimates yielded free Achilles tendon mechanical properties.

Findings

Free Achilles tendon maximal force, deformation and stiffness were 1924 (SD 229) N, 2.2 (SD 0.6) mm and 2622 (SD 534) N/mm on day 1. For between-day reproducibility there were no significant differences between days for free Achilles tendon mechanical properties. The between-day correlation coefficient and typical error percent were 0.81 and 5.3% for maximal Achilles tendon force, 0.85 and 11.8% for maximal Achilles tendon deformation and 0.84 and 8.8% for Achilles tendon stiffness respectively. Last, osteotendinous junction proximal displacement on average contributed with 71 (SD 12) % of proximal myotendinous junction displacement.

Interpretation

This study, for the first time, presents an ultrasonography based in vivo method for measurement of free AT mechanical properties. The method is applicable for evaluation of free human Achilles tendon mechanical properties in relation to training, injury and rehabilitation.     

Achilles tendon ruptures

The incidence of acute Achilles tendon ruptures is on the rise. This is thought to be due to the increasing number of middle-aged persons participating in athletic and/or strenuous activity. Ruptures of the Achilles tendon can be severely debilitating, with deficits seen years after the initial incident. Also, these injuries can have substantial socioeconomic impacts regardless of the treatment selected. Debate continues over the optimal treatment of Achilles tendon ruptures, especially the argument whether to treat patients nonoperatively or surgically. Newer evidence shows that functional rehabilitation, including early weight-bearing, should be an integral part of successful treatment of acute Achilles ruptures. Further research is needed to further investigate the ideal treatment and rehabilitation protocols.     

股前外侧皮瓣带血管化的阔筋膜在跟腱及软组织缺损中的应用

目的探讨股前外侧皮瓣带血管化的阔筋膜修复跟腱及软组织缺损的临床效果。 方法自2012年10月至2014年12月,采用股前外侧皮瓣带血管化的阔筋膜治疗跟腱及软组织缺损11例。皮肤缺损4 cm×6 cm~9 cm×13 cm,跟腱损伤部分缺损或全部缺损,病例的缺损长度2~5 cm。根据创面大小及跟腱损伤或缺损的程度,切取相应大小的股前外侧皮瓣及阔筋膜,设计跟腱缺损区处于穿支血管蒂部,修复跟腱缺损。患足跖屈位术后石膏固定6周。供区行中厚皮片移植修复。 结果11例皮瓣全部成活。2例皮瓣边缘少许坏死,部分指肪液化,换药后愈合。部分植皮的供区植皮完全成活。随访6~12个月,跟腱张力恢复,踝部跖屈背伸功能正常。 结论股前外侧皮瓣带血管化的阔筋膜修复跟腱及软组织缺损效果良好。     

Pathogenesis, detection and treatment of Achilles tendon xanthomas

Tendon xanthomatosis often accompanies familial hypercholesterolaemia, but it can also occur in other pathologic states. Achilles tendons are the most common sites of tendon xanthomas. Low-density lipoprotein (LDL) derived from the circulation accumulates into tendons. The next steps leading to the formation of Achilles tendon xanthomas (ATX) are the transformation of LDL into oxidized LDL (oxLDL) and the active uptake of oxLDL by macrophages within the tendons. Although physical examination may reveal Achilles tendon xanthomas (ATX), there are several imaging methods for their detection. It is worth mentioning that ultrasonography is the method of choice in everyday clinical practice. Although several treatments for Achilles tendon xanthomas (ATX) have been proposed (LDL apheresis, statins, etc.), they target mostly in the treatment of the basic metabolic disorder of lipid metabolism, which is the main cause of these lesions. In this review we describe the formation, detection, differential diagnosis and treatment of ATX as well as the relationship between tendon xanthomas and atheroma.     

Effects of foot orthoses on Achilles tendon load in recreational runners

Background

Achilles tendon pathology is a frequently occurring musculoskeletal disorder in runners. Foot orthoses have been shown to reduce the symptoms of pain in runners but their mechanical effects are still not well understood.

Methods

This study aimed to examine differences in Achilles tendon load when running with and without orthotic intervention. Twelve male runners ran at 4.0 m·s^− 1. Ankle joint moments and Achilles tendon forces were compared when running with and without orthotics.

Findings

The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics.

Interpretation

In addition to providing insight into the mechanical effects of orthotics in runners, the current investigation suggests that via reductions in Achilles tendon load, foot orthoses may serve to reduce the incidence of chronic Achilles tendon pathologies in runners.     

Achilles tendon problems: Not just an orthopaedic issue

Purpose. To review the current concepts on Achilles tendon involvement in various pathological conditions.

Method. A literature search was conducted to trace relevant literature on Achilles tendon problems in general pathologies.

Results. The Achilles tendon can be involved in inflammatory and autoimmune conditions, genetically determined collagen abnormalities, infectious diseases, tumours, and neurological conditions which are not of a primary surgical nature.

Conclusions. Although Achilles tendon problems are classically considered frequent in active individuals from overuse or a single acute episode, problems in the Achilles tendon can be a consequence of several conditions.     

WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?

Achilles Tendinopathy is a complex problem, with the most common conservative treatment being eccentric exercises. Despite multiple studies assessing this treatment regime little is known about the mechanism of effect. This lack of understanding may be hindering therapeutic care and preventing optimal rehabilitation. Of the mechanisms proposed, most relate to tendon adaptation and fail to consider other possibilities. The current consensus is that tendon adaptation does not occur within timeframes associated with clinical improvements, therefore the clinical benefits must occur through another unidentified pathway. This clinical commentary critically reviews each of the proposed theories and highlights that muscle alterations are observed prior to onset of Achilles Tendinopathy and during the disease. Evidence shows that the observed muscle alterations change with treatment and that these adaptations have the ability to reduce tendon load and thereby improve tendon health. The purpose of this clinical commentary is to review previous theories regarding the mechanisms by which eccentric exercise might affect Achilles tendinopathy and offers a novel mechanism by which the plantarflexor muscles may shield the Achilles tendon.

Level of Evidence

5