The factors affecting patient satisfaction with the outcome following treatment of Tendo-Achilles rupture were assessed. 35 patients were reviewed. 14 were treated non-operatively and 21 by open surgical repair. Mean follow up was 2 years (range 9 months- 4 years). Evaluation consisted of questionnaire and information from medical records. Mechanism of injury, type and time of injury, co-morbidity and follow-up were noted from the medical records. From the questionnaire, pre injury activities, occupation, post-injury activities and overall satisfaction with their function were collected. The overall satisfaction level was quoted by the patients themselves by grading 10 for excellent recovery and 1 for the poor recovery.
Reduced post injury leisure activity, delay in initiation of treatment and post treatment physiotherapy had a significant influence on patient satisfaction with outcome. There was no significant difference in the overall outcome between the operative and non-operative group.
The factors affecting patient satisfaction with the outcome following treatment of Tendo-Achilles rupture were assessed. 35 patients were reviewed. 14 were treated non-operatively and 21 by open surgical repair. Mean follow up was 2 years (range 9 months– 4 years). Evaluation consisted of questionnaire and information from medical records. Mechanism of injury, type and time of injury, co-morbidity and follow-up were noted from the medical records. From the questionnaire, pre-injury activities, occupation, post-injury activities and overall satisfaction with their function were collected. The overall satisfaction level was quoted by the patients themselves by grading 10 for excellent recovery and 1 for the poor recovery. Seventy percent were very satisfied with the outcome of treatment with a mean visual analogue score of 8.4 (7–10). The age, gender and occupation did not have any significant influence on the satisfaction level. The main determinant in the unsatisfied group was reduced post injury leisure activities. This was statistically significant between the two groups at p=0.003. Delay in initiation of treatment had a significant influence, with the group that presented late for treatment being less satisfied with p=0.015. Regression analysis showed that physiotherapy following treatment increased post injury activity and the level of satisfaction with p=0.034. Reduced post injury leisure activity, delay in initiation of treatment and post treatment physiotherapy had a significant influence on patient satisfaction with outcome. There was no significant difference in the overall outcome between the operative and non-operative group.
ECSWT has been on the medical horizon for last 30 years mainly in urology for urolithiasis and has found a parallel use in orthopaedics for various chronic soft tissue conditions like Tendoachilles tendinoses and plantar fasciitis etc. ECSWT acts a piezoelectric device releasing acoustic energy and causing micro-trauma activating cytokine mediated response stimulating local angiogenesis and tissue repair. 56 patients were recruited for the trial after ethics approval was achieved. The diagnosis was confirmed with ultrasound scan and measuring the width of the swelling and the local hypervascularity. The cohort of the patients was randomised in groups for physiotherapy [n=23] and shockwave therapy [n= 23]. The patient groups with shockwave therapy received a 3-week treatment with typical 2000 impulses per session once a week and physiotherapy group was subjected to eccentric loading exercises. Patients were assessed at 12 week with AOFAS, VISA-A scores and repeat ultrasound scan. The average age of the average age was 51 years [36- 73 years] Mean duration of symptoms prior to treatment was 25 months (range 6-60 months). AOFAS scores increased in both groups: from 64□86 in the ECSWT group and 72□79 in the physiotherapy group. VISA-A scores also increased in both groups from 39□73 in the ECSWT group and from 36□56 in the physiotherapy group. Scores were significantly higher in the ECWST group post treatment. The ultrasound scan findings suggested the tendon girth receding from 10.9 mm□9.9 mm in physiotherapy group while 9.8 mm□8.7 mm in the ECSWT group with hypervascularity decreasing from marked to mild in both groups. Statistical significance was established using SPSS 16 p < 0.001in post treatment group.Methodology
Results
From mid-1992 to 2000 and in conjunction with our paediatric department, we have run a screening program to detect congenital orthopaedic abnormalities. Over this period, we have been referred 245 patients with a provisional diagnosis of clubfeet, of these 54 or 22% were true CTEV (78 feet) giving an incidence in the general population of 0.18% while the rest were diagnosed as having simple postural clubfoot (0.6%). Each patient was assessed clinically and classified according to the Harrold and Walker scale as well as being checked for other congenital/neurological abnormalities. 83% of patients were seen within two weeks of referral. Initial management entailed strapping for 6 weeks with further periods of plaster immobilization (required by 46%). Those who failed to respond or who deteriorated underwent surgical correction with sub-talar release. A small percentage required secondary procedures such as Tibialis Anterior transfer,
