Chronic Achilles tendinopathy is characterised by sub-acute inflammation with pro-inflammatory type 1 macrophages (M1), tissue degeneration and consequent partial or total tendon injury. Control of the inflammatory response and M1-to-M2 macrophage polarisation can favour tendon healing both directly and indirectly, by allowing for the regenerative process driven by local mesenchymal stem cells. Ten patients (3 females and 7 males aged between 32 and 71 years old) with partial Achilles tendon injury were treated with injections of autologous peripheral blood mononuclear cells (PB-MNCs). The cell concentrate was obtained from 100-120 cc of each patient's blood with a selective point-of-care filtration system. PB-MNCs remained trapped in the filter and were injected immediately after sampling. Around 60% of the PB-MNC concentrate was injected directly into the injured area, while the remaining 40% was injected in smaller amounts into the surrounding parts of the Achilles tendon affected by tendinosis. All patients were evaluated both clinically with the help of the American Orthopaedic Foot & Ankle Society (AOFAS) scale, and radiologically (MRI examination) at baseline and 2 months after the PB-MNC injection. A clinical reassessment with the AOFAS scale was also performed 6 months after the intervention. The rehabilitation protocol implied full weight-bearing walking immediately after the procedure, light physical activity 3-4 days after the injection, and physiotherapist-assisted stretching exercises and eccentric training. In all patients, functional and radiological signs of tendon healing processes were detected as early as 2 months after a single treatment and the AOFAS scale rose from the initial mean value of 37.5 (baseline) to 85.4 (6 months). Our preliminary results indicate that regenerative therapies with PB-MNCs can prove useful for partial Achilles tendon injuries as a valid alternative to surgical options, especially when other conservative approaches have failed. Advantages of this therapy include rapid execution, no need for an operating theatre, easy reproducibility, quick recovery and good tolerability regardless of the patient's age (the procedure is not to be performed in subjects who are below 18 years old). Further studies on the topic are recommended to confirm these observations

Abstract. Objectives. Achilles tendon ruptures are common in the UK, with data demonstrating a significant rise in incidence over the past years. Chronic Achilles ruptures have been less well defined in literature, and repair techniques vary significantly. A surge in publications reporting various management options for chronic Achilles ruptures has necessitated a review that systematically maps and summarises current evidence regarding treatments and identifies areas for future research. This scoping review aims to improve knowledge of various treatment strategies and their associated outcomes, thereby aiding clinicians in optimising treatment protocols. Methods. The Arksey and O'Malley, Levac and Peters frameworks were used. A computer-based search in PubMed, Embase, Emcare, Cinahl, ISI Web of Science and Scopus was performed for articles reporting the treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to a pre-defined selection criteria. Results. A total of 747 articles were identified, of which 73 were finally included. Various management strategies were described with flexor hallucis longus tendon transfer being the most common. The American Orthopaedic Foot and Ankle Society (AOFAS) score was the most commonly reported outcome, but 16 other measures were described within the literatures. All studies comparing pre- and post-operative outcomes reported a significant improvement. 50 studies reported complications, with an overall pooled complication rate of 168/1065 (15.8%). Conclusions. Beneficial results were reported following various techniques, but comparison between these was challenging due to the low-level study designs used and confounding factors including treatment delay and tendon gap size. Further research exploring the efficacy of different techniques is required to facilitate the development of evidenced-based treatment protocols. Such a work would allow for clinicians to better understand the suitability of specific techniques, thereby selecting the optimal management strategy for each individual patient

Lisfranc injuries are uncommon and can be challenging to manage. There is considerable variation in opinion regarding the mode of operative treatment of these injuries, with some studies preferring primary arthrodesis over traditional open reduction and internal fixation (ORIF). We aim to assess the clinical and radiological outcomes of the patients treated with ORIF in our unit. This is a retrospective study, in which all 27 consecutive patients treated with ORIF between June 2013 and October 2018 by one surgeon were included with an average follow-up of 2.4 years. All patients underwent ORIF with joint-sparing surgery by a dorsal bridging plate (DBP) for the second and third tarsometatarsal (TMT) joint, and the first TMT joint was fixed with trans-articular screws. Patients had clinical examination and radiological assessment, and completed American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Foot Function Index (FFI) questionnaires. Our early results of 22 patients (5 lost to follow-up) showed that 16 (72%) patients were pain free, walking normally without aids, and wearing normal shoes and 68% were able to run or play sports. The mean AOFAS midfoot score was 78.1 (63–100) and the average FFI was 19.5 (0.6–34). Radiological assessment confirmed that only three patients had progression to posttraumatic arthritis at the TMT joints though only one of these was clinically symptomatic. Good clinical and radiological outcomes can be achieved by ORIF in Lisfranc injuries with joint-sparing surgery using DBP

Background. Surgical resection of middle facet tarsal coalition is a well documented treatment option in symptomatic individuals that do not respond to conservative treatment. The ability to return to full recreational activity post resection may have implications on foot biomechanics and possibly degenerative changes in the subtalar and adjacent joints. Hypothesis. Open resection of middle facet tarsal coalitions should improve subtalar joint motion and biomechanical function and facilitate return to sports. Aim. The aim of this study was to assess the outcomes of open resection of middle facet tarsal coalitions (MFTCs) with particular emphasis on return to sports. Methods. Retrospective review of clinical and radiographic records of paediatric and adolescent patients who had open resection of middle facet tarsal coalitions. The ankle and hind foot were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hind foot Scale (AOFAS). We also quantified the return-to-activity time after tarsal coalition surgery. Results. We identified thirteen patients (Mean age; 13.7years Range; 7–21 years) with eighteen middle facet tarsal coalitions operated over a seven year period. Ten patients (12 feet) who underwent resection had an average return to recreational activity time of approximately twelve weeks and reported better exercise tolerance post resection. Conclusion. Surgical excision of middle facet tarsal coalitions has a favourable outcome with respect to return to sports