Aims. Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation. Methods. This retrospective cohort study analyzed a total of 43,287 patients from national health claims data spanning 2008 to 2018, focusing on patients who underwent surgical treatment for primary Achilles tendon rupture. Short-term ATRR was defined as cases that required revision surgery occurring between six weeks and one year after the initial surgical repair, while omitting cases with simultaneous infection or skin necrosis. Variables such as age, sex, the presence of Achilles tendinopathy, and comorbidities were systematically collected for the analysis. We employed multivariate stepwise logistic regression to identify potential risk factors associated with short-term ATRR. Results. From 2009 to 2018, the short-term re-rupture rate for Achilles tendon
Aims. Treatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT
In the context of tendon degenerative disorders, the need for innovative conservative treatments that can improve the intrinsic healing potential of tendon tissue is progressively increasing. In this study, the role of pulsed electromagnetic fields (PEMFs) in improving the tendon healing process was evaluated in a rat model of collagenase-induced Achilles tendinopathy. A total of 68 Sprague Dawley rats received a single injection of type I collagenase in Achilles tendons to induce the tendinopathy and then were daily exposed to PEMFs (1.5 mT and 75 Hz) for up to 14 days - starting 1, 7, or 15 days after the injection - to identify the best treatment option with respect to the phase of the disease. Then, 7 and 14 days of PEMF exposure were compared to identify the most effective protocol.Aims
Methods
Objectives. To evaluate the applicability of MRI for the quantitative assessment
of anterior talofibular ligaments (ATFLs) in symptomatic chronic
ankle instability (CAI). Methods. Between 1997 and 2010, 39 patients with symptomatic CAI underwent
surgical treatment (22 male, 17 female, mean age 25.4 years (15
to 40)). In all patients, the maximum diameters of the ATFLs were
measured on pre-operative T2-weighted MR images in planes parallel
to the path of the ATFL. They were classified into three groups based
on a previously published method with modifications: ‘normal’, diameter
= 1.0 - 3.2 mm; ‘thickened’, diameter >
3.2 mm; ‘thin or absent’,
diameter <
1.0 mm. Stress radiography was performed with the
maximum manual force in inversion under general anaesthesia immediately
prior to
Objective. The main object of this study was to use a geometric morphometric
approach to quantify the left-right symmetry of talus bones. . Methods. Analysis was carried out using CT scan images of 11 pairs of
intact tali. Two important geometric parameters, volume and surface
area, were quantified for left and right talus bones. The geometric
shape variations between the right and left talus bones were also
measured using deviation analysis. Furthermore, location of asymmetry
in the geometric shapes were identified. . Results. Numerical results showed that talus bones are bilaterally symmetrical
in nature, and the difference between the surface area of the left
and right talus bones was less than 7.5%. Similarly, the difference
in the volume of both bones was less than 7.5%. Results of the three-dimensional
(3D) deviation analyses demonstrated the mean deviation between
left and right talus bones were in the range of -0.74 mm to 0.62
mm. It was observed that in eight of 11 subjects, the deviation
in symmetry occurred in regions that are clinically less important
during talus
The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits. A PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.Objectives
Methods
Charcot neuroarthropathy is a rare but serious complication of diabetes, causing progressive destruction of the bones and joints of the foot leading to deformity, altered biomechanics and an increased risk of ulceration. Management is complicated by a lack of consensus on diagnostic criteria and an incomplete understanding of the pathogenesis. In this review, we consider recent insights into the development of Charcot neuroarthropathy. It is likely to be dependent on several interrelated factors which may include a genetic pre-disposition in combination with diabetic neuropathy. This leads to decreased neuropeptides (nitric oxide and calcitonin gene-related peptide), which may affect the normal coupling of bone formation and resorption, and increased levels of Receptor activator of nuclear factor kappa-B ligand, potentiating osteoclastogenesis. Repetitive unrecognized trauma due to neuropathy increases levels of pro-inflammatory cytokines (interleukin-1β, interleukin-6, tumour necrosis factor α) which could also contribute to increased bone resorption, in combination with a pre-inflammatory state, with increased autoimmune reactivity and a profile of monocytes primed to transform into osteoclasts - cluster of differentiation 14 (CD14). Increased blood glucose and loss of circulating Receptor for Advanced Glycation End-Products (AGLEPs), leading to increased non-enzymatic glycation of collagen and accumulation of AGLEPs in the tissues of the foot, may also contribute to the pathological process. An understanding of the relative contributions of each of these mechanisms and a final common pathway for the development of Charcot neuroarthropathy are still lacking.
The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.Objectives
Methods
Objective. The objective of this study was to evaluate the rotation and
translation of each joint in the hindfoot and compare the load response
in healthy feet with that in stage II posterior tibial tendon dysfunction
(PTTD) flatfoot by analysing the reconstructive three-dimensional
(3D) computed tomography (CT) image data during simulated weight-bearing. . Methods. CT scans of 15 healthy feet and 15 feet with stage II PTTD flatfoot
were taken first in a non-weight-bearing condition, followed by
a simulated full-body weight-bearing condition. The images of the
hindfoot bones were reconstructed into 3D models. The ‘twice registration’
method in three planes was used to calculate the position of the
talus relative to the calcaneus in the talocalcaneal joint, the
navicular relative to the talus in talonavicular joint, and the cuboid
relative to the calcaneus in the calcaneocuboid joint. Results. From non- to full-body-weight-bearing condition, the difference
in the talus position relative to the calcaneus in the talocalcaneal
joint was 0.6° more dorsiflexed (p = 0.032), 1.4° more everted (p
= 0.026), 0.9 mm more anterior (p = 0.031) and 1.0 mm more proximal
(p = 0.004) in stage II PTTD flatfoot compared with that in a healthy
foot. The navicular position difference relative to the talus in
the talonavicular joint was 3° more everted (p = 0.012), 1.3 mm more
lateral (p = 0.024), 0.8 mm more anterior (p = 0.037) and 2.1 mm
more proximal (p = 0.017). The cuboid position difference relative
to the calcaneus in the calcaneocuboid joint did not change significantly
in rotation and translation (all p ≥ 0.08). . Conclusion. Referring to a previous study regarding both the cadaveric foot
and the live foot, joint instability occurred in the hindfoot in
simulated weight-bearing condition in patients with stage II PTTD
flatfoot. The method used in this study might be applied to clinical
analysis of the aetiology and evolution of PTTD flatfoot, and may
inform biomechanical analyses of the effects of foot
Objectives. The Manchester–Oxford Foot Questionnaire (MOXFQ) is a validated
16-item, patient-reported outcome measure for evaluating outcomes
of foot or ankle surgery. The original development of the instrument
identified three domains. This present study examined whether the
three domains could legitimately be summed to provide a single summary
index score. . Methods. The MOXFQ and Short-Form (SF)-36 were administered to 671 patients
before
The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.Objectives
Methods
Inflammation of the retrocalcaneal bursa (RB) is a common clinical problem, particularly in professional athletes. RB inflammation is often treated with corticosteroid injections however a number of reports suggest an increased risk of Achilles tendon (AT) rupture. The aim of this cadaveric study was to describe the anatomical connections of the RB and to investigate whether it is possible for fluid to move from the RB into AT tissue. A total of 20 fresh-frozen AT specimens were used. In ten specimens, ink was injected into the RB. The remaining ten specimens were split into two groups to be injected with radiological contrast medium into the RB either with or without ultrasonography guidance (USG).Objectives
Methods