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
We report the incidence and intensity of persistent
pain in patients with an otherwise uncomplicated total ankle replacement
(TAR). Arthroscopic debridement was performed in selected cases
and the clinical outcome was analysed. Among 120 uncomplicated TARs, there was persistent pain with
a mean visual analogue scale (VAS) of 2.7 (0 to 8). The intensity
of pain decreased in 115 ankles (95.8%). Exercise or walking for
more than 30 minutes was the most common aggravating factor (62
ankles, 68.1%). The character of the pain was most commonly described
as dull (50 ankles, 54.9%) and located on the medial aspect of the
joint (43 ankles, 47.3%). A total of seven ankles (5.8%) underwent subsequent arthroscopy.
These patients had local symptoms and a VAS for pain ≥ 7 on exertion.
Impingement with fibrosis and synovitis was confirmed. After debridement,
the median VAS decreased from 7 to 3 and six patients were satisfied.
The median VAS for pain and the American Orthopaedic Foot and Ankle
Society score of the ankles after debridement was similar to that
of the uncomplicated TARs (p = 0.496 and p = 0.066, respectively). Although TAR reduces the intensity of pain, residual pain is
not infrequent even in otherwise uncomplicated TARs and soft-tissue
impingement is the possible cause. Cite this article:
We undertook a retrospective review of 24 arthroscopic procedures in patients with symptomatic ossicles around the malleoli of the ankle. Most of the patients had a history of injury and localised tenderness in the area coinciding with the radiological findings. Contrast-enhanced three-dimensional fast-spoiled gradient-echo MRI was performed and the results compared with the arthroscopic findings. An enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 20 patients (83%). The arthroscopic findings correlated well with those of our MRI technique and the sensitivity was estimated to be 91%. At a mean follow-up of 30.5 months (20 to 86) the mean American Orthopaedic Foot and Ankle Society score improved from 74.5 to 93 points (p <
0.001). Overall, the rate of patient satisfaction was 88%. Our results indicate that symptomatic ossicles of the malleoli respond well to arthroscopic treatment.
