The aim of this pilot study was to evaluate the accuracy of two different methods of navigated retrograde drilling of talar lesions. Artificial osteochondral talar lesions were created in 14 cadaver lower limbs. Two methods of navigated drilling were evaluated by one examiner. Navigated Iso-C3D was used in seven cadavers and 2D fluoroscopy-based navigation in the remaining seven. Of 14 talar lesions, 12 were successfully targeted by navigated drilling. In both cases of inaccurate targeting the 2D fluoroscopy-based navigation was used, missing lesions by 3 mm and 5 mm, respectively. The mean radiation time was increased using Iso-C3D navigation (23 s; 22 to 24) compared with 2D fluoroscopy-based navigation (14 s, 11 to 17).
Incomplete avulsion of the proximal hamstrings
can be a severely debilitating injury that causes weakness, pain
while sitting and inability to run. The results of the surgical treatment
of 23 consecutive patients with such injuries at least two years
after surgery are described. The surgery consisted of the repair
of the hamstrings directly onto the ischial tuberosity. At review,
using a visual analogue scale (VAS, 0 to 100), pain while sitting improved
from a mean of 40 (0 to 100) to 64 (0 to 100) (p = 0.024), weakness
from a mean of 39 (0 to 90) to 76 (7 to 100) (p = 0.0001) and the
ability to run from a mean of 24 (0 to 88) to 64 (0 to 95) (p =
0.0001). According to a VAS, satisfaction was rated at a mean of
81 (0 to 100) and 20 patients (87%) would have the same procedure
again. Hamstring strength measured pre- and post-operatively had
improved significantly from a mean of 64% (0% to 95%) to 88% (50%
to 114%) compared with the normal side. Most of these patients with symptomatic incomplete hamstring
avulsions unresponsive to conservative treatment had an improved
outcome after surgical repair.
We The triple-strand technique significantly increased the tensile
strength (p = 0.0001) and gap resistance (p = 0.01) of bovine tendon
repairs, and might have advantages in human application for accelerated
post-operative rehabilitation.
We performed two independent, randomised, controlled trials in order to assess the potential benefits of immediate weight-bearing mobilisation after rupture of the tendo Achillis. The first trial, on operatively-treated patients showed an improved functional outcome for patients mobilised fully weight-bearing after surgical repair. Two cases of re-rupture in the treatment group suggested that careful patient selection is required as patients need to follow a structured rehabilitation regimen. The second trial, on conservatively-treated patients, provided no evidence of a functional benefit from immediate weight-bearing mobilisation. However, the practical advantages of immediate weight-bearing did not predispose the patients to a higher complication rate. In particular, there was no evidence of tendon lengthening or a higher re-rupture rate. We would advocate immediate weight-bearing mobilisation for the rehabilitation of all patients with rupture of the tendo Achillis.