Objective To summarize the cl inical appl ication and experience of repairing acute avulsion-type achilles tendon rupture by locking-loop stereoscopic suture. Methods Between January 2006 and June 2010, 41 cases of acute avulsion-type achilles tendon rupture were treated by locking-loop stereoscopic suture. Among 41 patients, 33 were male and 8were female with an average age of 41 years (range, 18-56 years); the locations were left side in 27 cases and right side in 14 cases. There was palpable defect in 33 cases, 7 cases underwent B-ultrasound, and 1 case underwent MRI to confirm the diagnosis. The time from injury to operation was 36 hours to 7 days. All cases were restored by locking-loop stereoscopic suture. Results All incisions healed by first intention. Thirty-one cases were followed up 12 months to 3 years and 10 months with an average of 17 months. The muscle strength reached grade 5; the patients could walk normally, and the heel raising was powerful at 1 year after operation. The circumference difference between wrong leg and good leg was less than 3 cm, and the ankle dorsiflexion was 20-30°, plantar flexion was 40-50°. No re-rupture of achilles tendon or deep infection occurred during follow-up period. At last follow-up, according to evaluation of curative effects by Arner-Lindholm standard, the results were excellent in 21 cases and good in 10 cases with an excellent and good rate of 100%. Conclusion Locking-loop stereoscopic suturing is a safe and effective method with avulsion-type control abil ity, tensile strength, l ittle effect on the blood supply of the achilles tendon for repairing acute avulsion-type achilles tendon rupture.
Objective To study the method and cl inical results of arthroscopic double-bundle posterior cruciate l igament (PCL) reconstruction using achilles tendon allograft. Methods From September 2005 to September 2006, 17 patients with PCL injuries of grade III received arthroscopic double-bundle PCL reconstruction using achilles tendon allograft. There were 12 males and 5 females with an average age of 31.7 years (range, 19-48 years), including 10 cases of left PCL injuries and 7 cases of right PCL injuries. Injury was caused by sports in 6 cases and traffic accident in 11 cases. The average time from injury to surgery was 16 days (range, 7-30 days). The preoperative knee flexion was (121.8 ± 4.1)°. The posterior drawer test was positive and the varus angulation test was negative in all 17 patients. Lysholm score was 50.8 ± 6.1 and Tegner score was 1.3 ± 0.7. The side-to-side difference was (10.5 ± 1.6) mm by KT-1000 arthrometer. Results The hospital ization were (13.6 ± 2.4) days. The operation time was (67.8 ± 9.4) minutes. The time was (5.4 ± 1.2) days when the body temperature was higher than 37.4 ℃ after operation. All incisions healed by first intention. No compl ication occurred. All 17 patients were followed up 25 months on average (range, 18-30 months). The knee flexion was (116.9 ± 3.1)° at the final follow-up, showing no significant difference when compared with that of preoperation (P gt; 0.05). The posterior drawer test and the varus angulation test were negative in all 17 patients. Lysholm score and Tegner score were 91.6 ± 3.2 and 6.0 ± 0.7, respectively, and the side-to-side difference was (2.7 ± 1.7) mm, showing significant differences when compared with those of preoperation (P lt; 0.05).Conclusion Achilles tendon allograft is fit for PCL reconstruction. Arthroscopic double-bundle posterior cruciate l igament reconstruction using achilles tendon allograft can reconstruct both anterolateral and posteromedial bundles of the PCL. The knee joint function can be restored effectively. The short-term outcome has been proved, but the long-term outcome needs more observations
Objective To assess the short-term effect of the mini-invasive surgical method by Achillon in repair of acute achilles tendon rupture. Methods Between December 2009 and February 2010, 11 patients (11 feet) with acute achilles tendon ruptures were treated, including 8 males (8 feet) and 3 females (3 feet) with an average age of 35.4 years (range, 23-58 years). There were 9 cases of jump injury, 1 case of glass cut injury, and 1 case of fall injury. The results of Thompson testwere positive in 11 cases (11 feet). According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfootscoring system, the score was 53.19 ± 6.31. MRI indicated that the gap of the acute achilles tendon rupture was 1-5 cm (3.8 cm on average). The interval between injury and operation was 2-7 days (3.6 days on average). An approximately longitudinal 3- 4 cm incision was performed and the ruptured achilles tendon was repaired by use of Achillon. Early rehabil itation was carried out. Results The operation time was 27-58 minutes (38 minutes on average). The hospital ization time were 2-3 days (2.5 days on average). Superficial wound infections occurred in 2 cases, and wound healed after dressing change; orther incision healed by first intention. All the patients were followed up 5-8 months with an average of 6.7 months. No wound problems, sural nerve injuries, or re-ruptures occurred in the other cases. After a 3-month follow-up, all patients were able to return to normal walking. The AOFAS ankle-hindfoot score was 94.32 ± 4.23, showing significant difference when compared with that before operation (P lt; 0.05). Conclusion The technique with Achillon offers patients a safe procedure for repair of acute achilles tendon ruptures and early active rehabil itation can be carried out.
Objective To review the progress in the diagnosis and treatment of chronic disorders of achilles tendon. Methods Recent l iterature concerning the diagnosis and treatment of chronic disorders of achilles tendon was revi ewed. Results Ultrasonography and MRI were commonly used for diagnoses, and MRI could provide extensive informationfor the choice of therapy protocol. Nonsurgical therapy was the mainstay of treatment for most patients with overuse syndromes, surgical techniques for patients due to no effect in the conservative treatment and with chronic rupture, the cl inical treatment project should be determined based on the cl inical evaluation. Conclusion The surgical indication of chronic disorders of achilles tendon remains controversial, the long-term results of each treatment method are unknown, the randomized prospective studies are still required.
Objective To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. Methods The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture(8 cases of complete rupture and 2 cases of incomplete rupture). Results The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5±2.5 cm. The width of origin tendon was 0.9±0.2 cm and the thickness was 0.3±0.1 cm; the width on apex of lateral malleolus was 0.7±0.1 cm and the thickness was 0.4±0.1 cm, the width on head of cuboid was 0.7±0.1 cm and the thickness was 0.3±0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2 292.4±617.3 Non tendon calcaneus, 1 020.4±175.4 N on long peroneal muscles tendon, 752.0±165.4 N on peroneus brevis tendon and 938.2±216.7 N on tibialis posteriortendon. Tencases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 1824 months. No Achilles tendon rerupture, necrosis of skin or other complications occurred. According to AmerLindholm criterion forcurative results, the results were excellent in 7 cases and good in 3 cases and the excellent and good rate was 100%. Conclusion The long peroneal muscles tendon transposition is a perfect and simple way to repair occlusive Achilles tendon rupture.
This study was aimed to design a new, accurate and easy-to-use water bath cryo-jaw, and try to solve the problems met in small animals achilles tendon mechanical testing. The muscle-tendon-bony units were fixed in the clamps. SD rats achilles tendon were randomly divided into group A and B. Group A was tested by the newly designed water bath cryo-jaw, while group B was treated by non-water bath cryo-jaw. The mechanical tests revealed that non of the samples of the newly-designed water bath cryo-jaw in group A slipped and fell off, and the achilles tendons were in a physiologically active state, but one of the group B samples slipped and fell off, and the others had the frozen phenomenon obviously. The maximum stress, fracture displacement and Young's modulus of the rats in group A were significantly different compared to those in group B (P<0.05). In conclusion, the new water bath cryo-jaw has more advantages than traditional ones. It exhibits a good simulation in vivo in the environmental conditions for testing the mechanical properties of the achilles tendon.