Calcaneus Tendon Research Articles

In vivo attenuation profile of 660 nm and 830 nm wavelengths on human elbow skin and calcaneus tendon of different phototypes.

Physical factors and tissue characteristics determine the transmission of light through tissues. One of the significant clinical limitations of photobiomodulation is the quantification of fluence delivered at application sites and optical penetration depth in vivo. There is also the difficulty of determining the distances of the application points to cover a uniformly irradiated area. Thus, the aim was to evaluate in vivo the influence of melanin on light transmission of the 660 nm and 830 nm laser wavelengths on skin and tendon. Thirty young individuals of both sexes were recruited, divided into two groups based on melanin index, and submitted to photobiomodulation protocols in the posterior region of the elbow (skin-skin) and the calcaneus tendon (skin-tendon-skin). The irradiation area was evaluated using a homemade linear array of five sensors. We found significant transmission power values for different melanin indexes and wavelengths (p<0.0001). Also, different equipment can generate significant differences in the transmitted power at an 830-nm wavelength. Average scattering values are 14 mm and 21 mm for 660 nm, in higher and lower melanin index, respectively. For 830 nm, values of 20 mm and 26 mm are indicated. Laser light transmission in vivo tissues is related to wavelength, beam diameter, tissue thickness, and composition, as well as melanin index. The 830-nm laser presents higher light transmission on the skin than 660 nm. The distances between the application points can be different, with higher values for 830 nm than 660 nm.

The Effect of Fibroblast Growth Factor and Cold Atmospheric Plasma Treatment on Calcaneus Tendon Healing Activity in Rabbits

The Effect of Fibroblast Growth Factor and Cold Atmospheric Plasma Treatment on Calcaneus Tendon Healing Activity in Rabbits

Infrared thermography in the diagnosis of Achilles tendinitis. A randomized double-blind pilot clinical trial

Background: The Achilles tendon (AT) is the widest and most resistant of the osteoarticular system and has the greatest load-bearing capacity. It is involved in daily functioning and sports activities performance. Exposure to excessive stress on the calcaneus tendon (CT) can prevent an effective repair process and favor permanent injuries. Tendinopathy is a clinical syndrome resulting from disorientation of AT fibers, and inflammatory signs characteristic of tendinitis or tissue degeneration present in tendinosis can be found. The condition can manifest itself through functional changes accompanied by clinical signs such as crackling, tenderness, pain and edema. Infrared thermography is used to trace thermographic profiles, capable of detecting thermal changes related to pathologies. Objectives: The main goal of this study was to correlate AT region thermograms with clinical and functional characteristics in healthy individuals with CT pathology. Methods: The present work consists of a double-blind pilot randomized trial, of qualitative and quantitative nature. Individuals with TC tendinopathy, classified in the Tendinopathy Group (TG) and individuals without tendinopathy, classified in the Control Group (CG) participated. Assessments were performed to characterize the subjects belonging to the TG and CG: anamnesis, infrared thermography, referred pain, crepitation and thickness on palpation, algometry, arch sign test and Royal London Hospital test, pain on passive dorsiflexion, pain on lifting the heel and long jump. Results: The results obtained in infrared thermography were consistent with those obtained in the clinical evaluation for TG and GC. The results demonstrate that healthy tendons presented an average temperature difference of 0.24 ± 0.15 ºC between legs with a maximal difference of 0.4 ºC. On the other hand, unilateral tendinopathy presented an average temperature difference of 1.2 ± 0.9 ºC, however, this difference could be as big as 5.1 ºC. Conclusion: It is concluded that infrared thermography can be used safely and non-invasively to aid in the diagnosis of Achilles tendon tendinopathy.

Variant plantaris muscle with degenerated accessory head: Gross and histological analysis.

The variant plantaris muscle has itself been reported to have variable presentations. Here, we report an unusual finding of the plantaris muscle and report its gross and histological findings. A duplicated head of the plantaris muscle was identified in the right leg of an adult cadaver age and sex. The more anterior head of the muscle was in the typical location and originated from the superolateral condyle of the femur. However, the more posteriorly located head arose from the iliotibial band at the level of the distal thigh. The two heads united and continued as the typical distal tendon of the plantaris muscle to insert into the calcaneus tendon (Achilles). The normally positioned head of the plantaris muscle was found to be composed of typical skeletal muscle fibres. However, the accessory head of the plantaris muscle was found to be severely degenerated and infiltrated with adipose tissue. We report a duplicated head of the plantaris muscle. Histologically, the accessory head was degenerated and infiltrated with adipose tissue. To our knowledge, this is the first report of such a case. Further cases are now necessary to further elucidate this finding.

Pulmonary embolism with bilateral pulmonary infarction after surgical correction of Achilles tendon - a rare complication.

Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary artery or one of its branches. Herein we report a rare, bilateral PE after surgical correction of the Achilles tendon. To report a bilateral PE after calcaneus tendon repair, and to review the literature on this rare condition. A search of the literature was carried out in electronic databases and a review of medical records. PTE, although rare, is a serious and potentially fatal complication, requiring adequate and early treatment. Pharmacological prophylaxis in these situations is still controversial in the medical literature; however, there is consensus for the use of intermittent pneumatic compression in the postoperative period.

Morphological and functional changes in skeletal muscle in type 2 diabetes mellitus: A systematic review and meta-analysis

ABSTRACT Introduction Changes in the skeletal muscle are common in patients with type 2 diabetes mellitus (T2DM). These changes impair your motor skills. Objective This systematic review aimed to investigate changes in skeletal muscle in patients with T2DM. Methods The search was carried out in the PubMed, Scopus, and Web of Science databases until December 1, 2021. Observational studies that evaluated musculoskeletal changes in people with T2DM were included. The review was based on PRISMA recommendations. The primary parameters analyzed were muscle strength, muscle mass, muscle power, and muscle endurance. Results Forty-eight studies were included, with a total of 26,042 participants. The results revealed that T2DM is associated with a reduction in handgrip [−2.64 (CI 95% = −3.33 to −1.95, Z = −7.50, p < .0001], and knee extension muscle strength [−0.56 (CI 95% = −0.76 to −0.36, Z = −5.64, p < .0001)], a higher percentage of type II fibers [11.74 (CI 95% = 6.24 to 17.25, Z = 4.18, p < .0001)], and a lower percentage of type I fibers [−15.69 (CI 95% = −18.22 to −13.16, Z = −12.16, p < .0001], in addition to a greater thickness of the calcaneus tendon (p < .0001). Conclusion Individuals with T2DM present skeletal muscle impairments, mainly reduced muscle strength, mass, and endurance; increase in the thickness of the calcaneus tendon, and alteration in the proportion of type I and II fibers, even in the initial stage of the disease.

Treatment of partial injury of the calcaneus tendon with heterologous fibrin biopolymer and/or photobiomodulation in rats.

The present study aimed to evaluate the new heterologous fibrin biopolymer associated, or not, with photobiomodulation therapy for application in tendon injuries, considered a serious and common orthopedic problem. Thus, 84 Rattus norvegicus had partial transection of the calcaneus tendon (PTCT) and were randomly divided into: control (CG); heterologous fibrin biopolymer (HFB); photobiomodulation (PBM); heterologous fibrin biopolymer + photobiomodulation (HFB + PBM). The animals received HFB immediately after PTCT, while PBM (660nm, 40 mW, 0.23J) started 24h post injury and followed every 24h for 7, 14, and 21days. The results of the edema volume showed that after 24h of PTCT, there was no statistical difference among the groups. After 7, 14, and 21days, it was observed that the treatment groups were effective in reducing edema when compared to the control. The HFB had the highest edema volume reduction after 21days of treatment. The treatment groups did not induce tissue necrosis or infections on the histopathological analysis. Tenocyte proliferation, granulation tissue, and collagen formation were observed in the PTCT area in the HFB and HFB + PBM groups, which culminated a better repair process when compared to the CG in the 3 experimental periods. Interestingly, the PBM group revealed, in histological analysis, major tendon injury after 7days; however, in the periods of 14 and 21days, the PBM had a better repair process compared to the CG. In the quantification of collagen, there was no statistical difference between the groups in the 3 experimental periods. The findings suggest that the HFB and PBM treatments, isolated or associated, were effective in reducing the volume of the edema, stimulating the repair process. However, the use of HFB alone was more effective in promoting the tendon repair process. Thus, the present study consolidates previous studies of tendon repair with this new HFB. Future clinical trials will be needed to validate this proposal.

Foot and Ankle Medicine: Analysis of a Decade of Research in Renowned Brazilian Orthopedic Journals

Evidence-based medicine is a new paradigm for medical practice in situations that generate uncertainties regarding disease diagnosis, prognosis, and therapeutic management, requiring professionals to develop expertise in the critical evaluation and validation of scientific publications. Thus, this study aimed to evaluate the articles published in Brazil between 2010 and 2019 on foot and ankle medicine. Three researchers independently searched for articles on foot and ankle medicine in three renowned Brazilian orthopedic journals, as follows: Revista Brasileira de Ortopedia, Acta Ortopedica Brasileira, and Revista Abtpe. In total, 296 articles were identified and complied with the inclusion criteria, being thus analyzed. Applying the Oxford hierarchy of evidence classification, we found that, across the three journals, most articles were at levels 4 and 5 of evidence and originated in the state of Sao Paulo. The most discussed topics were trauma, hallux valgus, pathologies of the calcaneus tendon, and ligament injuries. Given that the predominance of articles with a lower level of evidence has also been reported in the literature for international journals, initiatives that encourage an increase in the number, in the popularization, and the improvement of the level of evidence for foot and ankle medicine research in Brazil are warranted.

Inflammatory response of two invasive techniques in the mouse with collagenase induced tendinopathy

Abstract Background Percutaneous needle electrolysis (PNE) is a physiotherapy technique which has demonstrated its effectiveness for the treatment of tendinopathies and muscle pathologies. All the authors consulted base its therapeutic effect on the capacity to produce an important inflammatory response during the initial phase of the regenerative process. However, presently, the histological effects of the technique on tendinopathies are unknown. The aim of this study was to histologically examine the inflammatory response provoked by the PNE versus dry needling (DN) in mice with collagenase-induced tendinopathy. Material and Methods In order to achieve the proposed aim, a murine model was used with a total of 18 C57BL/6J mice. One week prior to the intervention, collagenase-induced tendinopathy was performed in the common calcaneal tendons of all mice. Once the pathology was established, they received DN in the left common calcaneus tendon, whereas, on the right, they received treatment with PNE. Groups of animals were sacrificed at 3, 7 and 14 days to evaluate the histological evolution of injuries. Samples of the common calcaneal tendon were taken and were later fixed in formalin, processed, and included in paraffin blocks. Sections of 3 microns thick were performed, which were dyed using hematoxylin-eosin for conventional histopathological examination. Results In both groups, tissue damage was observed with collagen fragmentation and the presence of fibroblasts. Dry needling of the common calcaneal tendon induced the presence of an acute inflammatory infiltrate (characterized by the presence of polymorphonuclear neutrophils and macrophages) at the level of the peritenon and adjacent fat tissue which was detectable after day 3, and notable after days 7 and 14. The application of PNE induced a similar effect, although on day 14, the inflammatory infiltrate of PNE was more evident, compared to DN. Conclusion The proposed in vivo murine model has demonstrated to be useful for the study of the evolution of the first phases of the regenerative process induced by both techniques. The histopathological results reveal that PNE generates a pro-inflammatory stimulus which is superior to DN on day 14.

Critical evaluation of the surgical techniques to correct the equinus deformity.

The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.

Use of Autogenous Fascia Lata Graft in the Treatment of Chronic Segmental Defect of the Common Calcaneus Tendon in Domestic Feline

Background: The common calcaneus tendon is formed by the common tendon of the femoral biceps muscle, tendon of the superficial digital flexor muscle and gastrocnemius muscle tendon, and its rupture is related to acute traumas in small animals. Among some applications described, surgical repair can be adopted in the correction of tendon ruptures and theuse of grafts may be indicated in some severe lesions, where it is not possible to perform tenorrhaphy. This study aims to report the case of a feline with rupture of the common calcaneus tendon in which the tenorrafia associated with the autogenous fascia lata graft was performed as adjuvant to the cicatrization of the same.Case: A 24-month-old, undefined male feline with approximately 3 kg was treated at the FCAV Veterinary Hospital, UNESP Jaboticabal, State of São Paulo, Brazil, with a history of falling, for approximately two weeks, and has since plantigrade posture. Upon physical examination, it was possible to identify a discontinuity of the common calcaneus tendon. The radiographs were performed, which did not show any bone changes. A hemogram and biochemical profile were performed, which were within normal limits. The patient underwent surgery, and a complete lesion of the common calcaneus tendon was identified, with a chronic aspect. Approximation of the stumps was impossible, so a flap of fascia lata, about two centimeters long and one centimeter wide, was removed, which was used as a bed and tendon support for tendon growth. After removal all of the present fibrosis, the tendon stumps were approximated by means of modified Kessler suture with mononylon thread, and fascia lata flap of the ipsilateral limb was sutured with separate single points in both tendon endsand in their lateral and medial portion. In the tibiotarsic joint, the external skeletal fixator type II was used for immobilization, during a period of 30 days. In the immediate postoperative period the patient was already able to support the member on the floor, with progressive improvement, and after 60 days of surgery the animal presented complete support of thelimb, without pain or any other alteration coming from the surgery. The animal presented a rapid recovery after surgical treatment with the autogenous fascia lata flap.Discussion: The rupture of the common calcaneus tendon is not commonly reported in felines and its occurrence is related to acute trauma, where the animals will present lameness and plantigrade posture. Depending on the degree of tendon involvement, there are different procedures that may be indicated, such as tenorrhaphy, reimplantation for avulsion cases, and transplantation with grafts when there is segment loss. In the present study, the use of tenorrhaphy associated with the implantation of autogenous lata-fascia graft was chosen, since the grafts generally provide the framework for healing due to its replacement by collagen tissue in the recipient, in addition to providing mechanical protection initially. Fascia lata, due to its antigenic character as being autogenous, has been shown to be a viable and easily obtained surgical option. The use of the fascia lata graft associated with external immobilization with external fixator type II in the tibiotarsal joint allowed an excellent result and is therefore a recommended treatment for cases of rupture of the common calcaneus tendon in felines.Keywords: cats, lameness, plantigrade stance.

Staging of diabetic tendinopathy in the calcaneal tendon of Wistar rats

Materials and methods In the 100 days of life, 16 male Wistar rats were induced to DM by intraperitoneal administration of Streptozotocin and divided into four groups according to the number of weeks post induction in which the tendons were collected: Group 1st week post induction (1st WEEK PI), Group 2nd week post induction (2nd WEEK PI), Group 3rd week post induction (3rd WEEK PI) and Group 4th week post induction (4th WEEK PI). After the trial period, the animals were anesthetized and the left calcaneus tendons were removed for the mechanical traction rehearsal. From the rehearsal the following parameters were evaluated: Elastic Modulus (MPa), Maximum Tension (MPa), Specific Strain (%), Maximum Strength (N), Cross-sectional Area (mm2). For statistical analysis it had been used the ANOVA and Tukey post hoc. Results In the 16 animals induced, two have not become diabetic (one rat of the 3rd WEEK PI and one of the 4th WEEK PI). Maximum strength and maximum tension did not differ between the groups. The cross-sectional area and the specific strain showed reduction in 3rd WEEK PI (p=0.012; p=0.006, respectively) and in the 4th WEEK PI (p=0.005; 0.008, respectively) compared to the 1st WEEK PI; specific strain decreased also in the 3rd WEEK PI (p=0.002) and 4th WEEK PI (p=0.002) compared to 2nd WEEK PI. On the other hand, the elastic modulus was greater in the 3rd WEEK PI (p=0.047) and 4th WEEK PI (p=0.032) compared to 1st WEEK PI, besides the increase in the 4th WEEK PI (p=0.036) compared to 2nd WEEK PI.

Rupture distale du tendon calcanéen par avulsion osseuse : réinsertion transcalcanéenne par ancres. À propos d’un cas avec revue de la littérature

The Achilles tendon ruptures are increasing. Its localization is mostly in the middle of the tendon. The distal rupture is rare and is often observed in elderly people. Avulsion of the calcaneus is an exceptional form. A 48-year-old man playing football consults with a distal left Achilles tendon rupture in a context of degenerative tendinopathy for 6 months before the rupture. An ultrasound objectified a microfissure enthesitis next to the posterior superior corner of the calcaneus tendon bursitis and was confirmed on MRI. The patient had received a steroid injection by his general practitioner. He consulted at the urgencies within 15 days with typical symptoms of a ruptured Achilles tendon. By surgery, we found a bony avulsion of the tendon insertion with inflammatory and degenerative appearance. Two anchors intraosseous were displayed, ensuring the distal tendon. A resin boot was crafted for two months then a simple self-rehabilitation without support was prescribed. The functional outcome was assessed by measuring the strength of the triceps surae. Most surgical techniques are not feasible in the case of calcaneal avulsion. Transcalcaneal reintegration by two anchors is a solution that provides strength and good functional outcome.

Effects of distance and barriers between resources on bone and tendon strength and productive performance of broiler chickens

Lameness or leg weakness is becoming an important problem in broilers selected for rapid growth, and although the causes are not known, sedentary behavior could be a cause. Two experiments were conducted to study the effects of distance and the presence of ramps between resources (feed and water) on bone and tendon strength, ability to stand, and productive performance. In experiment 1, straight run Ross 708 chicks (n = 1,260) were randomly assigned to 1 of 3 treatments: 1.0, 3.3, or 6.6 m between resources (6 pen replicates/treatment). In experiment 2, Cobb 500 male chicks (n = 864) were randomly assigned to 1 of 4 treatments (2 × 2 factorial, 4 pen replications/treatment) consisting of 2 distances (3 or 8 m) with (WR) or without (NR) a ramp (a triangular prism 31 cm high and 132 cm wide at the base). At d 21, 45, and 56 (experiment 1), or at d 28, 35, 42, and 49 (experiment 2), birds were weighed, killed, and tibias collected to measure breaking strength (BBS), and abdominal fat (AbF) content. At d 49 (experiment 2), calcaneus tendons were also collected to measure breaking strength (TBS). Foot pad lesions and latency to lie (LTL) were determined before killing the birds. In experiment 1, distance did not affect BBS, LTL, foot pad lesions, or BW, but at d 49, birds in the 6.6 m treatment had lower AbF than birds in the other treatments. In experiment 2 at d 49, birds in the 8 m treatment tended to have a higher BBS than birds in the 3 m treatment (P = 0.09), whereas WR birds had lower tendon breaking strength than NR birds (P < 0.01); however, LTL was highest in 8-m NR birds. Final BW was not affected by distance, but birds in the NR group were heavier than birds in the WR group. Furthermore, AbF was lower in 8 m than in 3 m birds. Our results suggest that longer distances between resources have limited effects on bone strength, but increase the LTL, and may change feeding patterns and carcass characteristics, as evidenced by the lower AbF content. Ramps or inclination affected tendon breaking strength.

Biomechanical and Structural Parameters of Tendons in Rats Subjected to Swimming Exercise

The aim of this study was to evaluate the effect of swimming exercise, without overloading, on the biomechanical parameters of the calcaneal tendon of rats. 27 male Wistar rats (70 days) were distributed randomly into 2 groups, Control Group (CG; n=15) with restricted movements inside the cage and Swimming Group (SG; n=12), subjected to exercise training in a tank with a water temperature of 30±1°C, for 1 h/day, 5 days/week for 8 weeks. All animals were kept in a reversed light/dark cycle of 12 h with access to food and water ad libitum. After that, they were anesthetized and had their calcaneus tendons collected from their left rear paws. The tendon was submitted to a mechanical test on a conventional test machine. From the stress vs. strain curve, the biomechanical data were analyzed. For the statistical analysis, the Student-T test was used (p<0.05). Of the variables examined, the maximum tension (p=0.009), maximum force (p=0.03), energy of deformation/tendon cross sectional area (p=0.017) and elastic modulus of the tendon (p=0.013) showed positive outcomes in SG. There was no difference in the other parameters. The results indicate that the swimming exercise training, without overloading, was an important stimulus for improving the biomechanical parameters and structural properties of the calcaneal tendon.

IMMEDIATE AND LATE EFFECT OF SUTURES IN EXTRASYNOVIAL TENDONS: BIOMECHANICAL STUDY IN RATS

Objective: The aim of this study was to evaluate the effects on the mechanical properties of rats’ calcaneus tendons, of repair arrangements using suture material in the absence of any healing process. Method: Twelve male Wistar rats were used. They were subjected to placement of a modified Kessler suture stitch in the calcaneus tendon. The sacrifices were performed immediately after and six weeks after the operation. The mechanical properties studied were maximum load, tension in the maximum load and module of elasticity. The contralateral tendon was used as a control. Results: The statistical analysis showed that for the times studied, the values for mechanical properties did not present any significant differences. In relation to the control, i.e. the contralateral tendon without a suture, the results demonstrated that, six weeks after the operation, the values for the modulus of elasticity were lower, whereas there were no significant variations in maximum load or tension at maximum load. Conclusion: Placement of suture material on an extrasynovial tendon without lesions decreased the modulus of elasticity, but it did not interfere with the maximum load or tension at maximum load, six weeks after the operation.

Low-Intensity Pulsed Ultrasound Accelerates Healing in Rat Calcaneus Tendon Injuries

Controlled laboratory study. To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process. Therapeutic ultrasound promotes formation and maturation of scar tissue. Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ). A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was -3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was -47.7% ± 19.5% compared to -28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption. Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.

Acute Calcaneus Tendon Rupture Associated with Ipsilateral Malleolar Fracture: Case Report and Literature Review

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.

Tratamento cirúrgico do pé eqüino na paralisia cerebral: uma revisão sistemática e quantitativa da literatura

OBJECTIVE: To perform an systematic and quantitative review of the literature dealing with the surgical treatment of equinus foot in cerebral palsy, to perform a statistical analysis of the results in order to characterize a meta-analysis, the purpose of which is to clarify which of the surgical techniques has the lesser risk of recurrence of the equinus deformity, and when to operate on. METHODS: Systematic and quantitative review of the literature between 1966 and 2007. The selection of articles followed a pre-established inclusion and exclusion criteria. The studies were identified and chosen using the computer databases in the Internet as the search strategy (Medline, Embase, Lilacs, and Cochrane Virtual Library). A manual search in journals and books was also done. The data of each study were collected in a pre-established form. The methodological quality of each study was evaluated. For each study selected an estimate was made of the effects of the treatment (relative risk of recurrence). The data were submitted to clinical analysis and to statistical heterogeneity appreciation by analyzing subgroups (mean age, duration of follow-up, and surgical technique used). RESULTS: From the 70 publications found, 20 observational, retrospective studies were selected. Analysis of the studies with mean follow-up longer than five years shows that the rate of recurrence are of higher absolute value in proportion with the longer duration of the follow-up. The studies in which the mean age of patients at the time of surgery was older than seven years show a smaller sum total of relative risks when compared to the group with mean ager younger than seven years, showing a significant reduction of the absolute risk. The comparative analysis of studies that mention performance of lengthening of the calcaneus tendon shows a lower sum total of risks when compared to studies that mention lengthening in the muscle-tendon junction, but with a small reduction in absolute risk. CONCLUSIONS: Zetaplasty for the lengthening of the calcaneus tendon tends to be safer. Patients should operated on after seven years of age. In the long term, the risk of recurrence increases significantly, which reinforces the need for a follow-up of these patients at least till they reach skeletal maturity.

Efeitos do laser de baixa potência sobre a dor e edema no trauma tendíneo de ratos

A dor e o edema são sinais, entre outros, que ocorrem durante a fase inflamatória no processo de cura de tendões lesados. A terapia antiinflamatória farmacológica recebe algumas críticas, com relação a seus efeitos deletérios para o reparo. Dessa forma, ganha corpo o uso de recursos físicos para o controle do processo. O objetivo do presente estudo foi avaliar o uso do laser de baixa potência sobre a dor e edema em tendão calcâneo de ratos submetidos a trauma experimental. Foram utilizados 28 ratos Wistar, divididos em quatro grupos: GC - submetido à lesão traumática e ao tratamento placebo; G2 - submetido à lesão e irradiado com laser 2J/cm²; G4 - submetido à lesão e irradiado com 4J/cm²; G8 - submetido à lesão e irradiado com 8J/cm². A lesão foi realizada com a queda de um peso sobre a face lateral do tendão calcâneo direito de cada animal, com energia de aproximadamente 0,40J. A dor foi avaliada pelo tempo de elevação da pata (TEP) do animal caminhando durante um minuto, sobre um cilindro metálico com 30cm de diâmetro em 3rpm; a avaliação do edema ocorreu através de paquimetria; os momentos de avaliação foram: pré-lesão, pós-lesão, pós-tratamento, duas horas, oito horas, 24 horas e 5º dia de lesão. O tratamento com laser 670nm ocorreu de forma pontual e diária. Os resultados mostraram aumentos do TEP e formação de edema em todos os grupos após a lesão; para os grupos tratados houve redução da dor e do edema, fato observado no grupo controle apenas com relação à diminuição de edema no 5º dia de placebo. Conclui-se que o tratamento com laser de baixa potência diminuiu dor e edema nos animais com trauma tendíneo, de forma dose-dependente.