Incidence Of Re-rupture Research Articles

Platelet-Rich Plasma in Acute Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis

Category: Trauma; Sports Introduction/Purpose: Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment. Methods: The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ('plasma' OR 'platelet-rich' OR 'platelet-rich plasma' or 'PRP') AND ('Achilles tendon rupture/tear' OR' calcaneal tendon rupture/tear' OR 'tendo calcaneus rupture/tear'). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf- circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random and fixed-effects models. Results: After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re- rupture (OR 1.13, 95% CI, 0.46 to 2.80, p = 0.79). Conclusion: PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.

Сравнительный анализ клинических результатов применения шва вращательной манжеты плеча в зависимости от способа фиксации сухожилия

Partial or full-thickness rotator cuff tear is one of the leading causes of pain and dysfunction in the shoulder joint. Despite the variety of existing surgical techniques, the incidence of re-ruptures after surgical treatment, according to MRI studies, varies from 20 % to 39 %. Purpose To evaluate and compare the clinical results of full-thickness rotator cuff tears surgical treatment using various methods of tendon fixation. Materials and methods A retrospective analysis of case histories, surgery protocols and interviews of patients who underwent surgical treatment for rotator cuff tears at the Krasnoyarsk Regional Clinical Hospital within a period of 6 years was carried out. The sample consisted of 120 patients. All patients were divided into three groups depending on the method of fixation: 1) SutureBridge technique using anchors, 2) classic double-row transosseous suture, 3) double-row transosseous suture using extracortical fixators (Endobutton, Fliptack). Results In the first group, excellent and good results were obtained in 72.86 % and poor results were observed in 18.57 %. In the second group, excellent and good results were obtained in 66.66 % of cases, unsatisfactory results in 18.18 %. In the third group, e xcellent and good results were obtained in 76.47 %, there were no poor outcomes. The best clinical results were obtained in the group of patients who underwent postoperative rehabilitation. Conclusion Anchor SutureBridge technique and classical transosseous suture technique demonstrate comparable long-term outcomes. The absence of poor outcomes in the group of extracortical fixators makes further study of this method promising and should be shown in a larger sample.

Psychological, physical and social factors influence decision to return to sport after revision ACL reconstruction with BPTB graft.

There is limited evidence in literature regarding the patient-reported factors that influence their return to sport (RTS) in revision anterior cruciate ligament reconstruction (ACLR). The medium-term results of a prospective consecutive cohort of patients undergoing single- and two-stage revision ACLR with bone patellar tendon bone graft (BPTB) and patient-reported factors that influence their decision to return to sport are presented in this study. Seventy-two patients were included in this prospective study. Single- or two-stage revision with BPTB graft was performed based on pre-operative planning. Iliac crest bone graft was used. Pre-operative and follow-up Lysholm and Tegner activity scores and RTS, level of sport and patient-reported factors affecting RTS were recorded. The mean follow-up was 9years (SD 2.7years). Single-stage revision ACLR was performed in 61 patients. In 11 patients (15%), revision ACLR was performed in two stages. There was a significant improvement in Lysholm score from mean 51.1 to 86.7 (p < 0.001). The incidence of re-rupture in this cohort was 0%. The median Tegner score was 6 (range 2-9). Twenty-five patients (34.7%) did not return to anysport at final follow-up. Twenty-nine (40.2%) patients returned to their pre-injury level of sport. Fear of reinjury (79%, p < 0.001) and persistent knee symptoms (35.8%, p = 0.03) were the most common factors limiting RTS in non-returners. Psychological and social factors may have an influence on RTS in addition to physical factors. Level III.

Twelve-years’ experience in minimal invasive Achilles tendon repair using a suture-guiding device

Introduction: Minimal invasive Achilles tendon repair is becoming more and more popular recently. We have evaluated our results in Achilles tendon repair using minimally invasive method by a suture-guiding device. Methods: This is a retrospective review of patients with acute Achilles tendon rupture, which was repaired using minimally invasive method namely the suture-guiding device, that was performed during 2003 to 2015 in our department. Outcome parameters were the incidence of re-rupture, other complications, and the functional outcome. Results: There were 36 men (90%) and 4 women (10%) in this study. Mechanisms of injury were basketball (28%), football (15%), squash (15%), and trauma (13%). The mean operating time was 59 min (range 30–90 min). The mean follow-up time was 8 months (range 3–35 months). The mean duration with casting was 7 weeks. The mean range of movement at 3 months was 8° dorsiflexion and 33° plantar flexion. There was no major complication necessitating surgical re-interventions such as re-ruptures and infections. No patient suffered from dysfunction of the sural nerve or delay wound healing. Conclusion: Minimally invasive Achilles tendon repair using suture-guiding device is a safe and quick procedure with a low rate of re-rupture and a satisfactory short-term and long-term recovery. Level of evidence: IV.

Infection and Rerupture After Surgical Repair of Achilles Tendons.

Background:Surgical repair of an Achilles tendon rupture has been shown to decrease rerupture rates. However, surgery also increases the risk of complications, including infection.Purpose:To determine the risk factors for infection and rerupture after primary repair of Achilles tendon ruptures.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was performed on 423 patients who underwent operative treatment of Achilles tendon ruptures between the years 2008 and 2014. The primary outcome of interest was the total rate of infection, and the secondary outcome of interest was the incidence of rerupture within 2 years of operation.Results:A total of 423 patients were analyzed, with a mean age of 46 years (range, 16-83 years) and a mean body mass index of 31.4 kg/m2 (range, 17-55 kg/m2). The overall infection rate was 2.8%, and the rerupture rate was 1%. The median time between surgery and superficial surgical site infection was 30 days, and the median time between surgery and rerupture was 38 days. Longer tourniquet times (100.3 ± 34.7 minutes vs 69.9 ± 21.4 minutes; P = .04) and greater estimated blood loss (15.0 ± 9.1 mL vs 5.1 ± 12.0 mL; P = .01) were associated with an increased rate of deep surgical site infections. Patients who had longer operation and tourniquet times trended toward higher rerupture rates (P = .06 and .08, respectively). When compared with nonsmokers, current and previous smokers had an increased incidence of superficial or deep surgical site infections (6.25% vs 1.42%; P = .02). Age, sex, race, body mass index, alcohol use, diabetes, past steroid injections, and mechanism of injury did not contribute to complication rates.Conclusion:Achilles tendon repairs were associated with a low risk of infection and rerupture. Patients with longer tourniquet times, higher estimated blood loss, and a history of smoking were at increased risk for surgical site infections. Patients with longer operative times had increased rates of rerupture.

Reconstruction of ruptured archilles tendon using peroneus brevis tendon transfer to OS calcis

Background: Increase in the incidence of reruptures after non operative management of ruptured Achilles tendon and advances in operative modalities led to primary surgical management of Achilles tendon ruptures in the majority. The present study was undertaken to elucidate the effectiveness of operative management of ruptured Achilles tendon by reconstructing it with Peroneus brevis tendon transfer and evaluate the benefits and risks of this technique in acute and chronic ruptures. Method: This study comprised of 37 patients with Achilles tendon rupture which were primarily operated upon at Santhiram Medical College and General Hospital, Nandyal, Kurnool (OT), A.P. between october 2013 and october 2015. All patients were treated by reconstruction of ruptured tendon with peroneus brevis tendon transfer. Results: Maximum numbers of patients were in the 41-50 year age group (49%). Most of the patients sustained injuries on their right lower extremity (78.3%). Stumbling in the fields (dorsiflexion injury) was the mechanism of injury in the majority (59.4%), while it was fall at bathroom in the aged population. Acute ruptures were 22 and chronic ruptures were 15 patients. The average follow-up was 11.3 months (6-12 months). Functional scoring was done Achilles tendon Total Rupture Score (ATRS). We could achieve functionally excellent result in both acute and chronic ruptured patients. Conclusion: Based on these findings, it can be concluded that reconstruction of ruptured Achilles tendon can be successfully done by peroneus brevis tendon transfer with achievement of excellent functional outcome and plantar flexion in both acute and chronic ruptures with very minimal complications.

Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture

To explore the effectiveness of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture. Between October 2013 and July 2016, 25 cases with acute Achilles tendon rupture were repaired by simple Krackow suture via limited small incision. There were 21 males and 4 females with an average age of 33.6 years (range, 25-39 years). The left side was involved in 15 cases and the right side in 10 cases. The injury caused by sport in 22 cases and by falling in 3 cases. The time from injury to operation was 3-7 days (mean, 4.4 days). Physical examination showed that the Thompson sign and single heel raising test were positive. The operation time was 30-60 minutes with an average of 39.2 minutes. All incisions healed by first intention. There was no complication of wound infection, deep vein thrombosis, tendon re-rupture, and sural nerve injury. All patients were followed up 9-20 months (mean, 14.2 months). The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 92-97 (mean, 94.9) after 9 months. The AOFAS score results were excellent in 13 cases, good in 9 cases, and fair in 3 cases. The range of motion of ankle joint was 49-58° with an average of 53.7°. All single heel raising tests were negative. The method of simple Krackow suture via limited small incision has the advantages of minimal injury, less incidence of re-rupture and sural nerve injury, quicker recovery and so on.

Re-rupture rate of primarily repaired distal biceps tendon injuries

Distal biceps tendon rupture is a common injury, and primary repair results in excellent return of function and strength. Complications resulting from distal biceps tendon repairs are well reported, but the incidence of re-ruptures has never been investigated. A search of the Mayo Clinic's Medical/Surgical Index was performed, and all distal biceps tendon repairs from January 1981 through May 2009 were identified. All patients who completed 12 months or more of follow-up were included. All charts were reviewed and patients contacted as necessary to identify a re-rupture. We also investigated the situation causing the re-rupture. We identified a total of 190 distal biceps tendon ruptures that underwent repair and met our inclusion and exclusion criteria. Of the 190 repairs, 172 (90.5%) were performed by the Mayo modification of the Boyd-Anderson 2-incision technique. Bilateral ruptures occurred in 13 patients (7.3%). Six primary ruptures (3.2%) occurred in women, 4 of the 6 being partial ruptures. Partial ruptures were found to be statistically more common than complete ruptures in women (P = .05). We identified 3 re-ruptures (1.5%), all occurring within 3 weeks of the index surgery. The re-rupture rate after primary repair of the distal biceps tendon is low at 1.5% and occurs within 3 weeks of index repair. This appears to be due to patient compliance and excessive force placed on repairs. We also found the incidence of women who sustain a distal biceps tendon tear to be 3.2%, with partial tears being statistically more common than complete ruptures. Level IV, case series, treatment study

E-011 Rupture of Aneurysms in the Immediate Post-Coiling Period

PurposeWe present a series of cases featuring re-rupture of posterior communicating aneurysm in the immediate post-coiling period, wherein clots obscured the neck of the aneurysm during the procedure. We report...

Rupture of aneurysms in the immediate post-coiling period

PurposeWe present a series of cases featuring re-rupture of posterior communicating artery aneurysms in the immediate post-coiling period, where clots obscured the neck of the aneurysm during the procedure. We...

Operative Versus Nonoperative Management of Acute Achilles Tendon Ruptures

Background: Despite several randomized controlled trials comparing operative to nonoperative management of Achilles tendon ruptures, the optimal management of this condition remains the subject of significant debate. Rerupture is a known complication, but most level I studies have not shown a significant difference in the incidence of reruptures when comparing operative to nonoperative management. Purpose: The goal of this systematic review was to identify all randomized controlled trials comparing operative and nonoperative management of Achilles tendon ruptures and to meta-analyze the data with reruptures being the primary outcome. Secondary outcomes including strength, time to return to work, and other complications were analyzed as well. Study Design: Meta-analysis. Methods: We searched multiple online databases to identify English-language, prospective randomized controlled trials comparing open surgical repair of acute Achilles tendon ruptures to nonoperative management. Rerupture was our primary outcome. Secondary outcomes included strength, time to return to work, deep infections, sural nerve sensory disturbances, noncosmetic scar complaints, and deep venous thrombosis. Coleman methodology scores were calculated for each included study. Data were extracted from all qualifying articles and, when appropriate, pooled and meta-analyzed. Results: Seven level I trials involving 677 patients met inclusion criteria. Coleman scores were 95, 95, 95, 89, 78, 97, and 92. Open repair was associated with a significantly lower rerupture rate compared with nonoperative treatment (3.6% vs 8.8%; odds ratio, 0.425; 95% confidence interval, 0.222-0.815). The incidence of deep infections was significantly higher for patients treated with surgery (P = .0113). The incidences of noncosmetic scar complaints and sural nerve sensory disturbances were also significantly higher in patients treated with surgery (P < .001 for each). Strength measurements were not standardized and therefore could not be meta-analyzed. Conclusion: Open surgical repair of acute Achilles tendon ruptures significantly reduces the risk of reruptures when compared with nonoperative management. Several other complications, which are clearly avoided with nonoperative treatment, occur with a significantly higher incidence when surgical repair is performed. The available literature makes it difficult to compare the return of strength in the involved lower extremity after operative or nonoperative management. Future studies may focus on testing strength in a more functional and reproducible manner than isokinetic testing.

Achilles Tendon Repair with Acellular Tissue Graft Augmentation in Neglected Ruptures

Neglected Achilles tendon rupture injuries present surgical challenges because of the quality and quantity of tendon tissue during repair combined with the magnitude of mechanical forces placed on this tendon. The purpose of this study was to evaluate the effects of an acellular human dermal tissue matrix, GRAFTJACKET, as an augmentation material in neglected Achilles tendon repair. Nine patients with neglected Achilles tendon ruptures were evaluated and followed up for a minimum of 20 months. Primary repair was followed by augmentation with the graft and suturing circumferentially around the tendon. Patients were placed in an early, functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20 to 30 months postoperative follow-up range, there has been no incidence of re-rupture or recurrent pain. The average return-to-activity time was 15.2 +/- 1.7 weeks. The results from this retrospective clinical series suggest that using an acellular human dermal tissue matrix to augment neglected Achilles tendon rupture primary repair offers desirable return-to-activity time points and viable surgical alternative over previously reported surgical options.

The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment

There is still controversy regarding the optimal surgical technique and post-operative treatment of acute Achilles tendon ruptures. We evaluated a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight bearing. A consecutive group of 163 patients was prospectively followed during a 6 year period (1998-2004) in one university hospital and five teaching hospitals. Data were collected during the outpatient department visits at 1, 3, 5, and 7 weeks, 4 months and 12 months after the intervention. Outcome parameters were the incidence of re-rupture, other complications, the functional outcome and the period of sick leave concerning work and sport. The patient group consisted of 128 men (79%) and 35 women (21%). The mean operating time was 41 min. In 9 patients (5.5%) a major complication occurred, necessitating 5 surgical re-interventions (2 for re-ruptures, 2 for infections and 1 for tendon necrosis). Fifteen patients (9.2%) suffered from dysfunction of the sural nerve. The median time of returning to work was 28 days (range 1-368) and the median time of returning to sport was 167 days (range 31-489). The majority of patients (150; 92%) were satisfied with the results. Minimally invasive Achilles tendon repair in combination with a functional rehabilitation program is a safe and quick procedure with a low rate of re-rupture and a high level of patient satisfaction.

Analysis of 223 ruptured intracranial aneurysms with special reference to rerupture

A review of 223 patients with ruptured intracranial aneurysms, including 46 with rerupture, showed that the operability rate was higher and the prognosis better in patients with one rupture. Rerupture cases with low Hunt-Hess grades (0-II) had no better prognosis than one-rupture cases of grade IV. The mean interval between first rupture and rerupture was 12 days. Aneurysms located in the vertebrobasilar system showed the highest rate of rerupture. Daughter and bleb-shaped aneurysms had a greater tendency to rerupture. The incidence of rerupture was increased in patients with narrowly localized vasospasm and acute hydrocephalus. Time-course studies of factors of the coagulating and fibrinolytic system suggested their usefulness in predicting the occurrence of vasospasm, infarction, and rerupture and the prognosis of patients with ruptured intracranial aneurysms. Patients at high risk for rerupture of aneurysm should undergo early operation.