Partial Achilles Tendon Research Articles

PARTIAL ACHILLES TENDON TEAR: A FIGURE OF OUR IMAGINATION?

AimOur collaborative study aims to demonstrate that acute partial Achilles Tendon Tears (ATTs) are not separate diagnostic entities from full ATTs. and should be thought of as a continuum rather than binary partial or full.MethodsWe pooled anonymised data from four hospitals, identifying patients with acute partial ATTs on USS reports from 2019–2021. Patients were only included if they had an acute injury and no previous background Achilles tendinopathy.Results91 patients had acute partial ATTs reported on USS. 74/91 (81%) of patients had clinical findings in keeping with a full ATT (positive Simmonds test, palpable gap). 88/91 (97%) of patients were managed according to local full ATT protocols. 2 patients had MRIs – one showed no tear, the other showed a full rupture. 2 patients underwent surgical repair and both intra-operatively were found to have full ATTs.ConclusionOur regional data suggests that a significant proportion (81%) of USS diagnosed partial ATTs may in fact be misdiagnosed full ATTs. All injuries clinically suspicious for an ATT should be managed according to local Achilles Protocol. USS is useful to diagnose the presence or absence of a tear but is not good at differentiating partial vs full tear. There is significant tendon end fibrillation and overlap on USS of an acute full ATT, which can give the impression of a partial ATT. More research is needed into whether any threshold exists to support the current distinction of “partial” and “full” as relates to management and outcomes.

Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy.

The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT. To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity. Cohort study (diagnosis); Level of evidence, 3. The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests. The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001). The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

Platelet-rich Plasma Injection for the Treatment of Partial Achilles Tendon Rupture: A Case Report

Introduction: Achilles tendon rupture is one of the most common adult tendon injuries and continues to increase in incidence. This case report outlines a comprehensive approach for stand-alone leukocyte-poor platelet-rich plasma treatment of a partial subacute Achilles tendon rupture in a professional athlete who had received prior autologous conditioned serum injections with an interleukin-1 receptor antagonist. Patient History: A 32-year-old male professional ice hockey player presented with persistent left ankle pain approximately seven months after suffering a partial acute Achilles tendon tear. Imaging confirmed a subacute partial Achilles tendon rupture. Injection: Following local anesthesia, a 25-gauge 1.5-inch needle was advanced to the target structure under ultrasound guidance and 3 mL of autologous platelet-rich plasma was divided amongst several areas of the patient's Achilles tendon, while simultaneously tenotomizing the tendon. No complications were observed. Imaging: Follow-up magnetic resonance imaging approximately 9 months after platelet-rich plasma injection revealed complete resolution of the Achilles tendon rupture. Conclusion: Ultrasound-guided leukocyte-poor platelet-rich plasma injection could be considered an effective treatment option for acute Achilles tendon rupture during the subacute stages of tendon healing, leading to complete radiographic resolution of the tear and enabling a return to high-level athletics.

A Comprehensive Evaluation of Minimally Invasive Achilles Tendon Reconstruction with Hamstring Graft Indicates Satisfactory Long-Term Outcomes.

Background and objectives: The Achilles tendon, the largest tendon in the body, is vulnerable to injury because of its limited blood supply and the combination of forces to which it is subjected. Given the relevance of the Achilles tendon in the proper function of the foot and ankle, the primary goal of the present study was to use a holistic approach for a comprehensive evaluation of Achilles tendon reconstruction results on multiple levels. Materials and Methods: The study was designed in the following way: 30 patients with partial or total Achilles tendon tears were subjected to the minimally invasive Achilles tendon reconstruction. Patients were then subjected to the clinical, functional and isokinetic tests 12 and 24 months after the treatment. The clinical evaluation included calf circumference measurements and subjective patient-reported tests: ATRS, EQ-5D-5L and VAS scales. The functional evaluation was based on three tests: the weight-bearing lunge test, the heel rise test and single leg hop. Isometric and isokinetic evaluation was performed using a Biodex 3 dynamometer. Results: The calf circumference of the operated limbs was significantly lower than the non-operated limb 12 months after the surgical procedure, however this improved at the second evaluation. All subjective outcomes improved significantly 24 months after the surgery. Significantly better results in the function of the operated limbs were also obtained 24 months after the surgery. However, most of the muscle strength parameters of the operated limbs were already comparable to non-operated ones 12 months after the surgery and were comparable between two evaluation times. Conclusions: The overall results of this extensive evaluation are highly satisfactory and patients returned to their normal physical activity. From a medical point of view, it is assumed that the healing process is completed 12 months after the surgery, however, importantly, our results indicate that we should consider the healing process and the rehabilitation process separately.

Clinical and Histologic Evaluation of Partial Achilles Tendon Injury Repair with Amniotic Membrane in Rats.

Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process. Thirty-five rats were divided evenly into five groups, and the left lower extremity was used in this study. No interventions were applied to the control group (group 5). In the other groups, Achilles tendons were partially cut to the midline. Then, primary repair (group 1), amniotic membrane treatment with no repair (group 2), primary repair and amniotic membrane treatment (group 3), or secondary healing with no repair (group 4) was performed. Use of amniotic membrane in tendon healing resulted in decreased adhesion formation and positive effects on collagen sequencing and anti-inflammatory effects. In addition, for the vascular endothelial growth factor evaluation there was no difference among the amniotic membrane repair groups, but there was an increase in vascular endothelial growth factor positivity compared with the control group. These data show that amniotic membrane treatment can alter biological behavior and induce surface-dependent angiogenesis and can have angiogenetic effects on ischemia and inflammation.

Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle

To investigate the effectiveness of lateral circumflex femoral artery chimeric flap transplantation in repair of complex wounds of foot and ankle. A retrospective study was conducted to analyze the clinical data of 20 patients with complex wounds of foot and ankle treated with lateral circumflex femoral artery chimeric flap between June 2017 and June 2020. There were 14 males and 6 females with an average age of 42.8 years (range, 21-65 years). Among them, 8 cases had dorsalis pedis tendon defect with or without bone exposure, 4 cases had partial or total Achilles tendon defect without bone exposure, and 8 cases had deep cavity and bone exposure. The wound area ranged from 10 cm×6 cm to 21 cm×11 cm. The time from injury to operation ranged from 6 to 22 days, with an average of 9.4 days. The lateral femoral circumflex artery flap was used in 6 cases with fascia lata flap, 6 cases with rectus femoris aponeurosis flap, and 8 cases with lateral femoral muscle flap. The flap area ranged from 12.0 cm×6.5 cm to 35.0 cm×7.5 cm. All flap donor sites were sutured directly. The survival, appearance, texture, sensation of the flap, and complications of the donor site were observed. The foot and ankle function was evaluated by Kofoed score. All patients were followed up 8-24 months (mean, 14.2 months). On the 3rd day after operation, 1 case had partial necrosis of 1 flap with fascia lata flap and healed after dressing change; 1 case of chimeric muscle flap developed venous crisis at 12 hours after operation; the chimeric flaps survived successfully in the other 18 patients and the wounds were primary healing. The color and texture of the flaps were good, the flaps recovered protective sensation. Only linear scar remained in the donor site of thigh. There was no sensory disturbance around the incision or walking disturbance. The Kofoed score of the foot and ankle function at last follow-up was 75-96, with an average of 89.8. Among them, 15 cases were excellent, 4 cases were good, and 1 case was qualified. The excellent and good rate was 95.0%. The application of lateral circumflex femoral artery chimeric flap can accurately and stereoscopically repair the complex wounds of foot and ankle and achieve satisfactory effectiveness.

Concomitant Partial Achilles Tendon Rupture and Lateral Luxation of the Superficial Digital Flexor Muscle Tendon in a Dog

AbstractThe aim of this study was to report a posttraumatic partial Achilles tendon (AT) rupture associated with lateral luxation of the superficial digital flexor tendon (SDFT) in a Whippet. This article is a brief communication. A Whippet was presented with posttraumatic plantigrade stance and non-load-bearing lameness of the right pelvic limb. The objective findings consisted in partial AT rupture and SDFT lateral luxation. Surgical treatment ensued: tenorrhaphy of the torn tendons and calcaneo-tibial screw insertion for tarsal immobilization, followed by suturing of the SDFT retinaculum. A casting bandage was employed for additional immobilization. Nonetheless, a bandage complication prompted the premature removal of the fixation screw and casting wrap. Complete functional recovery was achieved by the 20th postoperative week. The simultaneous occurrence of SDFT luxation and partial AT tear has not been reported in the literature before. The long-term postoperative functional outcome was highly satisfactory.

Partial Achilles Tendon Rupture-A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options.

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities.

Ultrasound and MRI in the assessment of Achilles tendon rupture: are both necessary?

Summary Background This prospective observational study aims to evaluate the accuracy of ultrasound, compared with MRI, in assessing the ATr features, to safely plan the surgical treatment. Material and methods Patients surgically managed at our Institution for ATr were prospectively recruited. All the patients underwent clinical examination, ultrasound and MRI. These examinations were performed in a blind manner by different authors, who were unaware of the results of the complementary imaging technique. Results 34 patients (32 males; 2 females; mean age: 47) were included in the present study. Both ultrasound and MRI showed no significant differences, compared with intraoperative measurement, in assessing the gap between the two stumps (MRI: p=0.13; US: p=0.26) and the distance between the ATr and the tendon calcaneal insertion (MRI: p = 0.23; US: p = 0.51) All the partial Achilles tendon ruptures intraoperatively identified, 4 out of 34 (11.76%), were correctly classified in ultrasound, whereas one ATr classified as partial on MRI appeared intraoperatively complete. Conclusions The present study shows ultrasound, when performed by an experienced sonographer, is accurate in defining the main features of acute Achilles tendon rupture. Hence, this cheap imaging technique is useful in decision making and to plan the surgical management of the tendon injury.

Right Arm Pain and Swelling in an End-Stage Kidney Disease Patient.

### Case Description A 51-year-old man with ESKD secondary to FSGS on thrice weekly hemodialysis presented with an expanding painful right arm mass. He had long-standing secondary hyperparathyroidism with a persistently elevated PTH level > 2000 pg/ml and had been refusing to take calcimimetics or to undergo parathyroidectomy. Physical examination demonstrated a hard and tender mass on the lateral aspect of the humerus. An x-ray showed a 7.2×4-cm expanding lytic lesion with periosteal reaction (Figure 1). A skeletal survey showed similar smaller masses in the left humerus, left second metatarsal bone, and distal ulna together with few calcified soft tissue lesions in the right forearm, as well as partial Achilles tendon calcification and calcified abdominal aorta. A diagnosis …

Hronična parcijalna ruptura Ahilove tetive - transfer tetive flexor hallucis longus - prikaz dva slučaja

Achilles tendon injuries most commonly occur in athletes, but also in the middle-aged population practicing recreational sports. The aetiology of injury and disease of the Achilles tendon has not been completely clarified. While acute injury can be attributed to trauma, research showed that a chronic degenerative process is present in most ruptures. While there are still a lot of dilemmas when it comes to treating acute rupture, chronic rupture and disease are predominantly treated operatively. Many operative procedures can be used when treating chronic Achilles tendon diseases, such as excision of degenerative changes and tendon decompression, reconstruction using fascia lata and VY plastics, tendon transfer (Flexor Hallucis Longus - FHL, Flexor Digitorum Longus - FDL, Peroneus Brevis - PB) and allograft and synthetic graft reconstruction. The objective of the paper was to present the results of treating chronic partial Achilles tendon rupture by scar excision and FHL tendon transposition. The patients were one professional and one recreational athlete, both of whom were treated nonoperatively for a long time. They were both tested using AOFAS and ATRS tests preoperatively and postoperatively. The results showed a significant improvement of function and both patients were able to return to their usual activities. Postoperative results of AOFAS and ATRS tests were almost identical to the result on the uninjured leg. Our little series, as well as a lot of research performed by other authors, shows that an FHL tendon transposition is a safe and efficient method in treating diseases and injuries of the Achilles tendon.

Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4-year cohort.

Achillodynia is common and includes Achilles tendinopathy, partial Achilles tears and Achilles tendon ruptures. However, we believe an additional pathology should be considered for Achillodynia differentials - the intratendinous tear (ITT). Examinations of 740 achillodynic patients in one specialist centre were reviewed. ITTs were defined as a clearly visualised echopoor area situated centrally and extending to, but not through the tendon periphery, with pain on palpation and no clinical findings consistent with Achilles rupture. Descriptive statistics were used to analyse differences between pathological sub-groups, and images described qualitatively. 5% (29 males, 8 females) of 740 patients had an ITT. Patients typically presented with a history of sudden onset localised pain and the ability to train but not reach maximal loading. Average age was 36.3 years (range 20-64), significantly lower than mid-tendon tendinopathy (8.48 years; p<0.01). 92% had concurrent Achilles tendinopathy. Elite sportspeople were more highly represented in the ITT than mid-tendon tendi nopathy groups (86.2% ITT group vs 13.8% mid-tendon AT group; p<0.01). ITTs should be actively searched for in patients with Achilles pathology, especially in elite male athletes with a history of high-impact pain. Prospective research is warranted concerning diagnosis and management. IV.

Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism.

Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE. Prognostic, Level III: Case Control Study.

Effect of unintentional partial Achilles tenotomy on Ponseti clubfoot management outcomes.

The congenital talipes equinovarus (clubfoot) is one of the most common congenital conditions requiring orthopedic intervention. This study was carried out to evaluate the effect of unintentional partial Achilles tendon cut during percutaneous tenotomy on the success rate of Ponseti management. Percentage of Achilles tendon cut following percutaneous tenotomy was measured by ultrasound in 16 clubfeet (11 patients). After a mean of 21 months of follow-up, the final results (Dimeglio score) were compared between two groups of patients: those with complete tendon cut and those with partial cut. Complications and parameters such as feeling of pop during tenotomy and ankle dorsiflexion during tenotomy were also compared. There was no significant correlation between the percentage of Achilles tendon cut and increase in ankle joint dorsiflexion, age at diagnosis, or pop sensation. There was no statistically significant difference between the two groups in their ankle joint dorsiflexion, feeling of pop, and final follow-up Dimeglio score. No complications were encountered following tenotomy. One patient needed tibialis anterior transfer at his last follow-up visit. Partial cut of Achilles tendon following tenotomy does not necessarily compromise the final results of Ponseti management. Achieving more than 10°-20° ankle dorsiflexion even with a partial tendon cut can ensure good final results.

PREVENTION OF POSTTRAUMATIC ADHESIONS AROUND THE ACHILLES TENDONS IN RABBITS

The problem of treatment of tendon injuries remains unresolved despite on the variety of ways for its restoration. Unsatisfactory outcomes after surgical treatment according to different authors range from 15 to 62 %. The most important problem of tendon surgery is restoration of its function of sliding. Objective: To study the structural organization of the injured tendon by implementation of medications around tendon suture. Methods: The experiments were performed on 12 mongrel rabbits aged 12–18 months, weight 1 850–2 000 g. Partial Achilles tendon injury was modeled after cutting it at 1/2 diameter. In the control group (1st series) stitches were not treated. In experimental animals we injected around the tendon suture in the 2nd series — 1 ml 1 % hyaluronic acid (Syngial™), 3rd series — 1 ml of 4.5 % three-dimensional polyacrylamide polymer (Noltrex™), 4th series — 1 ml 64 IU hyaluronidase/ml (Lidasa-Biolik™). The study was conducted by means of light and polarization microscopy. Results: after 60 days in the area of traumatic injury tendon-like tissue that contained diverse bundles of collagen fibers made of collagen types I and III formed. Maximum accumulation of collagen type III was detected in regenerates of the animals in 1 and 4 series. Destructive tendon disorders in the areas located above or below of the injury zone found in all series of experiments: the most pronounced in the 4 (II stage), less pronounced — in 2 and 3 (I stage). The growth of connective tissue that violates sliding of bundles of collagen fibers was the most pronounced in the 1st and 4th series of experiments. Conclusion: For restoration of sliding function of the tendon and for prevention of tendon adhesions can be recommended medications Syngial™ and Noltrex™.

Intraoperative Value of the Thompson Test

The purpose of the present study was to assess the validity of the Thompson sign and determine whether the deep flexors of the foot can produce a falsely intact Achilles tendon.Ten unmatched above-the-knee lower extremity cadaveric specimens were studied. In group 1, the Achilles tendon was sectioned into 25% increments. The Thompson maneuver was performed after each sequential sectioning of the Achilles tendon, including after it had been completely sectioned. If the Thompson sign was still intact after complete release of the Achilles tendon, we proceeded to release the tendon, and tendon flexor hallucis longus, flexor digitorum longus, and posterior tibial tendons. The Thompson test was performed after the release of each tendon. In group 2, the tendon releases were performed in a reverse order to that of group 1, with the Thompson test performed after each release. In group 1, the Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the tendon. After complete (100%) release of the tendon, the Thompson sign was absent in all specimens. In group 2, the Thompson sign remained intact after sectioning of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons in all specimens. The Thompson sign remained intact in all specimens after sectioning of 25%, 50%, and 75% of the Achilles tendon. After complete release of the tendon, the Thompson sign was absent in all specimens.The Thompson test is an accurate clinical test for diagnosing complete Achilles tendon ruptures. However, it might not be a useful test for diagnosing partial Achilles tendon ruptures. Our findings also call into question the usefulness of the Thompson test in the intraoperative setting.

Mast Cell Curve-Response in Partial Achilles Tendon Rupture After 830 nm Phototherapy

The aim of this study was to quantify mast cells at different time intervals after partial Achilles tendon rupture in rats treated with low-level laser therapy (LLLT). There is a high incidence of lesions and ruptures in the Achilles tendon that can take weeks and even months to heal completely. As the mast cells help in the healing repair phase, and LLLT has favorable effects on this tissue repair process, study of this modality on the quantity of mastocytes in the ruptured tendon is relevant. Sixty Wistar rats were subjected to partial Achilles' tendon rupture by direct trauma, randomized into 10 groups, and then divided into the group treated with 80 mW aluminum gallium arsenide infrared laser diode, continuous wave, 2.8 W/cm(2) power density, 40 J/cm(2) energy density, and 1.12 J total energy, and the simulation group. Both the groups were subdivided according to the histological assessment period of the sample, either 6 h, 12 h, 24 h, 2 days, or 3 days after the rupture, to quantify the mastocytes in the Achilles' tendon. The group subjected to LLLT presented a greater quantity of mastocytes in the periods of 6 h, 12 h, 24 h, 2 days, and 3 days after rupture, compared with the simulation groups, but differences were detected between the sample assessment periods only in the simulation group. LLLT was shown to increase the quantity of mastocytes in the assessment periods compared with the simulation groups.

Paper # 77: Histhopathologic Findings in Partial Achilles Tendon Ruptures

The surgical findings and histopathology are reported in 217 patients (49 females and 168 males, age: 18-66, 70% professional or amateur athletes) with Achilles tendon ruptures. We analysed and compared the history of those patients, taking into consideration following aspects: first onset of symptoms, aggravating and relieving factors, duration of symptoms, previous treatment, injections, clinical examination (local Achilles deformity, pain localisation, gastro-soleus muscle development/atrophy, biomechanical evaluation). All of the patient had US examination. There were 42 cases (19,35%) of partial ruptures. Samples for histopathological examination were always taken from clinically symptomatic and macroscopically injured parts of the tendon. In all cases (both complete and partial rupture) histopathologic picture was similar. Intraoperative evaluation of partial injures always revealed changes within one (in some cases in two) bundles of Achilles tendon. In all cases we could point the bundle with the biggest or asymetrical load and that we believe is the main factor for partial Achilles tendon injury. On the other hand histopathologic evaluation revealed: micro-injuries, fatty metaplasia, degenerative tendon-like tissue and pathologic vessels, but no inflammatory process and no potential for self healing. Mean follow-up is 3 years. In conclusion, on bases of our experience, outcomes and surgical as well as histopathological findings we believe that: Partial rupture of Achilles tendon may be a result of acute injury or a consequence of repeated microinjuries. There are three bundles of Achilles tendon and force transmission direction of each bundle is different. Acute partial Achilles tendon injuries occur during excessive asymmetric loading of the tendon. The injury occurs in the most loaded bundle. Clinically in our study, it is most often the bundle running from the medial head of gastrocnemius muscle or from the soleus muscle. Chronic processes may also be a result of overload (repetitive microtrauma) of one of the Achilles tendon bundles. The goal of operative treatment is to restore full biomechanical function of the tendon (or as similar to physiology as possible) and to restore the ability to correct transmission of contractile forces, which is possible only by careful reconstruction of the three-bundle structure of Achilles tendon. Surgical treatment has also another purpose - to enhance healing process, which in histopathologic examination has been proven to be very limited.

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images.

Healing parameters in a rabbit partial tendon defect following tenocyte/biomaterial implantation

Although rabbits are commonly used as tendon repair model, interpretative tools are divergent and comprehensive scoring systems are lacking. Hence, the aim was to develop a multifaceted scoring system to characterize healing in a partial Achilles tendon defect model. A 3 mm diameter defect was created in the midsubstance of the medial M. gastrocnemius tendon, which remained untreated or was filled with a polyglycolic-acid (PGA) scaffold + fibrin and either left cell-free or seeded with Achilles tenocytes. After 6 and 12 weeks, tendon repair was assessed macroscopically and histologically using self-constructed scores. Macroscopical scoring revealed superior results in the tenocyte seeded PGA + fibrin group compared with the controls at both time points. Histology of all operated tendons after 6 weeks proved extracellular matrix (ECM) disorganization, hypercellularity and occurrence of irregular running elastic fibres with no significance between the groups. Some inflammation was associated with PGA implantation and increased sulphated proteoglycan deposition predominantly with the empty defects. After 12 weeks defect areas became hard to recognize and differences between groups, except for the increased sulphated proteoglycans content in the empty defects, were almost nullified. We describe a partial Achilles tendon defect model and versatile scoring tools applicable for characterizing biomaterial-supported tendon healing.