Repair Of Rupture Research Articles

Laparoscopic repair of pericardio-diaphragmatic rupture: A case report

Diaphragmatic rupture following blunt trauma is a common pathology which has good outomes when discovered early and treated. The common practice has been to manage these patients with either a laparotomy or thoracotomy, with some reports showing the safety of laparoscopy. We present a case of a patient who presented with a pericadio-diaphragmatic rupture who was managed successfully using laparoscopy.

Postinfarction ventricular septal rupture repair: Is it just a matter of the surgical technique?

Postinfarction ventricular septal rupture repair: Is it just a matter of the surgical technique?

Unrecognized concomitant ventricular septal rupture and left ventricular aneurysm 10\xa0months after myocardial infarction in a patient presenting with chronic heart failure

BackgroundWe report a rare case of concomitant inferior left ventricular aneurysm and ventricular septal rupture in a patient presenting with chronic heart failure.Case presentationAn 81-year-old man suffered from congestive heart failure. His symptoms were alleviated by medical management; however, heart failure symptoms continued according to the New York Heart Association Functional Classification III. Ten months after presentation, ventricular septal rupture was diagnosed using echocardiography. The left ventricular aneurysm was also complicated. Surgical repair of the ventricular septal rupture and left ventricular aneurysm was successfully performed. The ventricular septal rupture consisted of multiple holes, and the infarcted myocardium had already progressed to firm, fibrotic scar tissue. We closed the ventricular septal rupture with a small bovine pericardial patch and performed an aneurysmectomy with a liner technique.ConclusionsCases of ventricular septal rupture can have various clinical scenarios, and treatment should be optimized for each patient, especially with respect to the timing of surgery.

Abstract 13869: The Impact of Genotype on Aortic Dilation in Pediatric Patients With RASopathy

Introduction: Proximal aortic dilation is an important cause of morbidity and mortality secondary to rupture, dissection, and complications of repair. It has been described as a rare finding in RASopathy, but data is limited regarding prevalence, severity, and genetic factors. This study aims to examine outcomes and genotype associations in pediatric patients with aortic dilation and RASopathy. Methods: A retrospective review performed at a single pediatric referral center. Study population included children with a molecularly confirmed RASopathy diagnosis evaluated between January 2000 and August 2019. Baseline data included demographics, genetic data, cardiac diagnostic data, clinical course, and mortality outcome. Results: Ninety patients were identified (mean age 10.4, female 48%). Aortic dilation was found in 28%. Of these, 68% had mild dilation, while moderate and severe dilation were each seen in 16%. Aortic dilation occurred in all major RASopathy types (Noonan, Noonan with Multiple Lentigenes, Costello, and Cardiofaciocutaneous). Hypertrophic cardiomyopathy was seen in 30% and pulmonary stenosis in 53% of RASopathy patients, with similar prevalence among those with aortic dilation (p=1 and 0.45, respectively). Aortic dilation was more prevalent in RAS ( KRAS , HRAS , NRAS ) variants (4/9 versus 12/81, p=0.0494). It was also seen in 16 of 60 patients with PTPN11 variants in association with all three commonly involved regions (exon 3 of N-SH2 region and exons 8 and 13 of PTP domain). The two patients with extreme dilation (z-score > 6) had variants of amino acids 61 and 63 in exon 3 of PTPN11 . No surgical interventions targeting aortic dilation were performed in any patient, and there were no reports of dissection or rupture. There was no clear progression of dilation, and two patients had complete resolution with time. Discussion: Aortic dilation occurred in all four major types of RASopathy and was associated with most of the affected genes, with distribution along the PTPN11 gene being similar to the distribution of RASopathy. The dilation was not progressive and there were no complications or interventions. RAS genes and exon 3 of the PTPN11 gene demonstrated a possible higher association with aortic dilation and warrant further investigation.

Double-patch repair of left ventricular rupture after mitral valve replacement

Cardiovascular Surgery and Interventions publishes original articles on topics in cardiovascular surgery, cardiovascular anesthesia and cardiology. These encompass all relevant clinical, surgical and laboratory studies, editorials, current and collective reviews, technical know-how papers, case reports, interesting images, “How to Do It” papers, correspondence and commentary.

The Impact of Clients\u2019 and Therapists\u2019 Characteristics on Therapeutic Alliance and Outcome

This article investigates distances between therapists and their clients in their experience of the therapeutic alliance across the duration of the psychotherapeutic treatments in a naturalistic study. We looked at the working alliances from different vantage points—rupture, repair of ruptures, distances in the alliance impressions of both clients and therapists—and their correlation with treatment outcome. The only predictive variable of alliance ruptures was the inability of therapists to bond sufficiently with their clients regarding a sustainable working atmosphere, which could be identified through a continuous distant alliance rating by the therapists. Alliance ruptures in turn significantly predicted premature termination of treatments, whereas alliance ruptures per se did not necessarily predict treatment outcome. The paper discusses the possible role of the quality of therapists’ attachment styles as a potentially crucial variable in an effective working alliance in psychotherapy.

Revision Quadriceps Tendon Repair With Bone-Achilles Allograft Augmentation

Background: Surgical repair of chronic quadriceps tendon ruptures can be daunting, especially after failure of a prior repair. In this setting, tissue quality is usually poor, necessitating graft augmentation. In this video, we describe our technique for Achilles tendon allograft augmentation for revision quadriceps tendon repair. Indications: Failed quadriceps tendon repair defined as ongoing extensor mechanism deficit including patella baja, functional deficit, or palpable quadriceps defect with confirmed retear on advanced imaging. Technique Description: Patient is placed in the supine position, and a midline incision is extended to the tibial tubercle. Full thickness medial and lateral flaps are raised, nonviable scar tissue is excised, and suprapatellar adhesions are released to ensure full mobilization of the viable remnant quadriceps. A plane is then developed deep to the patellar tendon paratenon from proximal to distal. A reamer is used to prepare a socket just medial to the tibial tubercle. The calcaneal bone block of the Achilles allograft is fashioned to match the recipient site on the tibia with a sagittal saw. The graft is shuttled deep to the paratenon, and the bone plug is fixed to the tibia with an interference screw. Suture from the patellar anchors is then used to place 2 running Krackow stitches spanning the remnant quadriceps tendon proximally. The remnant tissue is subsequently reduced and tied with an anchor pull-through technique. The soft tissue component of the Achilles graft is laid over the repair and oversewn with free nonabsorbable suture. Patient is placed in a brace locked in extension for 6 weeks and allowed to be weight bearing as tolerated. Results: Long-term patient-reported outcomes of Achilles allograft reconstruction for revision extensor mechanism repairs are limited. Two studies of 17 reconstructions each reported this to be a reliable and durable option at a mean follow-up of 65 and 52 months, respectively. Discussion/Conclusion: Revision surgery for extensor mechanism deficits can be a challenging procedure. Our preference is to perform augmentation with Achilles allograft with bone plug fixation on the tibial side. This allows for augmentation of the entire extensor mechanism, as well as bone-to-bone healing on the tibial side.

Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture

BackgroundTo reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture.MethodsFrom January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated.ResultsThe mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000).ConclusionsAcute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy.Study designCase-control studies, Level of evidence, 3.

Tendoachilles reconstruction by a gastrosoleus turn-down flap: a case report

Acute and chronic rupture of the Achilles tendon (TA) is a common entity which requires surgery to either bridge the gap or to reinforce the strength of the repair or the tendon. This was done with a turn down flap of the gastrosoleus. Both the above conditions of acute and chronic rupture were usually misdiagnosed and mistreated. Hence, they presented to us late or with complications affecting the gait. Here, we presented a case of acute rupture of the TA presented late in a young female in which the defect was managed with a gastrosoleus aponeurosis turn down flap. Primary repair of acute TA rupture augmented with a gastrosoleus turn down flap provides a good outcome.

No effects of early functional mobilization on gait patterns after acute Achilles tendon rupture repair.

This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mean age 38.7 (7.3) years, were included. Patients were postoperatively randomized to EFM (n = 29), including immediate weightbearing and ankle motion for 6 weeks, or ST (n = 18), with 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis. Three-dimensional gait analyses were performed at 8 weeks and 6 months postoperatively to evaluate ankle and knee kinematics and kinetics. Ultrasound imaging was performed to assess tendon length and calf muscle atrophy. At 8 weeks, there were no significant group differences in ankle and knee kinematics and kinetics, while side-to-side differences between injured and uninjured side were present within both groups. At 6 months, the ST group exhibited higher generating ankle power and greater peak moments in ankle and knee compared to the EFM group. In both groups, peak ankle dorsiflexion angle was greater on the injured side compared to the uninjured side. No correlations were found between ankle joint gait deviations and degree of tendon elongation or muscle atrophy. Clinical significance: The accelerated rehabilitation regimen with EFM did not result in a more symmetrical gait pattern. The gait pattern deviations in the ankle joint were not related to the degree of muscle atrophy or tendon elongation.

Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair

The incidence of Achilles tendon rupture is increasing. Postoperative rehabilitation after repairing acute Achilles tendon rupture is very important because the choice of treatment during the rehabilitation period can influence the results. Moreover, the method of functional rehabilitation varies and is developing steadily. Recent studies recommend a functional rehabilitation protocol, and this approach is accepted widely. This study aimed to introduce our most accelerated functional rehabilitation protocol following surgery for acute Achilles tendon rupture and to review the results retrospectively. From July 2014 to July 2016, 67 patients underwent surgery for acute Achilles tendon rupture by one surgeon. Age, sex, body mass index, injury mechanism, rehabilitation method and progress, time to return to previous physical activity, and complications were evaluated. The mean time to be able to squat fully was 10 ± 4.7 (4-20) weeks. Full squatting was possible in 92.8% (52 patients). The mean time to perform a single-limb heel rise and repetitive single-limb heel rise was 12.6 ± 3.9 (6-24) and 23.3 ± 7.7 (8-40) weeks, respectively. The mean time to return to sports was 20.6 ± 5.2 (12-32) weeks. The major complication rate was 3.5% (one re-rupture and one tendon elongation). The mean pre- and postoperative Achilles Tendon Total Rupture Score was 29.5 ± 3.7 (20-38) and 79.3 ± 18.5 (20-98) points, respectively. The increase was significant (p < .01). In conclusion, immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results.

Love in a time of anti-Blackness: social rank, attachment, and race in psychotherapy

ABSTRACT This paper draws on critical race theory and research on attachment, social rank and dehumanization to theorize the implications of addressing anti-Blackness in psychotherapy with both Black and non-Black clients in the context of White Supremacy. Drawing on and critiquing a recent review of attachment theory and race, the author draws on historical and empirical research outlining the contours of a racial capitalist world. Recontextualizing attachment theory through this critical race theory lens, it will be argued psychotherapy must address anti-Blackness with both Black and non-Black clients, redefining therapeutic action not only as the provision of repair of interpersonal ruptures, but also as the capacity to mentalize about socio-historical ruptures, allowing space to clarify and pursue one’s values despite an anti-Black, capitalist and White Supremacist world. This paper will provide case examples illustrating these principles with Black and non-Black clients and conclude with their clinical and political implications.

Learning curve of the Krackow suture technique for the repair of Achilles tendon rupture.

Knowledge on the learning curve for the repair of Achilles tendon rupture is limited. The aim of this study was to quantify the learning curve for the Krackow suture technique for the repair of Achilles tendon rupture and to identify the correlation between the cumulative volume of cases and clinical outcome measures. A total of 226 cases of Achilles tendon repair using the Krackow suture technique were reviewed. Each surgery was independently performed by four surgeons who started a foot and ankle specialty career after fellowship training. After logarithmic transformation of the operative time and cumulative volume of cases, a linear regression analysis was performed to determine the best-fit linear equations to predict the required time for the Krackow suture technique according to the cumulative volume of cases. The correlation between the cumulative volume of cases and clinical outcome measures was analyzed using Pearson correlation coefficients. Receiver operating characteristic curves were constructed to determine the minimum number of cases with an operative time shorter than the average in the first 30 cases. In all four surgeons, significant log-linear correlations were observed between the operative time and cumulative volume of cases. The best-fit linear equations showed estimated learning rates of 90%, 87%, 92%, and 86% for each of the four surgeons, indicating that the necessary operative time decreased by 10%, 13%, 8%, and 14%, respectively, when the cumulative volume of cases had doubled. The minimum number of cases with an operative time shorter than the average was 9 (91% sensitivity and 59% specificity). The clinical outcome measures at 6 and 12months postoperatively were available for one surgeon; however, no correlation was found with the cumulative volume of cases. The learning rate for the Krackow suture technique for the repair of Achilles tendon rupture was approximately 89%, indicating that the required operative time can decrease by up to 11% when the cumulative volume of cases doubles. Therefore, it is important to rapidly accumulate surgical experience during the early phase of training.

The release of adhesions improves outcome following minimally invasive repair of Achilles tendon rupture

PurposeOperative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions.MethodsFrom February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have been prospectively evaluated using the Achilles tendon Total Rupture Score (ATRS) and Heel-Rise Height Index (HRHI), following acute Achilles tendon rupture.ResultsFourteen (5.6%) patients were identified as having adhesions. Four patients reported superficial adhesions and ten patients reported a deeper tightness of the tendon. At a mean (SD) of 10.5 (2.3) months following repair, the overall ATRS was at a median (IQR) 65 (44.5–78) points and (HRHI) was mean (SD) 81.5 (13.5)%. Of those deemed to have deep adhesions the antero-posterior diameter of the tendon was at mean (SD) 15.6 (4.6) mm. Open release of superficial adhesions resulted in improved ATRS in all patients. Endoscopic debridement anterior to the Achilles tendon led to alleviation of symptoms of tightness and discomfort from deep adhesions and improved outcome in terms of the ATRS score. At a mean (SD) of 15.9 (3.3)-month follow-up from initial rupture and repair, the patients reported at median (IQR) ATRS scores of 85 (64.8–92.8) points, Tegner level 5 (3–9) and mean (SD) HRHI 86.2 (9.5)%. Patients significantly improved both ATRS and HRHI following release at median (IQR) of 16.5 (− 1.8–29.3) points (p = 0.041) and mean (SD) 5.6 (8.3)% (p = 0.043).ConclusionsThe incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%. The occurrence of superficial adhesions was associated with a lower outcome scores as well as symptoms of anterior tendon tightness and stiffness were associated with a lower score in most patients. Surgical release of adhesions led to a significant improvement in outcome.

Biomechanical comparison of new Achilles tendon rupture repair technique the “Giftbox” versus the Krackow technique in New Zealand white rabbits: An experimental animal study

IntroductionTo compare the strength between the Achilles tendons repaired with the “Giftbox” and the Krackow techniques in New Zealand white rabbits post six weeks of tendon healing. Materials and MethodsEight rabbits were randomized into Giftbox and Krackow groups. Tenotomy was performed on the Achilles tendon of one side of the lower limb and repaired with the respective techniques. The contralateral limb served as control. Subjects were euthanized six weeks post-operative, and both repaired and control Achilles tendons were harvested for biomechanical tensile test. ResultsThe means of maximum load to rupture and tenacity in the Giftbox group (156.89 ± 38.49 N and 159.98 ± 39.25 gf/tex) were significantly different than Krackow's (103.55 ± 27.48 N and 104.91 ± 26.96 gf/tex, both p = 0.043). ConclusionThe tendons repaired with Giftbox technique were biomechanically stronger than those repaired with Krackow technique after six weeks of tendon healing.

Mini-open Repair for Acute Achilles Tendon Rupture: Ring Forceps vs the Achillon Device

Background: Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. Purpose: To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results: The AOFAS score (P = .669), Achilles Tendon Total Rupture Score (P = .753), and length of incision (P = .305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P < .001). The maximum height of the SLHR (P = .042) and the number of SLHRs (P = .043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s (P = .185) and 120 deg/s (P = .271). There was no significant difference in the occurrence of postoperative complications between the groups (P = .093). Conclusion: The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

Arthroscopic Flexor Halluces Longus Transfer and Percutaneous Achilles Tendon Repair for Distal Traumatic Ruptures

The Achilles tendon is the largest and strongest tendon in the human body. It is the tendon that most often suffers injury and accounts for 20% of all tendon ruptures. These types of ruptures often occur 2 to 6 cm proximal to the stumps in an area of reduced vascularity. One such injury, the distal acute Achilles tendon rupture, is quite uncommon. For distal repairs, there have been studies that used a pullout technique, a button technique, and the use of local tendons for open-fashion augmentation. Although percutaneous repair and endoscopic flexor hallucis longus (FHL) tendon transfer techniques have been described for both acute midportion and chronic Achilles tendon rupture repair, there are no studies that describe the use of percutaneous sutures and biological augmentation with FHL transfer as a treatment option for acute distal injuries. The purpose of this Technical Note is to describe a novel approach to repair. It combines arthroscopic FHL tendon transfer with a percutaneous Achilles tendon repair technique for traumatic distal ruptures.

Minimally Invasive versus Open Repair for the Treatment of Acute Achilles Tendon Rupture in Adults: A Prospective Randomized Controlled Study

Abstract BACKGROUND The aim of this study is to compare open repair and minimally invasive repair in acute Achilles tendon rupture in adults regarding operative techniques, functional outcome and complications. DESIGN A prospective randomized controlled comparative trial. METHODS 40 consecutive cases with acute complete Achilles tendon rupture were divided randomly in 2 equal groups (20 treated by open Krackow repair and 20 treated by minimally invasive repair with the PARS device), average age 41 years, follow up time was average of 7 months. Patients were assessed clinically and functional scoring system of postoperative American Orthopaedic Foot &amp; Ankle Society ankle-hindfoot score (AOFAS) was used postoperatively. RESULTS Our results found that there were no significant differences between both groups in rates of postoperative complications (MIS group 10%, open repair group 15; P = 0.134). PARS group had greater postoperative AOFAS score, early rehabilitation, better cosmetic appearance and smaller scar length than open Krackow repair of acute Achilles tendon rupture. CONCLUSIONS We have found out that minimally invasive techniques such as the PARS are clinically and biomechanically suitable alternatives to open repair based on both clinical outcomes and repair strength.

Chronic achilles tendon rupture repair with plantaris tendon augmentation and anchor sutures: A case report and review of literature

The Achilles tendon is the strongest and largest tendon in the human body. A chronic rupture can be defined as a rupture with a delay in diagnosis or treatment for more than 6 weeks. It is a challenging problem. Reconstruction of the Achilles tendon depends on numerous factors such as the gap between the debrided tendon ends, the presence of a distal stump, and the presence of scar tissue. Various surgical techniques have been described. Open surgical options include augmentation with free fascia tendon graft, fascia advancement, local tendon transfer and synthetic or allograft augmentation. Here we report a case of a 55 year old male patient with a chronic degenerative tear in tendoachilles treated surgically with repair of the tendoachilles rupture with plantaris tendon augmentation with anchor sutures and its functional outcome.

A case report of a rupture of the musculotendinous junction of the pectoralis major in an athlete.

IntroductionThe pectoralis major muscle (PM) is a large muscle on the anterior chest wall. The rupture of the PM is a rare entity in literature and most incidences had been reported frequently in weight lifting and contact sports. Acute repair of PM rupture yielded better outcome as compared to non-operative treatment in active individuals who wish to return to their sports.Case reportWe presented a case of a champion in bodybuilding who lifted a heavy weigh during his routine exercises, which caused a rupture in the musculotendinous junction of the left pectoralis major muscle.DiscussionAs it is rare to meet ruptures in this site of pectoralis major, we decided to insert anchors into the humeral bone (as in avulsions and tendon's tears), and to duplicate the suturing levels in multiple directions (as in muscular belly ruptures).ConclusionOur aim here is to confirm that the rupture of the musculotendinous junction of the pectoralis major muscle is rare and difficult to deal, but the acute surgical treatment by inserting anchors into the humerus, and duplicating the suturing layers in multiple directions can give good results especially in athletes.