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Nicola Maffulli, Francesco Oliva, Gayle D Maffulli, Alessio Giai Via, Nikolaos Gougoulias
Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively (p < .001). After a mean follow-up period of 40.5 months, 41 patients had resumed sporting activities at an average of 3...
June 25, 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
H Harman, E Süleyman
AIM: We analyzed the ultrasonographic (US) features of the Achilles tendon (AT), paratenon (AP), and enthesis in patients with axial spondyloarthropathies (SpA) and rheumatoid arthritis (RA), and compared these to healthy subjects. Relationships between these findings and clinical and functional parameters were identified. METHODS: The study included 40 axial SpA and 27 RA patients, as well as 30 healthy subjects. Clinical evaluation relied on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), AS Quality of Life Questionnaire (ASQoL), Disease Activity Score 28 (DAS28), and Health Assessment Questionnaire (HAQ), as well as on a visual analog scale (VAS) for entheseal pain and the Madrid Sonographic Enthesistis Index (MASEI)...
May 9, 2017: Zeitschrift Für Rheumatologie
William T DeCarbo, Mark J Bullock
Noninsertional Achilles tendinopathy often responds to nonoperative treatment. When nonoperative treatment fails, the clinician must distinguish between paratendinopathy and noninsertional tendinopathy. In paratendinopathy, myofibroblasts synthesize collagen, causing adhesions, and the paratenon may be released or excised. If a core area of tendinopathy is identified on MRI, the area is excised longitudinally and repaired with a side-to-side suture. If greater than 50% of the tendon diameter is excised, the authors recommend a short flexor hallucis longus tendon transfer with an interference screw...
April 2017: Clinics in Podiatric Medicine and Surgery
Clare Groves, Muthusamy Chandramohan, Ne Siang Chew, Tariq Aslam, Philip S Helliwell
INTRODUCTION: The purpose of the current study was to examine the painful elbow, and in particular enthesitis, in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) using clinical examination, ultrasonography (US) and magnetic resonance imaging (MRI). METHODS: Patients with elbow pain (11 with PsA and 9 with RA) were recruited. Clinical examination, US and MRI studies were performed on the same day. For enthesitis, the common extensor and flexor insertions and the triceps insertion were imaged (20 patients, giving a total of 60 sites with comparative data)...
June 2017: Rheumatology and Therapy
A Skalec, P Przyborowska-Zhalniarovich, I Janus, K Kirstein, M Mieszkowska, Z Adamiak, A Chrószcz, M Janeczek
In spite of recent advances in treatment protocols, tendinopathies continue to challenge orthopaedists and surgeons. Due to the complexity of both tendon injuries and the healing processes, animal models are essential for addressing fundamental questions in tendinopathy research. Diagnostic imaging could contribute to the evaluation of animal models, thus providing information, which could be translated to human tendinopathies. The objective of our study was to evaluate in situ appearance of the rabbit common calcanean tendon with ultrasonography and magnetic resonance imaging...
September 1, 2016: Polish Journal of Veterinary Sciences
Kadir Buyukdogan, Mahmut Nedim Doral, Onur Bilge, Egemen Turhan, Gazi Huri, Mustafa Fevzi Sargon
OBJECTIVE: The purpose of this study was to investigate the effects of the omentum, peritoneum, paratenon and skeletal muscle on the proliferation of the cartilage tissue using rabbit model as an in vivo culture medium. METHODS: 6 months old forty-five New Zealand rabbits were randomized into omentum, peritoneum, muscle, and Achilles paratenon groups. Standard sized osteochondral grafts were harvested from right knees and immediately placed into the specified tissues...
October 2016: Acta Orthopaedica et Traumatologica Turcica
Paul W Ackermann, Paul Salo, David A Hart
The regulation of tendon metabolism including the responses to loading is far from being well understood. During the last decade, however, accumulating data show that tendon innervation in addition to afferent functions, via efferent pathways has a regulatory role in tendon homeostasis via a wide range of neuromediators, which coordinate metabolic and neuro-inflammatory pathways.Innervation of intact healthy tendons is localized in the surrounding structures, i.e paratenon, endotenon and epitenon, whereas the tendon proper is practically devoid of neuronal supply...
2016: Advances in Experimental Medicine and Biology
Kristian Johansson, Lasse Lempainen, Janne Sarimo, Tiina Laitala-Leinonen, Sakari Orava
BACKGROUND: the origin of chronic Achilles tendinopathy (AT) is currently unclear and epidemiological factors, such as ethnicity, may be associated. METHODS: intraoperative findings from the treatment of 865 Finnish and 156 Italian athletic patients with chronic Achilles tendon related pain were evaluated, retrospectively. The mean age was 34 years (range, 18 to 65 years) in the Finnish and 29 years (range, 17-63 years) in the Italian patients. In total, 786 patients were males and 226 females of which 84 and 87% Finnish, respectively...
January 2016: Muscles, Ligaments and Tendons Journal
Erica Domeij Arverud, Olof Persson-Lindell, Fredrik Sundquist, Fausto Labruto, Gunnar Edman, Paul W Ackermann
INTRODUCTION: Achilles tendon (AT) rupture exhibits a prolonged healing process with varying clinical outcome. Reduced blood flow to the AT has been considered an underlying factor to AT rupture (ATR) and impaired healing. In vivo measurements using laser Doppler flowmetry (LDF) may be a viable method to assess blood flow in healthy and healing AT. METHODS: 29 persons were included in the study; 9 being ATR patients and 20 healthy subjects without any prior symptoms from the AT...
January 2016: Muscles, Ligaments and Tendons Journal
Gabriele Mattiussi, Michele Turloni, Pietro Tobia Baldassi, Carlos Moreno
Background. The anatomy and mechanical properties of the Crural Fascia (CF), the ubiquitous connective tissue of the posterior region of the leg, have recently been investigated. The most important findings are that (i) the CF may suffer structural damage from indirect trauma, (ii) structural changes of the CF may affect the biomechanics of tissues connected to it, causing myofascial pain syndromes, and (iii) the CF is in anatomical continuity with the Achilles paratenon. Consistent with these points, the authors hypothesize that the onset of acute Achilles paratendinopathy may be related to histological and biomechanical changes of the CF...
2016: Case Reports in Orthopedics
Vesna S Rakic
According to Greek mythology, Achilles was fatally wounded in his heel, bled out, and died. Several unproven hypotheses mention poisoning, infection, allergy, hemophilia, thyrotoxic storm (ie, pain and stress), and suicide. The author, a plastic surgeon who often treats chronic wounds, proposes an additional scenario: Although not mortally wounded, Achilles was considered dead, because in his time a wounded hero was as good as a dead hero, so he lived out the remainder of his life as former hero with a chronic wound far away from everyone...
May 2016: Ostomy/wound Management
Ryu Yoshida, Farhang Alaee, Felix Dyrna, Mark S Kronenberg, Peter Maye, Ivo Kalajzic, David W Rowe, Augustus D Mazzocca, Nathaniel A Dyment
Purpose of this study: To elucidate the origin of cell populations that contribute to rotator cuff healing, we developed a mouse surgical model where a full-thickness, central detachment is created in the supraspinatus. MATERIALS AND METHODS: Three different inducible Cre transgenic mice with Ai9-tdTomato reporter expression (PRG4-9, αSMA-9, and AGC-9) were used to label different cell populations in the shoulder. The defect was created surgically in the supraspinatus. The mice were injected with tamoxifen at surgery to label the cells and sacrificed at 1, 2, and 5 weeks postoperatively...
November 2016: Connective Tissue Research
David Saper, Kyle Lybrand, William Creevy, Xinning Li
Soft tissue management, dissection, and handling are of paramount importance during Achilles tendon repair. Although surgical repairs of Achilles tendons have predictably excellent outcomes, complications including wound infection and stiffness are not uncommon. The authors' surgical technique for Achilles tendon repair includes tagging the posterior paratenon for later layered repair and incising the posterior fascia, exposing the flexor hallucis longus muscle belly. This posterior compartment fasciotomy allows for both hematoma evacuation away from the tenuous posterior skin and mobilization of the posterior paratendon for complete closure over the repaired Achilles tendon...
July 1, 2016: Orthopedics
S Kriegelstein, S Altenberger, A Röser, M Walther
BACKGROUND: Endoscopic surgical techniques are nowadays standard procedures in medicine. The advantages of these minimally invasive techniques compared to open techniques are a smaller access route with reduced tissue damage, reduced scarring and often faster postoperative mobilization. Tendoscopy can be used to treat pathologies of tendons as well as of the surrounding tissues. OBJECTIVES: This article presents the advantages of endoscopic treatment of the Achilles tendon compared to open procedures as well as the chances and limitations of tendoscopy...
February 2016: Der Unfallchirurg
Richard Eickler, Stephen J Pomeranz
Achilles tendinitis is a common etiology of heel pain, which is a common patient complaint. Achilles tendinitis can be classified into noninsertional tendinosis and insertional tendinitis on the basis of clinical features, radiologic signs, and pathologic findings. Magnetic resonance imaging (MRI) allows classification and reveals associated findings, including retrocalcaneal bursitis, paratendinitis, and paratenonitis. Furthermore, MRI may not only confirm findings of Achilles tendinitis but also diagnose other etiologies of heel pain...
2015: Journal of Surgical Orthopaedic Advances
Aaron M Kociolek, Peter J Keir
Carpal tunnel syndrome is characterized by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT), a paratenon-like structure inside the carpal tunnel. This pathology suggests repetitive and/or excessive shear forces are involved in injury development. We assessed relative motion between the flexor digitorum superficialis (FDS) tendon and adjacent paratenon in Zone V using colour Doppler imaging as 16 healthy participants completed three long finger movements (metacarpophalangeal joint flexion, proximal and distal interphalangeal joint flexion, full finger flexion) in three wrist postures (30° extension, 0°, 30° flexion)...
July 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Tun Hing Lui
UNLABELLED: The causes of heel cord pain after repair of acute rupture of the Achilles tendon are unclear. The proposed etiologies include nonabsorbable suture granuloma formation, alteration of the pain receptors threshold in the tendon, and distension of the paratenon by the hypertrophied tendon, underlying tendinopathy, postrepair neovascularization, and peritendinous fibrous adhesion. We present an endoscopic technique of adhesiolysis of the Achilles tendon to deal with the various possible causes of postrepair heel cord pain...
October 2016: Foot & Ankle Specialist
Kristian Johansson, Lasse Lempainen, Janne Sarimo, Tiina Laitala-Leinonen, Sakari Orava
BACKGROUND: Nonsurgical treatments for chronic Achilles tendinopathy (AT) results in unpredictable success rates. Surgical treatment may be chosen as reports show mostly encouraging but variable success rates depending on the pathology. The distribution of surgically confirmed pathologies in AT is largely unknown. PURPOSE: To ascertain the distributions of macroscopically observed anomalies in participants undergoing surgical treatment for chronic AT. STUDY DESIGN: Case series; Level of evidence, 4...
December 2014: Orthopaedic Journal of Sports Medicine
Bruce Werber
Introduction. Allogeneic amniotic tissue and fluid may be used to treat chronic plantar fasciosis and Achilles tendinosis. This innovative approach involves delivering a unique allograft of live human cells in a nonimmunogenic structural tissue matrix to treat chronic tendon injury. These tissues convey very positive regenerative attributes; procurement is performed with maternal consent during elective caesarian birth. Materials and Methods. In the present investigation all patients were unresponsive to multiple standard therapies for a minimum of 6 months and were treated with one implantation of PalinGen SportFLOW around the plantar fascia and/or around the Achilles paratenon...
2015: Journal of Sports Medicine (Hindawi Publishing Corporation)
Sameh A Labib, C Edward Hoffler, Jay N Shah, Robert H Rolf, Alexis Tingan
Previous biomechanical studies have shown that the gift box technique for open Achilles tendon repair is twice as strong as a Krackow repair. The technique incorporates a paramedian skin incision with a midline paratenon incision, and a modification of the Krackow stitch is used to reinforce the repair. The wound is closed in layers such that the paratenon repair is offset from paramedian skin incision, further protecting the repair. The present study retrospectively reviews the clinical results for a series of patients who underwent the gift box technique for treatment of acute Achilles tendon ruptures from March 2002 to April 2007...
January 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
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