Achilles Tendon and Athletes

Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pathologies vary from tendinopathy to frank rupture. Diagnosis is made clinically. Imaging modalities are used adjunctively. Management of AT rupture in athletes is challenging to surgeons due to worldwide growing popularity of sports and potential social and financial impact of AT injury to an athlete. Hence, new surgical techniques aim at attaining quick recovery with good outcome, finding similar results with both open and percutaneous techniques when accompanying these with functional rehabilitation protocols. Non-operative strategies include shoe wear modification, physiotherapy and extracorporeal shock wave therapy. Surgical interventions vary based on the AT pathology nature and extent. Direct repair can work for small-sized defects. V-Y gastrocnemius advancement could approximate the tendon edges for repair within 2–8 cm original gap. Gastrocnemius turndown can bridge tendon loss > 8 cm. Autogenous, allogeneous or synthetic tendon grafts were used for AT reconstruction purposes. In AT tendinopathies with no tendon tissue loss, surgical procedures revolve around induction of tissue repair through lesion incision or debridement to full detachment followed by reattachment. Extra-precautions are exercised for prevention of AT disorders especially among susceptible athletes participating in sports involving excessive AT strain

Risk of anterior cruciate ligament injury in population with elevated body mass index

Aim Anterior cruciate ligament (ACL) injury is among the most common orthopaedic injuries. The elevated body mass index (BMI) can contribute to non-contact ACL injury. This study aims to assess the risk of ACL injury among elevated BMI population people (BMI ≥25 Kg\m2). Methods This is a cross sectional study that was conducted in a tertiary care centre in the Kingdom of Saudi Arabia. A total of 302 patients, who had an ACL reconstruction surgery in a ten-year-period (January 2008 to December 2018) were included. Results Sport related injury is significantly higher among the overweight and obese groups (p=0.002). Moreover, the combined ACL tear was higher among the overweight and obese groups (p=0.001). In univariate regression analysis for the selected baseline characteristics, it was found that individuals with higher BMI have chance to develop combined (ACL) injury 2 times higher when compared to those with isolated ACL injury (p=0.003). Also, the ACL type, mode of injury, types of injury and type of sports were statistically significant in univariate regression analysis. However, only the mode of injury was statistically significant after controlling the confounding factors. Other selected variables like type of sport, type of injury and ACL type were not significant. Conclusion Elevated BMI was associated with a higher risk of developing combined ACL tear as well as reinjured individuals

Magnetic Resonance Imaging (MRI): Emphasis may be Placed on New Developments in MRI Techniques, such as Functional Magnetic Resonance Imaging (FMRI) or Dynamic Contrast-Enhancing MRI (DCE-MRI)

Magnetic Resonance Imaging (MRI) has revolutionized medical diagnostics by providing detailed images of soft tissues without using ionizing radiation. In recent years, there has been a growing emphasis on advancing MRI techniques to enhance both anatomical and functional imaging capabilities. Two notable developments are **functional MRI (fMRI)** and **dynamic contrast-enhanced MRI (DCE-MRI) Functional MRI (fMRI) - Principles: fMRI detects changes in blood flow associated with neural activity. It relies on the blood-oxygen-level-dependent (BOLD) contrast. - Applications: - Brain mapping: Identifying regions responsible for motor, language, and memory functions. - Cognitive neuroscience: Investigating brain processes during tasks. - Neurological disorders: Assisting in epilepsy surgery planning and tumor localization. - Challenges: Addressing spatial and temporal resolution limitations and minimizing motion artifacts. Dynamic Contrast-Enhanced MRI (DCE-MRI) - Mechanism: DCE-MRI uses gadolinium-based contrast agents to assess tissue vascularity and permeability. - Clinical Applications: - Brain tumors: Characterizing neoplastic lesions and predicting treatment response. - Head and neck cancer: Early recurrence detection and treatment guidance. - Quantitative Analysis: Efforts toward standardization and refinement continue

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Management of Ankle Charcot Neuroarthropathy: A Systematic Review

Background: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. Methods: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. Results: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. Conclusions: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice

Anatomical Lateral and Medial Ligament Reconstruction in Rotational Chronic Ankle Instability

Category: Sports. Introduction/Purpose: Rotational (combined lateral and medial) chronic ankle instability (CAI) can present with pain and tenderness at the ankle joint, and can be associated with feeling of giving way, repetitive sprains, and life quality limitation. In case of surgery, anatomical reconstruction of the ligaments and treatment of comorbidities are essential for a solid outcome. Methods: A retrospective chart review of 81 rotational CAI patients (average age: 35.3 years, age range: 16-64; right sided: 41(50.6%); left sided: 40(49.4%)) was performed. The average latest follow-up visit was 10.8 months (range: 3-47 months). The patients underwent in our center a standardized surgical treatment protocol. Following diagnostic ankle arthroscopy, a combined lateral and medial anatomical ligament reconstruction was performed. Hindfoot realignment procedures and treatment of associated pathologies (such as talar osteochondral lesions) were carried out at the same time. Postoperatively, all patients were mobilised with partial weight bearing (15 kg) for six weeks in an Aircast walker ® (DJO, LLC, USA). Adequate postoperative analgesia and physiotherapy were initiated. Results: Combined lateral and medial ligament reconstruction without additional surgeries was performed in 20 cases (24.7%). In the other cases, to address associated pathologies, additional surgeries were performed, such as: lateral calcaneal lengthening osteotomy (LCLO) in 42 cases (51.9%), medial sliding calcaneal osteotomy (MSCO) in 3 Cases (3.7%), osteochondral lesion reconstruction in 20 cases (24.7%), peroneal tendon pathology treatment in 3 cases (3.7%), cavovarus foot correction in 1 case (1.2%), supramalleolar osteotomy in 1 case (1.2%), and calcaneonavicular coalition excision in 1 case (1.2%). The outcome variables will be presented at the conference. Conclusion: Anatomical lateral and medial ligament reconstruction of rotational CAI is a safe surgical treatment and leads to a favourable outcome. Beside the ligament reconstruction, associated comorbidities, as malalignment, osteochondral lesions, and others, have to be addressed at the same surgery to achieve physiological biomechanics and a complete pain relieve

Prevalence and perception of HPV vaccination among health science students in Saudi Arabia

Objective: This study was carried out to assess the prevalence and perception of human papilloma virus (HPV) vaccination in health science students in Majmaah University, Saudi Arabia. Methodology: A descriptive cross-sectional study was conducted at different health science colleges of Majmaah University on female students. The knowledge of the participants regarding HPV was assessed using a pre-tested questionnaire. The history of vaccination of these female participants was also enquired. Results: More than three-fifth of the participants had heard about HPV. Of these, 83 participants, 59 (71.1%), were aware that it is a disease of women and how to diagnose it. Most participants (86.7%) knew that it can cause cervical cancer, while only 57.8% knew it could be asymptomatic. There were 18% of such participants who thought that HPV and human immunodeficiency virus are the same and that there is no vaccine for the prevention of HPV. Only 14.5% (n = 12) were vaccinated against HPV. Conclusion: A clear gap between knowledge and practice of HPV vaccination was observed, and health education should be planned to educate health professionals to avoid misconceptions