Revisión narrativa de las roturas de tendón de Aquiles en deportes de raqueta

This review aims to report the existing research about Achilles tendon ruptures (ATR) in racket sports. Further, this narrative review will also include the acute management, rehabilitation, treatment and prognosis of an ATR. ATR is a common injury among individuals playing racket sports, however, the literature is limited and not up to date. Previous research claims that up to 70 percent of all ATR is related to sports activities where racket sports dominate. A large number of patients sustaining an ATR return to sport within a year from injury.Esta revisión pretende cubrir la investigación existente sobre las roturas del tendón de Aquiles (RTA) en los deportes de raqueta. Adicionalmente, esta revisión narrativa también incluirá el manejo agudo, la rehabilitación, el tratamiento y el pronóstico de una RTA. La RTA es una lesión común entre individuos que practican deportes de raqueta, sin embargo, la literatura es limitada y no está actualizada. Investigaciones previas afirman que hasta el 70% de todas las RTA están relacionadas con actividades deportivas donde predominan los deportes de raqueta. Un gran número de pacientes que sufren RTA regresan al deporte en el plazo de un año desde la lesión

No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

PURPOSE: This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients. METHODS: Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation. RESULTS: Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: - 6.9° (5.5), acute: - 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury. CONCLUSIONS: Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair. LEVEL OF EVIDENCE: III

Age and tightness of repair are predictors of heel-rise height after Achilles tendon rupture

Background: Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose: To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair. Study Design: Cohort study; Level of evidence, 3. Methods: From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI. Results: A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m Conclusion: Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation

Acute Achilles tendon rupture - The impact of calf muscle performance on function and recovery

There is an ongoing debate about the optimal treatment for patients with an acute Achilles tendon rupture. The overall purpose of this thesis was to acquire a greater knowledge of the way patients recover at different time points after the injury when treated with the currently recommended treatment protocols. This knowledge will then form the basis of the further development of treatment strategies with the ultimate goal of minimizing the risk of permanent disability after an Achilles tendon rupture. In Study I, a long-term follow-up of 66 patients included in a randomized, controlled trial revealed that, 7 years after the injury, there were continuing deficits in calf muscle endurance and strength. There was no continued improvement in calf muscle performance after the 2-year follow-up, apart from heel-rise height. Study II, a clinical prospective comparative study of a cohort of 93 patients, performed 3 months after the injury, concluded that standardized seated heel-rises were a safe and useful tool for evaluating calf muscle endurance and predicting future function and patient-reported symptoms. No differences in early calf muscle recovery were found between patients treated with surgery and patients treated with non-surgery, but the question of whether women recovered in the same way as men remained unanswered. In Study III, a clinical retrospective comparative study comprising 182 patients, it was found that female patients had a greater degree of deficit in heel-rise height compared with males, irrespective of treatment. Females had more symptoms after surgery, at both 6 and 12 months, but this difference was not found in non-surgically treated female patients. In Study IV, the effect of continued heel-rise height deficits on biomechanics during walking, running and jumping was further evaluated. This study revealed that heel-rise height, obtained during the single-leg standing heel-rise test, performed 1 year after the injury, was related to the long-term ability to regain normal ankle biomechanics. In this cross-sectional study, comprising 34 patients, the conclusion was drawn that minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping. This thesis shows that the early recovery of heel-rise height and calf muscle endurance has a significant impact on lower leg function and patient-reported outcome in the long term after an acute Achilles tendon rupture. No differences in early or late calf muscle recovery were found between patients treated with surgery and patients treated with non-surgery. Furthermore, it is concluded that females have more symptoms after surgery, but this difference is not found in non-surgically treated female patients. This knowledge could now form a new basis for developing more effective, individualized treatment protocols with the aim of optimizing the treatment after an acute Achilles tendon rupture

Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: a retrospective cohort study

Introduction Achilles Tendon Ruptures (ATR) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. Methods The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. Results From February 2009 to August 2023, 556 patients presented with an ATR. Of these 37 (6.7%) were diagnosed with a MT tear. At final follow up, at 12 months following injury, the MT group reported an Achilles tendon Total Rupture Score (ATRS) of mean (Standard Deviation (SD)) of 83.6 (3.5) (95% Confidence Interval (CI) 81.8, 85.4) and median (Inter-Quartile Range (IQR)) ATRS of 86 points (78-95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59-95) (p=0.673). Functional evaluation however, revealed statistically significant differences in mean (SD) heel-rise height index (HRHI) MT group 79% (25) (95%CI 65.9, 92.1) and MS group 59% (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. Conclusions When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. Level of evidence I

The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation

Background: Rupture of the Achilles tendon may result in reduced functional activity and reduced plantar flexion strength. These changes may arise from elongation of the Achilles tendon. An observational study was performed to quantify the Achilles tendon resting angle (ATRA) in patients following Achilles tendon rupture, surgical repair, and rehabilitation, respectively. Methods: Between May 2012 and January 2013, 26 consecutive patients (17 men), with a mean (standard deviation, SD) age of 42 (8) years were included and evaluated following injury, repair, and at 6 weeks, 3 months, 6 months, 9 months, and 12 months, respectively (rehabilitation period). The outcome was measured using the ATRA, Achilles tendon total rupture score (ATRS), and heel-rise test. Results: Following rupture, the mean (SD) absolute ATRA was 55 (8)° for the injured side compared with 43 (7)° (p<0.001) for the noninjured side. Immediately after repair, the angle reduced to 37 (9)° (p<0.001). The difference between the injured and noninjured sides, the relative ATRA, was −12.5 (4.3)° following injury; this was reduced to 7 (7.9)° following surgery (p<0.001). During initial rehabilitation, at the 6-week time point, the relative ATRA was 2.6 (6.2)° (p=0.04) and at 3 months it was −6.5 (6.5)° (p<0.001). After the 3-month time point, there were no significant changes in the resting angle. The ATRS improved significantly (p<0.001) during each period up to 9 months following surgery, where a score of 85 (10)° was reported. The heel-rise limb symmetry index was 66 (22)% at 9 months and 82 (14)% at 12 months. At 3 months and 6 months, the absolute ATRA correlated with the ATRS (r=0.63, p=0.001, N=26 and r=0.46, p=0.027, N=23, respectively). At 12 months, the absolute ATRA correlated with the heel-rise height (r=−0.63, p=0.002, N=22). Conclusion: The ATRA increases following injury, is reduced by surgery, and then increases again during initial rehabilitation. The angle also correlates with patient-reported symptoms early in the rehabilitation phase and with heel-rise height after 1 year. The ATRA might be considered a simple and effective means to evaluate Achilles tendon function 1 year after the rupture

Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures – a systematic review

Abstract Introduction A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft. Methods A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS). Results Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2–13) for all studies. Conclusion Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult. Level of evidence Level IV