The Achilles tendon evolved approximately 2 million years ago to allow humans to run faster. It is prone to injury due to its limited blood supply. A rupture typically occurs when a load is applied while the tendon is stretched, often due to pre-existing tendonitis. Treatment options include operative repair through open surgery or minimally invasive surgery, or non-operative casting and rehabilitation. Rehabilitation programs focus on regaining range of motion and strength over 4-6 months. Future research could investigate genetic risk factors, standardized strength testing for different treatment options, and outcomes of surgery for primary versus recurrent ruptures.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document summarizes the management of scaphoid nonunion bone fractures. It discusses the causes, symptoms, diagnosis and various treatment options for scaphoid nonunion, including non-operative treatments like electrical stimulation and various surgical procedures like bone grafting, vascularized bone grafts, proximal row carpectomy, scaphoid excision and wrist fusion. Key surgical techniques for bone grafting like the Russe, Fernandez and Stark methods are outlined. The goal of treatment is to relieve pain, correct deformity, achieve bone union and prevent the progression to wrist arthritis.
Arthroscopic management of anterior shoulder instability larissa 2016Aaron Venouziou
This document discusses the arthroscopic management of anterior shoulder instability. It provides background on the history and descriptions of anterior shoulder instability. Key factors for a successful arthroscopic stabilization include addressing associated injuries, patient factors, and achieving stable anatomic fixation of the detached anterior capsulolabral complex. The document outlines the surgical technique for arthroscopic Bankart repair including portal placement, diagnostic arthroscopy, preparation and fixation of the Bankart lesion with suture anchors, and management of concomitant injuries like SLAP lesions. Patient selection considerations and treatment algorithms based on the degree of any glenoid or humeral bone defects are also discussed.
Bioabsorbable Implants in Orthopaedics - Dr Chintan N PatelDrChintan Patel
This document discusses bioabsorbable implants used in orthopaedics. It defines bioabsorbable implants as those that gradually degrade through biological processes and are absorbed and excreted by the body. Common materials used include polyglycolic acid and polylactic acid. Bioabsorbable implants offer advantages over metallic implants by eliminating the need for removal surgery and avoiding problems like stress shielding. While offering promise, bioabsorbable implants also have drawbacks like inadequate strength and stiffness. Future areas of development include implants that degrade at medium time periods and ability to deliver drugs locally.
The Achilles tendon is the largest tendon in the body, originating from the gastrocnemius and soleus muscles and inserting on the calcaneal tuberosity. It lacks a true synovial sheath but has a paratenon that allows 1.5cm of tendon glide. The Achilles tendon has the highest risk of rupture between 2-6cm proximal to its insertion, where the tendon is avascular. Ruptures typically occur in athletes aged 30-40 years old and can result from repetitive microtrauma or sudden dorsiflexion injuries. Physical exam findings of a complete rupture include a defect, inability to perform a heel raise, and a positive Thompson test. Treatment
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
Soft Tissue Balancing in Primary Total Knee ArthroplastyIhab El-Desouky
The document discusses principles of soft tissue balancing during primary total knee replacement, including defining soft tissue stabilizers of the knee, techniques for soft tissue balancing like measured resection and gap balancing, and how to manage coronal plane deformities like varus and valgus knees through staged releases of tight soft tissues and bone cuts that create symmetrical flexion and extension gaps.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document summarizes the management of scaphoid nonunion bone fractures. It discusses the causes, symptoms, diagnosis and various treatment options for scaphoid nonunion, including non-operative treatments like electrical stimulation and various surgical procedures like bone grafting, vascularized bone grafts, proximal row carpectomy, scaphoid excision and wrist fusion. Key surgical techniques for bone grafting like the Russe, Fernandez and Stark methods are outlined. The goal of treatment is to relieve pain, correct deformity, achieve bone union and prevent the progression to wrist arthritis.
Arthroscopic management of anterior shoulder instability larissa 2016Aaron Venouziou
This document discusses the arthroscopic management of anterior shoulder instability. It provides background on the history and descriptions of anterior shoulder instability. Key factors for a successful arthroscopic stabilization include addressing associated injuries, patient factors, and achieving stable anatomic fixation of the detached anterior capsulolabral complex. The document outlines the surgical technique for arthroscopic Bankart repair including portal placement, diagnostic arthroscopy, preparation and fixation of the Bankart lesion with suture anchors, and management of concomitant injuries like SLAP lesions. Patient selection considerations and treatment algorithms based on the degree of any glenoid or humeral bone defects are also discussed.
Bioabsorbable Implants in Orthopaedics - Dr Chintan N PatelDrChintan Patel
This document discusses bioabsorbable implants used in orthopaedics. It defines bioabsorbable implants as those that gradually degrade through biological processes and are absorbed and excreted by the body. Common materials used include polyglycolic acid and polylactic acid. Bioabsorbable implants offer advantages over metallic implants by eliminating the need for removal surgery and avoiding problems like stress shielding. While offering promise, bioabsorbable implants also have drawbacks like inadequate strength and stiffness. Future areas of development include implants that degrade at medium time periods and ability to deliver drugs locally.
The Achilles tendon is the largest tendon in the body, originating from the gastrocnemius and soleus muscles and inserting on the calcaneal tuberosity. It lacks a true synovial sheath but has a paratenon that allows 1.5cm of tendon glide. The Achilles tendon has the highest risk of rupture between 2-6cm proximal to its insertion, where the tendon is avascular. Ruptures typically occur in athletes aged 30-40 years old and can result from repetitive microtrauma or sudden dorsiflexion injuries. Physical exam findings of a complete rupture include a defect, inability to perform a heel raise, and a positive Thompson test. Treatment
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
Soft Tissue Balancing in Primary Total Knee ArthroplastyIhab El-Desouky
The document discusses principles of soft tissue balancing during primary total knee replacement, including defining soft tissue stabilizers of the knee, techniques for soft tissue balancing like measured resection and gap balancing, and how to manage coronal plane deformities like varus and valgus knees through staged releases of tight soft tissues and bone cuts that create symmetrical flexion and extension gaps.
Discuss approaches to the knee and Describe in detail TKRSoliudeen Arojuraye
This document discusses approaches to the knee joint and describes the operation of total knee arthroplasty (TKA) in detail. It outlines various approaches to the knee including medial para-patellar, subvastus anteromedial, and anterolateral approaches. It then describes the operative technique of TKA, including preoperative planning, bone cuts of the femur and tibia using cutting guides, and the importance of soft tissue balancing and implant fixation for achieving good results.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
High tibial osteotomy- All you need to knowdocortho Patel
This document discusses high tibial osteotomy (HTO), a surgical procedure to treat varus deformity and medial compartment osteoarthritis of the knee. It outlines the indications, contraindications, surgical techniques, preoperative planning, alignment goals, and complications of HTO. The goals of HTO are to relieve pain, improve function, and extend the life of the knee joint for active patients who are too young for knee replacement surgery. Attention to patient selection, preoperative planning, surgical accuracy, and rehabilitation are important for achieving successful outcomes.
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
The Masquelet technique is a two-stage process for treating bone defects using an induced membrane. In the first stage, radical debridement is performed followed by insertion of an antibiotic-loaded cement spacer and soft tissue coverage. This induces the formation of a membrane rich in growth factors. In the second stage 6-8 weeks later, the spacer is removed and cancellous bone graft is placed within the membrane chamber, which acts as a bioreactor promoting graft healing. The technique provides an alternative to bone transport or vascularized grafts for reconstructing large defects.
Otto Pelvis, also known as primary protrusio acetabuli, was first described by German pathologist Otto in 1824. It is characterized by medial protrusion of the acetabulum. There are two types: primary, which remains a diagnosis of exclusion, and secondary. Clinical features include a marked female predilection and bilateral involvement. Radiographs can identify protrusio using Kohler's line or central edge angle. Management depends on age and degeneration, ranging from valgus osteotomy in younger patients to total hip arthroplasty with grafting in older patients. Surgical techniques aim to restore the hip center through lateralization and reconstruction of bone defects.
This document discusses various foot and ankle deformities and their treatments. It covers deformities including claw toes, cavus deformity, dorsal bunions, talipes equinus, talipes equino varus, and talipes equino valgus. It describes classifications of deformities and discusses tendon transfers, osteotomies, and arthrodesis procedures to correct different types of deformities based on the underlying muscle imbalances. Key considerations for surgical timing and approach are also outlined.
Techniques in primary total knee arthroplastyHBGMedical
This document discusses techniques for balancing the soft tissues during primary total knee arthroplasty. It addresses approaches for correcting varus and valgus deformities, flexion contractures, and recurvatum. The key points emphasized are thoroughly assessing ligament balances and gaps, performing soft tissue releases in a sequential manner, and understanding how bone resections can impact soft tissue tension. Achieving balanced extension and flexion spaces between the medial and lateral sides is critical to surgical success.
This document discusses reconstructive surgery of the glenohumeral joint, including reverse total shoulder arthroplasty. It provides an anatomical overview of the glenohumeral joint and describes the indications, surgical procedure, components, and complications of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasty involves replacing the normal ball and socket articulation with a convex glenoid component and concave humeral cup to improve function and range of motion, especially for conditions involving rotator cuff dysfunction.
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
Total knee replacement involves replacing the knee joint with prosthetic components. Critical elements for success include proper anatomy, biomechanics, soft tissue balancing and alignment. A thorough preoperative evaluation is important. The surgical procedure involves exposing the knee joint through an incision and removing damaged bone and cartilage. Bone cuts are made to prepare the femur and tibia to receive prosthetic components. Proper alignment and soft tissue balancing are crucial. Factors like deformity, bone loss, and patellofemoral tracking must be addressed. Attention to surgical technique and postoperative rehabilitation can provide pain relief and improved function.
Modified sauve kapandji procedure for patients with old fracturesPonnilavan Ponz
The document discusses a study evaluating the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures of the distal radius. The modified procedure involves resection and reinsertion of the distal ulna into the distal radius after a 90-degree rotation. The study reviewed 15 patients who underwent the procedure with at least 7 months of follow up. Results found 80% of patients had excellent outcomes with reduced pain, improved range of motion, and grip strength. The modified Sauve-Kapandji procedure provides an effective treatment for chronic distal radioulnar joint disorders in patients with old distal radius fractures.
Total knee arthroplasty aims to restore mechanical alignment, preserve the joint line, balance ligaments, and maintain the Q angle through various surgical techniques. Restoring mechanical alignment involves cutting the femur and tibia perpendicular to the mechanical axis to allow forces through the knee to pass through the center. This optimizes load sharing and prevents excessive wear. Maintaining the original joint line height is also important for proper knee function and biomechanics. Ligament balancing in both the coronal and sagittal planes is required to achieve stability throughout range of motion.
Triple arthrodesis is a surgical fusion of the subtalar, calcaneocuboid, and talonavicular joints to provide hindfoot stability and alignment and relieve pain. It is used to treat conditions like rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, Charcot-Marie-Tooth disease, neglected clubfoot, poliomyelitis, and tarsal coalition. The Lambrinudi procedure is used for severe clubfoot and involves wedge resections of the calcaneum, talus, and navicular followed by fixation with K-wires, staples or screws. Postoperatively, the limb is immobilized for 6 weeks followed by ankle-foot orthosis use and weight bearing
This document discusses instability after total knee arthroplasty (TKA). It begins by outlining the goals and basic principles of TKA. It then describes the bone cuts made during TKA and emphasizes that resection of the proximal tibia influences both flexion and extension gaps. The document discusses various causes of instability after TKA including improper bone cuts, soft tissue imbalance, and component malpositioning. It provides details on managing different types of instability such as instability in extension, flexion, and mid-flexion. Prevention of instability through proper bone cuts and soft tissue balancing is emphasized.
This document discusses the history and evolution of total hip arthroplasty (THA) and hip replacement component designs. It outlines key developments from the late 19th century experiments with ivory and tissue replacements, to modern THA pioneered by Professor Charnley in the 1960s using bone cement and low friction materials. Current designs aim to restore normal hip biomechanics and include cemented or cementless femoral and acetabular components with various fixation methods and bearing surfaces to reduce wear. Future advances focus on minimally invasive techniques, computer navigation, and developing more durable and compliant bearing materials to improve implant longevity.
The document discusses the anterolateral ligament (ALL) of the knee and its role in rotational stability. While ACL reconstruction can restore anterior-posterior stability, it does not fully restore rotational control. The ALL is found in 97% of knees and acts as an internal rotatory stabilizer. Injury to the ALL can explain residual pivot shift seen after ACL reconstruction and why the pivot shift gets worse over time in ACL-deficient knees. Modified Lemaire's procedure, which adds an extra-articular tendon graft to ACL reconstruction, may help reduce rotational instability and graft failures by restoring the ALL.
This document provides an overview of common ligamentous and tendon injuries around the ankle. It describes the anatomy of the ankle joint and surrounding ligaments. It then discusses the evaluation and treatment of lateral and medial ankle sprains, syndesmotic injuries, ankle dislocations, Achilles tendon ruptures, and peroneal tendon dislocations. For each injury, the document outlines the typical mechanism, clinical findings, imaging evaluation, classification systems, and non-surgical and surgical management approaches.
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
An Achilles tendon rupture is often misdiagnosed as an ankle sprain and may be missed in up to 25% of cases. It most commonly occurs in men during sporting activities and is usually caused by sudden plantarflexion or dorsiflexion of the foot. Treatment involves either non-operative casting or surgical repair, with the latter having a lower re-rupture rate but higher risk of complications. Post-operative rehabilitation has shifted from long immobilization to early range of motion and progressive resistance exercises to limit muscle atrophy.
Discuss approaches to the knee and Describe in detail TKRSoliudeen Arojuraye
This document discusses approaches to the knee joint and describes the operation of total knee arthroplasty (TKA) in detail. It outlines various approaches to the knee including medial para-patellar, subvastus anteromedial, and anterolateral approaches. It then describes the operative technique of TKA, including preoperative planning, bone cuts of the femur and tibia using cutting guides, and the importance of soft tissue balancing and implant fixation for achieving good results.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
High tibial osteotomy- All you need to knowdocortho Patel
This document discusses high tibial osteotomy (HTO), a surgical procedure to treat varus deformity and medial compartment osteoarthritis of the knee. It outlines the indications, contraindications, surgical techniques, preoperative planning, alignment goals, and complications of HTO. The goals of HTO are to relieve pain, improve function, and extend the life of the knee joint for active patients who are too young for knee replacement surgery. Attention to patient selection, preoperative planning, surgical accuracy, and rehabilitation are important for achieving successful outcomes.
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
The Masquelet technique is a two-stage process for treating bone defects using an induced membrane. In the first stage, radical debridement is performed followed by insertion of an antibiotic-loaded cement spacer and soft tissue coverage. This induces the formation of a membrane rich in growth factors. In the second stage 6-8 weeks later, the spacer is removed and cancellous bone graft is placed within the membrane chamber, which acts as a bioreactor promoting graft healing. The technique provides an alternative to bone transport or vascularized grafts for reconstructing large defects.
Otto Pelvis, also known as primary protrusio acetabuli, was first described by German pathologist Otto in 1824. It is characterized by medial protrusion of the acetabulum. There are two types: primary, which remains a diagnosis of exclusion, and secondary. Clinical features include a marked female predilection and bilateral involvement. Radiographs can identify protrusio using Kohler's line or central edge angle. Management depends on age and degeneration, ranging from valgus osteotomy in younger patients to total hip arthroplasty with grafting in older patients. Surgical techniques aim to restore the hip center through lateralization and reconstruction of bone defects.
This document discusses various foot and ankle deformities and their treatments. It covers deformities including claw toes, cavus deformity, dorsal bunions, talipes equinus, talipes equino varus, and talipes equino valgus. It describes classifications of deformities and discusses tendon transfers, osteotomies, and arthrodesis procedures to correct different types of deformities based on the underlying muscle imbalances. Key considerations for surgical timing and approach are also outlined.
Techniques in primary total knee arthroplastyHBGMedical
This document discusses techniques for balancing the soft tissues during primary total knee arthroplasty. It addresses approaches for correcting varus and valgus deformities, flexion contractures, and recurvatum. The key points emphasized are thoroughly assessing ligament balances and gaps, performing soft tissue releases in a sequential manner, and understanding how bone resections can impact soft tissue tension. Achieving balanced extension and flexion spaces between the medial and lateral sides is critical to surgical success.
This document discusses reconstructive surgery of the glenohumeral joint, including reverse total shoulder arthroplasty. It provides an anatomical overview of the glenohumeral joint and describes the indications, surgical procedure, components, and complications of reverse total shoulder arthroplasty. Reverse total shoulder arthroplasty involves replacing the normal ball and socket articulation with a convex glenoid component and concave humeral cup to improve function and range of motion, especially for conditions involving rotator cuff dysfunction.
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
Total knee replacement involves replacing the knee joint with prosthetic components. Critical elements for success include proper anatomy, biomechanics, soft tissue balancing and alignment. A thorough preoperative evaluation is important. The surgical procedure involves exposing the knee joint through an incision and removing damaged bone and cartilage. Bone cuts are made to prepare the femur and tibia to receive prosthetic components. Proper alignment and soft tissue balancing are crucial. Factors like deformity, bone loss, and patellofemoral tracking must be addressed. Attention to surgical technique and postoperative rehabilitation can provide pain relief and improved function.
Modified sauve kapandji procedure for patients with old fracturesPonnilavan Ponz
The document discusses a study evaluating the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures of the distal radius. The modified procedure involves resection and reinsertion of the distal ulna into the distal radius after a 90-degree rotation. The study reviewed 15 patients who underwent the procedure with at least 7 months of follow up. Results found 80% of patients had excellent outcomes with reduced pain, improved range of motion, and grip strength. The modified Sauve-Kapandji procedure provides an effective treatment for chronic distal radioulnar joint disorders in patients with old distal radius fractures.
Total knee arthroplasty aims to restore mechanical alignment, preserve the joint line, balance ligaments, and maintain the Q angle through various surgical techniques. Restoring mechanical alignment involves cutting the femur and tibia perpendicular to the mechanical axis to allow forces through the knee to pass through the center. This optimizes load sharing and prevents excessive wear. Maintaining the original joint line height is also important for proper knee function and biomechanics. Ligament balancing in both the coronal and sagittal planes is required to achieve stability throughout range of motion.
Triple arthrodesis is a surgical fusion of the subtalar, calcaneocuboid, and talonavicular joints to provide hindfoot stability and alignment and relieve pain. It is used to treat conditions like rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, Charcot-Marie-Tooth disease, neglected clubfoot, poliomyelitis, and tarsal coalition. The Lambrinudi procedure is used for severe clubfoot and involves wedge resections of the calcaneum, talus, and navicular followed by fixation with K-wires, staples or screws. Postoperatively, the limb is immobilized for 6 weeks followed by ankle-foot orthosis use and weight bearing
This document discusses instability after total knee arthroplasty (TKA). It begins by outlining the goals and basic principles of TKA. It then describes the bone cuts made during TKA and emphasizes that resection of the proximal tibia influences both flexion and extension gaps. The document discusses various causes of instability after TKA including improper bone cuts, soft tissue imbalance, and component malpositioning. It provides details on managing different types of instability such as instability in extension, flexion, and mid-flexion. Prevention of instability through proper bone cuts and soft tissue balancing is emphasized.
This document discusses the history and evolution of total hip arthroplasty (THA) and hip replacement component designs. It outlines key developments from the late 19th century experiments with ivory and tissue replacements, to modern THA pioneered by Professor Charnley in the 1960s using bone cement and low friction materials. Current designs aim to restore normal hip biomechanics and include cemented or cementless femoral and acetabular components with various fixation methods and bearing surfaces to reduce wear. Future advances focus on minimally invasive techniques, computer navigation, and developing more durable and compliant bearing materials to improve implant longevity.
The document discusses the anterolateral ligament (ALL) of the knee and its role in rotational stability. While ACL reconstruction can restore anterior-posterior stability, it does not fully restore rotational control. The ALL is found in 97% of knees and acts as an internal rotatory stabilizer. Injury to the ALL can explain residual pivot shift seen after ACL reconstruction and why the pivot shift gets worse over time in ACL-deficient knees. Modified Lemaire's procedure, which adds an extra-articular tendon graft to ACL reconstruction, may help reduce rotational instability and graft failures by restoring the ALL.
This document provides an overview of common ligamentous and tendon injuries around the ankle. It describes the anatomy of the ankle joint and surrounding ligaments. It then discusses the evaluation and treatment of lateral and medial ankle sprains, syndesmotic injuries, ankle dislocations, Achilles tendon ruptures, and peroneal tendon dislocations. For each injury, the document outlines the typical mechanism, clinical findings, imaging evaluation, classification systems, and non-surgical and surgical management approaches.
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
An Achilles tendon rupture is often misdiagnosed as an ankle sprain and may be missed in up to 25% of cases. It most commonly occurs in men during sporting activities and is usually caused by sudden plantarflexion or dorsiflexion of the foot. Treatment involves either non-operative casting or surgical repair, with the latter having a lower re-rupture rate but higher risk of complications. Post-operative rehabilitation has shifted from long immobilization to early range of motion and progressive resistance exercises to limit muscle atrophy.
The Achilles tendon is the largest tendon in the body, originating from the gastrocnemius and soleus muscles and inserting on the calcaneal tuberosity. It lacks a true synovial sheath and is surrounded by a paratenon with visceral and parietal layers that allows 1.5cm of tendon glide. The tendon has a blood supply from the musculotendinous junction, osseous insertion, and multiple vessels on the anterior surface of the paratenon. Ruptures most commonly occur in the watershed area 4cm proximal to the insertion in those aged 30-40 years old during eccentric loading. Treatment involves diagnosis, primary care, and either operative
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
The Achilles tendon connects the calf muscles to the heel bone and allows walking, running, and jumping by tightening as the calf muscles contract. Achilles tendon ruptures are most common in recreational athletes aged 30-50 and can result from a sudden forced movement of the foot or overuse. While nonsurgical treatment is a option, surgery is often recommended to repair the torn tendon and speed recovery through physical therapy.
1) Achilles tendonitis is inflammation of the Achilles tendon in the back of the ankle with symptoms of pain when walking, pushing off, or jumping. 2) An Achilles rupture is a complete or partial tear of the Achilles tendon that causes a loud pop and inability to stand on toes. 3) Treatment for tendonitis is rest, ice, and physical therapy while a rupture requires immobilization and possibly surgery followed by a lengthy rehabilitation process.
Achilles tendon repair at the Stone Clinic is often performed percutaneously following a torn achilles tendon injury. This method has proven to be as effective as an open surgical technique while reducing recovery time.
Operative Management of Achilles Tendon Disorders washingtonortho
This document summarizes the operative management of Achilles tendon disorders. It discusses the surgical principles and various pathologic conditions including acute and chronic ruptures, paratenonitis, and tendinosis. For acute ruptures, open repair remains the gold standard but percutaneous repairs are gaining popularity due to smaller wounds and less pain. Chronic ruptures require reconstructive options like V-Y lengthening or tendon transfers depending on the defect size. Paratenonitis is generally treated non-operatively while tendinosis may require resection of degenerated tendon and augmentation. The document emphasizes surgical pearls like avoiding tight closures to prevent hematoma and infection.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In a single sentence, it pitches the idea of using Haiku Deck to easily create and publish online presentations.
Achilles was the greatest warrior in Homer's Iliad. He was the son of the water nymph Thetis and was dipped in the River Styx as a child, which made him invulnerable everywhere except for his heel. Achilles had an excessive pride that caused him to refuse to fight in the Trojan War at first. He was known for his rage and arrogance on the battlefield. After killing Hector, he dragged the body behind his chariot. Achilles' relationship with Briseis and his death of Patroclus drove much of his actions in the war.
The document provides background information on the Mycenaean civilization that existed during the late Bronze Age in Greece, including key events and figures associated with the Trojan War story. It discusses the decline of the Mycenaean civilization and introduces some aspects of Mycenaean culture such as government, social classes, food, wine, music, clothing, and jewelry. The Mycenaean civilization was ruled by kings and had a hierarchical social structure with slaves at the bottom. Music, banquets, and wine played important roles in their culture. Clothing generally consisted of simple tunics and other garments while soldiers wore protective armor and gear into battle.
Plantar fasciitis is a painful foot condition caused by inflammation of the plantar fascia, a thick band of connective tissue that runs along the bottom of the foot. It is most commonly caused by overuse from activities like long-distance running or jobs requiring prolonged standing. Symptoms include pain in the heel or bottom of the foot, especially first thing in the morning or with long periods of standing or walking. Conservative treatments like rest, stretching, orthotics, night splints, and steroid injections are usually effective in reducing pain and inflammation. Surgery is only considered if conservative treatments fail to provide relief after several months or years.
Agamemnon was the king of Mycenae in Greece in the 6th century BC. He led the Greek forces in the Trojan War against Troy after a curse could only be lifted by sacrificing his daughter Iphigenia. During the war, Agamemnon's wife Clytemnestra took a lover named Aegisthus. When Agamemnon returned home from the war victorious, Clytemnestra and Aegisthus killed him in revenge for Iphigenia's death. Their murder of Agamemnon was later avenged by Agamemnon's son Orestes.
W.H. Auden's poem "The Shield of Achilles" contrasts the idealized scenes depicted on the shield of Achilles in Homer's Iliad with the brutal realities of the modern world. When Achilles' mother Thetis asks the god Hephaestus to craft a new shield for her son, she envisions depictions of peace, rituals, and athletic games. However, Hephaestus instead covers the shield with disturbing images representing the meaningless violence and dehumanization of Auden's 20th century. The poem criticizes those who glorify war and reflects on how far the world has strayed from Homeric ideals of heroism.
1) The document describes the conflict between Achilles and Agamemnon in Homer's epic poem The Iliad. Achilles, the greatest of the Greek warriors, challenges Agamemnon's leadership over the Greek armies during the Trojan War.
2) Their struggle for power costs thousands of Greek and Trojan soldiers their lives but also provides a timeless lesson about the moral dimensions of politics.
3) The Iliad focuses on Achilles' withdrawal from battle after being dishonored by Agamemnon, and how this turn of events impacted the outcome of key battles in the Trojan War. It explores the character development of Achilles and the human themes of honor, grief, and compassion
This document discusses plantar fasciitis, a common cause of heel pain. It begins by explaining that plantar fasciitis is pain in the heel and arch of the foot, especially upon waking or with the first steps of the day. It then covers the typical symptoms of plantar fasciitis such as heel pain that is worst with the first steps and located inside the arch or central heel. The document discusses that plantar fasciitis is often caused by activities like running that put too much stress on the feet too quickly, hard surfaces, or old shoes without proper support. It concludes by outlining common treatment options for plantar fasciitis that can be done at home or in the doctor's office, such
Agamemnon was the king of Mycenae and Argos who commanded the Greek forces during the Trojan War. He sacrificed his daughter Iphigenia to appease the goddess Artemis to allow the expedition to sail to Troy. During the war, he led the Greeks to several victories but faced setbacks due to conflicts with Achilles. Upon his return home, Agamemnon was murdered by his wife Clytemnestra and her lover Aegisthus, leading to further revenge killings by his son Orestes.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Operative versus non-operative treatment of Achilles tendon ruptures remains controversial. While non-operative treatment with functional rehabilitation can have re-rupture rates as low as 2.8%, multiple studies have found no significant differences in outcomes between operative and non-operative treatment when both utilize accelerated functional rehabilitation protocols. For younger athletes and those unable to comply with strict non-operative rehabilitation, surgery may be preferred to lower the risk of re-rupture. Minimally invasive percutaneous repairs have gained popularity due to lower wound complication rates compared to open surgery, but care must be taken to avoid injury to the nearby sural nerve during percutaneous techniques. Post-operative rehabilitation emphasizing early weight bearing and range of motion appears
This document provides an overview of a physical therapy course on total hip rehabilitation. The course objectives are to understand hip surgery and exercises, describe hip biomechanics, and effectively progress patients through rehabilitation. The schedule covers topics like evidence-based practice, anatomy, exercises, and outcome measures. Recent advances in hip rehabilitation include smaller incisions, reduced hospital stays, and early mobilization leading to better short-term outcomes. Assessment tools for hip function include the Lower Extremity Function Scale and Harris Hip Score.
The document summarizes a case of a 29-year-old male patient referred to physical therapy with complaints of gradually developed right knee pain, increased stiffness with activity, mild swelling, and occasional popping sound while climbing stairs. The patient is an avid long distance runner covering 10 miles 4 days a week and occasionally does biking. The physical therapist suspects possible right iliotibial band syndrome based on the patient's medical history and symptoms affecting his normal exercise routine.
The document discusses rehabilitation after ACL reconstruction surgery. It begins with an introduction noting that ACL tears are a common sports injury. It then covers knee anatomy, the anatomy and biomechanics of the ACL, surgical treatment, and post-operative rehabilitation phases and techniques. The rehabilitation process involves regaining range of motion and quadriceps strength in early phases, advancing to sport-specific drills, with a focus on gradually increasing loads on the knee through strengthening and proprioceptive exercises.
Effects of ACL injuries on female performanceAmtulS24
Effect of ACL injuries on female performance which help to reduce chances of injuries on female and increase performance in physical activities and athletic events.
Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints like the knee and hip. It has multiple causes but is generally attributed to normal wear and tear over time. Knee osteoarthritis symptoms include pain, swelling, stiffness, and reduced mobility. Treatments include medications, physical therapy, bracing, and knee replacement surgery for severe cases. Knee replacement surgery involves removing damaged bone and cartilage and replacing them with artificial implants. Extensive physical therapy is then needed for rehabilitation and recovery of strength and mobility.
See discussions, stats, and author profiles for this publicati.docxedgar6wallace88877
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Cruciate ligament loading during common knee rehabilitation exercises
Article in Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine · September 2012
DOI: 10.1177/0954411912451839 · Source: PubMed
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Polio can cause muscle weakness and paralysis, especially in the legs. A modular knee ankle foot orthosis (KAFO) was designed with a spring cable placed above the knee to help lock and unlock the stance control knee joint. This allows patients to walk more naturally by providing stability during standing and swinging the leg freely during walking. Test results found patients could easily lock and unlock the KAFO and walk with better balance and load distribution through their joints.
The carrying angle of the elbow is the angle between the longitudinal axes of the upper arm and forearm. It averages 13.6 degrees in females and 6.7 degrees in males. The carrying angle increases progressively from childhood to age 16 and plays an important role in activities of daily living. Abnormal carrying angles outside of 5-15 degrees can indicate conditions like cubitus valgus or varus. Repetitive overhead motions like throwing can place stress on the medial elbow ligaments and lead to injuries or tears over time. Accurate measurement and assessment of the carrying angle is important for managing elbow injuries and planning reconstructive surgeries.
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The slide is about the prosthetic devices. how they are design and implemented along with the relation with the biomechanics. We have also discuss about the scenario in context of nepal.
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Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
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1) Pelvic fractures usually result from high-velocity trauma like car accidents or falls and involve bones in the pelvis joining at the pubis, ischium, and ilium.
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3) Imaging like x-rays and CT scans are used to classify the fracture using systems like Young's, Tile's or Apley's to guide treatment.
4) Physical therapy plays an important role in pelvic fracture recovery by reducing pain, improving hip and leg movement, strength, and balance through a personalized home exercise program to help return to normal activities
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Total knee replacement is a salvage procedure in orthopaedic surgery to provide a painless, mobile and stable knee joint to improve quality of life of patients suffering from afvanced painful arthritis commonly osteoarthritis, rheumatoid arthritis and rarely post-traumatic arthritis. Damaged cartilages and bones are carefully removed by measured resection and the collateral ligaments are preserved and balanced for creating a equal gap both in knee flexion as well as in knee extension for restoring anatomy. the main indication for doing total knee replacement is pain relief. The overall functional outcomes in terms of functional results are good after total knee replacement. Wound infection must be prevented by strict aseptic precautions during surgery.
Postural supports and Custom Wheelchair Seating Veronica206
Postural supports in wheelchairs are important to ensure proper positioning and function. Examples of postural supports include the seat, backrest, footrests, and armrests. A client-centered approach involving the client, caregivers, and therapist is important for selecting the appropriate wheelchair and seating system. Proper positioning can reduce complications like pressure sores and respiratory issues by supporting the trunk and allowing for full expansion of the lungs. Armrests in particular can assist with more efficient breathing by keeping the arms in a closed-chain position.
Reversing the Trend- Newer Types of Shoulder Replacementcoreinstitute
Recently, there has been much discussion about a relatively new type of shoulder replacement, which offers patients the prospects of pain relief and better shoulder function. View this presentation to learn more about this shoulder replacement surgery.
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This document discusses flexibility and movement. It explains that tightness can be caused by sedentary lifestyles, injury, poor nutrition, and age. Research shows that stretching provides flexibility gains, especially for tighter muscles, though regular stretching may provide more performance benefits than pre-exercise stretching. Myofascial release techniques like self-massage and foam rolling can improve range of motion and reduce muscle soreness. A comprehensive flexibility program incorporates assessment, exercises to address muscle imbalances, self-myofascial release, stretching, and functional movement training.
This document provides an overview of total hip replacement surgery. It describes the anatomy of the hip joint and causes for hip replacement, including osteoarthritis and fractures. The surgical procedure is explained in steps, from removing the femoral head to inserting the new components. Post-operative rehabilitation and potential complications are also outlined. The document concludes with references for additional information.
2. EVOLUTIONARY PURPOSE?
o Evolved approximately 2 million years ago & designed to allow humans to
run twice as fast.
o Advantages:
- Strongest tendon in the body
- Energy saving mechanism to allow fast locomotion
- Allows jumping and running
- Acts as a spring and shock absorber
o Why is it that it is so prone
to injury?
4. ENERGY SAVING
The Achilles is an important elastic energy store.
The plantaris muscle and tendon return >90% of the energy store.
Kinetic energy lost at one stage during gait is converted to elastic strain in the
plantaris muscle
Returned later as elastic recoil to the Achilles
This way, we save more than half of the metabolic energy
otherwise needed for locomotion.
5. STRENGTH
The Achilles is composed of collagen fibres that spiral
downwards, with medial fibres passing posteriorly
Responsible for the tendons elastic properties
Allows the tendon to act as a spring and shock absorber
Can be subjected to up to 3-12 times a persons body weight
during a sprint or push-off
6. WHEN DOES A RUPTURE OCCUR?
An Achilles tendon rupture typically occurs when a load is being
applied while the tendon is stretched.
It is believed that the main cause is most likely to be pre existing
degeneration – mainly Achilles tendonitis
7. PATHOLOGY
An evolutionary disadvantage to the Achilles tendon is it’s
vascularity
This is a factor that generally causes tendinosis
Healthy tendons are composed of 95% Collagen 1 fibres
Collagen 111 fibres (< tensile strength) replace torn collagen 1 fibres
Causes an incomplete repair process that can have detrimental
effects
In many cases, a concentric load is applied to the tendon followed
quickly by an eccentric load (such as running backwards)
9. PATHOLOGY
One study by Ribbans & Collins (2013) has highlighted that the
incidence of acute and chronic Achilles tendon conditions may be
due to genetic elements
The ABO blood group most likely to be a biochemical marker
N-acetylgalactosamine transferase activity
Gene for the O blood group is in close proximity to genes whose
protein products are directly involved in the biology and pathology of
Achilles tendonitis
Major sports companies are increasingly involved in
screening athletes for their relative risk of contracting an
injury
10. DIAGNOSIS
Can be misdiagnosed & neglect
can be severe due to the
insufficient repair system.
Swelling & pain (sometimes
severe)
Often hear a ‘pop’ or have a
feeling of something hitting the
back of the leg
Weakness with walking
Thompson’s Test
11. ACHILLES TENDON IN ATHLETES
o Several studies have attributed a larger
Achilles tendon to those who frequently
exercise.
o Ying et al. compared the tendons thickness and
cross sectional area between subjects who
exercised frequently (at least 2 hrs exercise 3x a
week) and those who didn’t.
o Significantly thicker Achilles tendons
o Significantly higher cross-sectional area in
dominant foot
13. TREATMENT OPTIONS
Operative
Percutaneous Surgery
o Re-approximation of Achilles
tendon using sutures
Open Surgical Repair
o Incision is made and Achilles is
sutured directly
Non-operative
o Casting & splinting regimens to
gradually heal the Achilles
tendon
15. TREATMENT OPTIONS
Treatment
Type
Advantages Disadvantages
Percutaneous
Surgery
• Minimal rate of infection
• ~80% of people can return to pre-
rupture activities
• High rates of sural nerve
entrapment
• Some studies suggest higher rates
of re-rupture than open surgery
• Costly
Open
Surgical
• Lowest re-rupture rates (1.7-
5.6%)
• Increased post-operative muscle
strength, power & endurance
• Most advantageous for young,
athletic individuals
• Deep infections
• Deep vein thrombosis
• Fistulae & drainage problems
• Necrosis of the skin/tendon
• Costly
Non-
operative
• Low cost
• No wound complications
• Some research reports re-rupture
rates as high as 40%
• More difficult for surgical repair
after re-rupture
• Tendon edges may heal in an
elongated position resulting in
decreased ROM of the ankle as
well as power & endurance
16. REHABILITATION
Following surgery:
o Following immobilization, patients begin active or active-assisted ROM
o In most cases, patients can progress to pre-injury activity levels in 4-6 months
Non-operative rehabilitation:
o Following cast removal, 2-cm heel lift is worn 2-4 months and rehabilitation program
is initiated
o Exercises include:
Time Frame Exercise
2-4 weeks (post op.) Pain-free active ankle ROM, hip & core strengthening
4-8 weeks (post op.) Frontal & sagittal plane stepping drills, gentle stretching, static
balance exercises, ankle strengthening with resistive tubing,
active ankle ROM
8 weeks (post op.) Multi-plane proprioceptive exercises, single leg stand, functional
movements (ie. Squat & lunges)
4 months (post op.) Impact control exercises, movement control exercises,
progression into sport/work related proprioceptive exercises,
stretching to avoid muscle imbalances
(UW Health Sorts Medicine Centre,
17. PREVENTATIVE MEASURES
Stretch & Strengthen
o Feel a noticeable pull, but not pain
o Do NOT bounce in the stretch
Alternate High Impact Sports
o Switch between high and low
intensities
Increase Training Intensities
Slowly
o Abruptly increasing intensity
commonly causes Achilles injuries
Choose Running Surfaces
Carefully
o Avoid slippery surfaces
18. FUTURE RESEARCH OPTIONS
1) Strength analysis of the calf muscles during rehabilitation are often not
comparable between studies due to differences in data collection. Studies
should be performed with standardized testing and larger sample sizes to
give the health field a better idea (less controversy) over which treatment
option is best for each individual.
2) Newer studies should be performed on those who opt for the non-operative
treatment due to the inconsistent findings of re-rupture rates (some ranging
from 5-40%) in many studies. Larger sample sizes would also be more
useful in representing probability.
3) Studies pertaining to the results of patients who undergo surgery upon the
first rupture of the achilles tendon versus those who undergo surgery upon
re-rupture should be performed. There is controversy in many studies about
which would be most beneficial when taking risks and benefits into account.
19. WHAT DO YOU THINK?
One study focused on the genetic factors that can be traced in
athletes that are suggested to be at higher risk of incurring an
Achilles rupture. Blood tests are being used increasingly more by
major sports companies to ‘Profile’ athletes based on these studies.
Do you think this should be a deciding factor for athletes looking to
make it big? Is it ethical?
Achilles ruptures can be very detrimental to the physical activity
levels of athletes; if the original resting length of the tendon changes
during the healing process, the force-tension relationship decreases
functional strength of the muscles. Knowing this, do you think
chances of re-rupture would be greater for those who choose the
non-operative option?
20. REFERENCES
Jacobs, B., Lin, D., & Schwartz, E. (October, 2012 10). Achilles tendon rupture treatment &
management. Retrieved from http://emedicine.medscape.com/article/85024-treatment
Poinier, A., & Bardana, D. (January, 2011 03). Surgery for an achilles tendon ruptur .
Retrieved from http://www.webmd.com/a-to-z-guides/surgery-for-an-achilles rupture
UW Health Sorts Medicine Centre. (2011). Rehabilitation guidelines for achilles tendon
repair. Retrieved from http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-
27399_AchillesTendonProtocol.pdf
http://www.mayoclinic.com/health/medical/IM04167
Editor's Notes
Injury to the achilles tendon is the 3rd most common major tendon disruption after rotator cuff tears and knee tendon injuries.
75-85% of these tears associated with athletic activity.
I will explore what current literature determines as predisposition to achilles ruptures, the relevant anatomy, surgical and rehabilitation procedures.
Achilles tendon extends from three posterior muscles of the leg including: the gastrocnemius, soleus & plantaris muscles which are all powerful flexors. These muscles combine at the achilles tendon and insert on the calcaneous tuberosity of the foot.
Gastrocnemius –making up the bulk of the calf it is vital in sports to propel us forward while walking, running and jumping.
Soleus – contains higher proportion of slow fibres and is very important posturally to help us prevent forward fall when we’re standing.
This image shows us the function of the Achilles for our walking capabilities. When our calf muscles contract, our heel lifts via the achilles.
This image shows the makeup of the Achilles tendon. It contains the Paratenon which replaces what would be a normal tendon sheath and is a soft tissue layer that surrounds the Achilles tendon allowing it glide during motion.
Means that as the tendon is stressed, the strain is taken up and a recoil effect is produced.
Around the mid section of the tendon, there is a decrease in the total area of blood vessels.
…..detrimental effects to the elastic component of the Achilles.
Eccentric = applying load while muscle is stretched
Concentric = applying load while muscle is shortened
Other contributing factors that are talked about in the many studies I read were things such as: calf flexibility, ankle ROM, fitness, proper warm up, and being between the age of 30-50.
Biochemical marker….the same study found a reduced incidence of rupture in patients with the A blood group.
Transferase activity…..is requireed for balanced composition of the matrix of connective tissue, bone & cartilage in our bodies. This activity is low in individuals with the O blood group
-Stump necrosis of the tendon fibres may occur which can lead to muscle atrophy of the gastrocnemius-soleus complex.
Patient lies facedown on a table and the calf muscle is squeezed. If the tendon is still intact, the foot will flex….if the tendon has a complete tear, the foot will not move.
Ying…the exercise group had:
Suggests that there is a relationship between fast locomotion (to be a benefit to the hunter/gatherers OR athletes in our day and age) and the physical structure of the tendon.
In contradiction….thicker tendons are more susceptible to injury and therefore athletes more prone than inactive subjects.
So I looked into a few professional athletes that have recently experienced achilles tears…
#1) Kobe Bryant – he experienced a full rupture when landing while his achilles was fully stretched. He underwent open surgery which he posted to the world via Instagram and he’s predicted to come back for the next line-up.
#2) Erik Karlsson – “apparently” a major NHL defensemen for the Ottawa Senators. His Achilles was sliced ~70% during this fluke ‘accident’ from the other player stepping down on the back of his heel. Underwent surgery to accelerate healing although much faster than complete tear (also expects to be back in the game)
#3) David Beckham – complete tear, retired from the game on a professional level.
Percutaneous: 6 stab wounds are made where sutures are passed through by needle point. The distal and proximal ends of the ruptured tendon are approximated while the foot is held in full dorsiflexion. The sutures are tied and cut then pushed subcutaneously. Patients are placed in casts for up to 8 weeks post-surgery.
Open: After palpation of the rupture gap, an incision is made through skin and subcutaneous fat to the paratenon. This is cut longitudinally to expose the ruptured tendon ends. The ends are reapproximated and sutured together. These may sometimes be augmented by a fascial graft OR woven tendon graft *MUST be careful not to overtighten as the length of the Achilles is optimized for human movement.
Non-operative: Usually a short leg cast is applied while the ankle is in slight plantar flexion. Theoretically the achilles tendon ends are better apposed for healing purposes. This is worn for ~4-6 weeks. After removal, a 2-cm heel lift in the shoe is worn for 2-4 months and a rehabilitation program is initialized.
There is controversy in the literature about whether a rupture should be treated surgically on the first rupture or upon re-rupture of the Achilles.
All cases first involve immobilization of the ankle joint via casting or splinting to allow the tendon to heal. One study mentioned that the relative tendon pain before surgery was a factor for how quickly the tendon healed post surgery (this wasn’t replicated in any other studies).
Exercises (after cast removal are generally similar for both groups and include…)
Calf strengthening will allow the muscle to absorb more force through the tendon.
Such as running with lower intensity such as biking, walking or swimming…..also avoid such activities as hill running which can place excessive force on the achilles.
Think about trying to return to previous sport/activity & decreased power/endurance. Maybe more psychological? Age factor? Maybe learn to use different techniques? How the muscle is trained?