Achilles Tendon

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Nicola Maffulli - One of the best experts on this subject based on the ideXlab platform.

  • chronic Achilles Tendon disorders tendinopathy and chronic rupture
    Clinics in Sports Medicine, 2015
    Co-Authors: Nicola Maffulli, Francesco Oliva
    Abstract:

    Abstract Tendinopathy of the Achilles Tendon involves clinical conditions in and around the Tendon and it is the result of a failure of a chronic healing response. Although several conservative therapeutic options have been proposed, few of them are supported by randomized controlled trials. The management is primarily conservative and many patients respond well to conservative measures. If clinical conditions do not improve after 6 months of conservative management, surgery is recommended. The management of chronic ruptures is different from that of acute ruptures. The optimal surgical procedure is still debated. In this article chronic Achilles Tendon disorders are debated and evidence-based medicine treatment strategies are discussed.

  • the Achilles Tendon resting angle as an indirect measure of Achilles Tendon length following rupture repair and rehabilitation
    Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology, 2015
    Co-Authors: Michael R Carmont, Nicola Maffulli, Karin Gravare Silbernagel, Annelie Brorsson, Nicklas Olsson, Jon Karlsson
    Abstract:

    Abstract 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 p p p =  0.04) and at 3 months it was −6.5 (6.5)° ( p p 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.

  • reliability of Achilles Tendon resting angle and calf circumference measurement techniques
    Foot and Ankle Surgery, 2013
    Co-Authors: Michael R Carmont, Gravare K Silbernagel, Y Mulji, Alexandre Mathy, Jon Karlsson, Nicola Maffulli
    Abstract:

    Abstract Background The resting angle of the ankle joint may be altered following apparently successful management of Achilles Tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined. Methods Three test–retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females. Results The mean left Achilles Tendon Resting Angle was mean 50.1° (range [26–61]), ICC 0.92 (CI [0.83–0.97]), SEM 2.4°. The mean right Achilles Tendon resting angle was mean 49.9° (range [26–60]), ICC 0.91 (CI [0.80–0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5cm (range [33.3–44.2]), ICC 0.97 (CI [0.94–0.98]), SEM 0.6cm, and the mean right calf circumference was mean 38.4cm (range [33.3–43.6]), ICC 0.97 (CI [0.94–0.99]), SEM 0.5cm. Conclusions The Achilles Tendon Resting Angle and Calf Circumference at 15cm from the antero-medial joint line had excellent test–retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with Tendon elongation and functional outcome. The Achilles Tendon resting angle may be used as a guide to Tendon length during intra-operative repair and rehabilitation

  • z shortening of healed elongated Achilles Tendon rupture
    International Orthopaedics, 2012
    Co-Authors: Nicola Maffulli, Filippo Spiezia, Umile Giuseppe Longo, Vincenzo Denaro
    Abstract:

    Purpose A rupture of the Achilles Tendon may heal in continuity, resulting in a lengthened Achilles Tendon. The elongated structure must be shortened to restore effective push off. We report the results of a longitudinal study using Z-shortening of ruptured Achilles Tendons that healed in continuity but were elongated.

  • free gracilis Tendon graft for reconstruction of chronic tears of the Achilles Tendon
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Nicola Maffulli, Vittorino Testa, Giovanni Capasso, Filippo Spiezia, Umile Giuseppe Longo, Vincenzo Denaro
    Abstract:

    Background: Chronic tears of the Achilles Tendon with a Tendon gap exceeding 6 cm are a surgical challenge. The purpose of this study is to report the long-term results of reconstruction of such chronic Achilles Tendon ruptures with use of a free autologous gracilis Tendon graft. Methods: Twenty-one patients underwent reconstruction of a chronic rupture of the Achilles Tendon. Fifteen patients were available for clinical and functional assessment on the basis of anthropometric measurements, isometric strength testing, and the Achilles Tendon Total Rupture Score after a mean duration of follow-up of 10.9 years (range, eight to twelve years). Results: All fifteen patients were able to walk on the tiptoes, and no patient used a heel lift or walked with a visible limp. At an average of 10.9 years of follow-up, the maximum calf circumference of the operatively treated leg remained substantially decreased and the operatively treated limb was significantly weaker than the contralateral, normal limb. Two patients had developed tendinopathy of the contralateral Achilles Tendon, one had developed tendinopathy of the reconstructed Tendon, and one had ruptured the contralateral Achilles Tendon eight years after the index tear. Conclusions: The long-term results of treatment of chronic tears of the Achilles Tendon with free gracilis Tendon grafting showed that patients retained good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Karin Gravare Silbernagel - One of the best experts on this subject based on the ideXlab platform.

  • the Achilles Tendon resting angle as an indirect measure of Achilles Tendon length following rupture repair and rehabilitation
    Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology, 2015
    Co-Authors: Michael R Carmont, Nicola Maffulli, Karin Gravare Silbernagel, Annelie Brorsson, Nicklas Olsson, Jon Karlsson
    Abstract:

    Abstract 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 p p p =  0.04) and at 3 months it was −6.5 (6.5)° ( p p 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.

  • predictors of clinical outcome after acute Achilles Tendon ruptures
    American Journal of Sports Medicine, 2014
    Co-Authors: Nicklas Olsson, Annelie Brorsson, Bengt I Eriksson, Max Petzold, Johanna Karlsson, Karin Gravare Silbernagel
    Abstract:

    Background:In patients with an acute Achilles Tendon rupture, it has not been possible to determine the superiority of a single specific treatment modality over other treatments with respect to symptoms and function. When several pertinent treatment protocols are available for an injury, it is of interest to understand how other variables, such as age, sex, or physical activity level, affect outcome to better individualize the treatment.Purpose:To investigate predictors of both symptomatic and functional outcomes after an acute Achilles Tendon rupture.Study Design:Cohort study (Prognosis); Level of evidence, 2.Methods:Ninety-three patients (79 men and 14 women; mean age, 40 years) were evaluated prospectively at 3, 6, and 12 months. The main outcome measures in this study were the Achilles Tendon Total Rupture Score (ATRS) for symptoms and maximum heel-rise height for function. The independent variables evaluated as possible predictors of outcome included treatment, sex, age, body mass index (BMI), physic...

  • deficits in heel rise height and Achilles Tendon elongation occur in patients recovering from an Achilles Tendon rupture
    American Journal of Sports Medicine, 2012
    Co-Authors: Karin Gravare Silbernagel, Robert Steele, Kurt Manal
    Abstract:

    Background:Whether an Achilles Tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury.Purpose:The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles Tendon length.Study Design:Case series; Level of evidence, 4.Method:Eight patients (mean [SD] age of 46 [13] years) with acute Achilles Tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles Tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles Tendon length was evaluated using motion analysis and ultrasound imaging.Results:The Achilles Tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in Tendon length and heel-rise height. Patients with Achilles ...

  • deficits in heel rise height and Achilles Tendon elongation occur in patients recovering from an Achilles Tendon rupture
    American Journal of Sports Medicine, 2012
    Co-Authors: Karin Gravare Silbernagel, Robert Steele, Kurt Manal
    Abstract:

    Background:Whether an Achilles Tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury.Purpose:The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles Tendon length.Study Design:Case series; Level of evidence, 4.Method:Eight patients (mean [SD] age of 46 [13] years) with acute Achilles Tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles Tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles Tendon length was evaluated using motion analysis and ultrasound imaging.Results:The Achilles Tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in Tendon length and heel-rise height. Patients with Achilles ...

Jon Karlsson - One of the best experts on this subject based on the ideXlab platform.

  • the Achilles Tendon resting angle as an indirect measure of Achilles Tendon length following rupture repair and rehabilitation
    Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology, 2015
    Co-Authors: Michael R Carmont, Nicola Maffulli, Karin Gravare Silbernagel, Annelie Brorsson, Nicklas Olsson, Jon Karlsson
    Abstract:

    Abstract 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 p p p =  0.04) and at 3 months it was −6.5 (6.5)° ( p p 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.

  • reliability of Achilles Tendon resting angle and calf circumference measurement techniques
    Foot and Ankle Surgery, 2013
    Co-Authors: Michael R Carmont, Gravare K Silbernagel, Y Mulji, Alexandre Mathy, Jon Karlsson, Nicola Maffulli
    Abstract:

    Abstract Background The resting angle of the ankle joint may be altered following apparently successful management of Achilles Tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined. Methods Three test–retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females. Results The mean left Achilles Tendon Resting Angle was mean 50.1° (range [26–61]), ICC 0.92 (CI [0.83–0.97]), SEM 2.4°. The mean right Achilles Tendon resting angle was mean 49.9° (range [26–60]), ICC 0.91 (CI [0.80–0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5cm (range [33.3–44.2]), ICC 0.97 (CI [0.94–0.98]), SEM 0.6cm, and the mean right calf circumference was mean 38.4cm (range [33.3–43.6]), ICC 0.97 (CI [0.94–0.99]), SEM 0.5cm. Conclusions The Achilles Tendon Resting Angle and Calf Circumference at 15cm from the antero-medial joint line had excellent test–retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with Tendon elongation and functional outcome. The Achilles Tendon resting angle may be used as a guide to Tendon length during intra-operative repair and rehabilitation

  • terminology for Achilles Tendon related disorders
    Knee Surgery Sports Traumatology Arthroscopy, 2011
    Co-Authors: C N Van Dijk, Jon Karlsson, M N Van Sterkenburg, Johannes I Wiegerinck, Nicola Maffulli
    Abstract:

    The terminology of Achilles Tendon pathology has become inconsistent and confusing throughout the years. For proper research, assessment and treatment, a uniform and clear terminology is necessary. A new terminology is proposed; the definitions hereof encompass the anatomic location, symptoms, clinical findings and histopathology. It comprises the following definitions: Mid-portion Achilles tendinopathy: a clinical syndrome characterized by a combination of pain, swelling and impaired performance. It includes, but is not limited to, the histopathological diagnosis of tendinosis. Achilles paratendinopathy: an acute or chronic inflammation and/or degeneration of the thin membrane around the Achilles Tendon. There are clear distinctions between acute paratendinopathy and chronic paratendinopathy, both in symptoms as in histopathology. Insertional Achilles tendinopathy: located at the insertion of the Achilles Tendon onto the calcaneus, bone spurs and calcifications in the Tendon proper at the insertion site may exist. Retrocalcaneal bursitis: an inflammation of the bursa in the recess between the anterior inferior side of the Achilles Tendon and the posterosuperior aspect of the calcaneus (retrocalcaneal recess). Superficial calcaneal bursitis: inflammation of the bursa located between a calcaneal prominence or the Achilles Tendon and the skin. Finally, it is suggested that previous terms as Haglund’s disease; Haglund’s syndrome; Haglund’s deformity; pump bump (calcaneus altus; high prow heels; knobbly heels; cucumber heel), are no longer used.

  • the Achilles Tendon total rupture score atrs development and validation
    American Journal of Sports Medicine, 2007
    Co-Authors: Katarina Nilssonhelander, Roland Thomee, Karin Gravaresilbernagel, Pia Thomee, Eva Faxen, Bengt I Eriksson, Jon Karlsson
    Abstract:

    BackgroundThere is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles Tendon rupture.PurposeTo develop and validate a new patient-reported instrument for measuring outcome after treatment for total Achilles Tendon rupture.Study DesignCohort study (diagnosis); Level of evidence, 1.MethodsDevelopment of this instrument consisted of item generation and test construction, item reduction, validation, evaluation of structure and internal consistency, test-retest, and test for responsiveness. The final version, the Achilles Tendon Total Rupture Score (ATRS), was tested for validity, structure, and internal consistency (Cronbach's alpha) on 82 patients and 52 healthy persons. A correlation analysis was performed of the ATRS with the 2 validated foot/ankle/Achilles Tendon scores, the Foot and Ankle Outcome Score (FAOS) and the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S). Structure was evaluated with fa...

Kurt Manal - One of the best experts on this subject based on the ideXlab platform.

  • deficits in heel rise height and Achilles Tendon elongation occur in patients recovering from an Achilles Tendon rupture
    American Journal of Sports Medicine, 2012
    Co-Authors: Karin Gravare Silbernagel, Robert Steele, Kurt Manal
    Abstract:

    Background:Whether an Achilles Tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury.Purpose:The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles Tendon length.Study Design:Case series; Level of evidence, 4.Method:Eight patients (mean [SD] age of 46 [13] years) with acute Achilles Tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles Tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles Tendon length was evaluated using motion analysis and ultrasound imaging.Results:The Achilles Tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in Tendon length and heel-rise height. Patients with Achilles ...

  • deficits in heel rise height and Achilles Tendon elongation occur in patients recovering from an Achilles Tendon rupture
    American Journal of Sports Medicine, 2012
    Co-Authors: Karin Gravare Silbernagel, Robert Steele, Kurt Manal
    Abstract:

    Background:Whether an Achilles Tendon rupture is treated surgically or not, complications such as muscle weakness, decrease in heel-rise height, and gait abnormalities persist after injury.Purpose:The purpose of this study was to evaluate if side-to-side differences in maximal heel-rise height can be explained by differences in Achilles Tendon length.Study Design:Case series; Level of evidence, 4.Method:Eight patients (mean [SD] age of 46 [13] years) with acute Achilles Tendon rupture and 10 healthy subjects (mean [SD] age of 28 [8] years) were included in the study. Heel-rise height, Achilles Tendon length, and patient-reported outcome were measured 3, 6, and 12 months after injury. Achilles Tendon length was evaluated using motion analysis and ultrasound imaging.Results:The Achilles Tendon length test-retest reliability (intraclass correlation coefficient = 0.97) was excellent. For the healthy subjects, there were no side-to-side differences in Tendon length and heel-rise height. Patients with Achilles ...

Vincenzo Denaro - One of the best experts on this subject based on the ideXlab platform.

  • z shortening of healed elongated Achilles Tendon rupture
    International Orthopaedics, 2012
    Co-Authors: Nicola Maffulli, Filippo Spiezia, Umile Giuseppe Longo, Vincenzo Denaro
    Abstract:

    Purpose A rupture of the Achilles Tendon may heal in continuity, resulting in a lengthened Achilles Tendon. The elongated structure must be shortened to restore effective push off. We report the results of a longitudinal study using Z-shortening of ruptured Achilles Tendons that healed in continuity but were elongated.

  • free gracilis Tendon graft for reconstruction of chronic tears of the Achilles Tendon
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Nicola Maffulli, Vittorino Testa, Giovanni Capasso, Filippo Spiezia, Umile Giuseppe Longo, Vincenzo Denaro
    Abstract:

    Background: Chronic tears of the Achilles Tendon with a Tendon gap exceeding 6 cm are a surgical challenge. The purpose of this study is to report the long-term results of reconstruction of such chronic Achilles Tendon ruptures with use of a free autologous gracilis Tendon graft. Methods: Twenty-one patients underwent reconstruction of a chronic rupture of the Achilles Tendon. Fifteen patients were available for clinical and functional assessment on the basis of anthropometric measurements, isometric strength testing, and the Achilles Tendon Total Rupture Score after a mean duration of follow-up of 10.9 years (range, eight to twelve years). Results: All fifteen patients were able to walk on the tiptoes, and no patient used a heel lift or walked with a visible limp. At an average of 10.9 years of follow-up, the maximum calf circumference of the operatively treated leg remained substantially decreased and the operatively treated limb was significantly weaker than the contralateral, normal limb. Two patients had developed tendinopathy of the contralateral Achilles Tendon, one had developed tendinopathy of the reconstructed Tendon, and one had ruptured the contralateral Achilles Tendon eight years after the index tear. Conclusions: The long-term results of treatment of chronic tears of the Achilles Tendon with free gracilis Tendon grafting showed that patients retained good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Achilles Tendon Ruptures in Elite Athletes
    Foot & Ankle International, 2011
    Co-Authors: Nicola Maffulli, Umile Giuseppe Longo, Gayle D. Maffulli, Anil Khanna, Vincenzo Denaro
    Abstract:

    Background: The management of Achilles Tendon (AT) ruptures in elite athletes can be challenging. We performed a retrospective review of prospectively collected data study to evaluate the results o...

  • ipsilateral free semitendinosus Tendon graft transfer for reconstruction of chronic tears of the Achilles Tendon
    BMC Musculoskeletal Disorders, 2008
    Co-Authors: Nicola Maffulli, Nikolaos Gougoulias, Umile Giuseppe Longo, Vincenzo Denaro
    Abstract:

    Many techniques have been developed for the reconstruction of the Achilles Tendon in chronic tears. In presence of a large gap (greater than 6 centimetres), Tendon augmentation is required. We present our method of minimally invasive semitendinosus reconstruction for the Achilles Tendon using one para-midline and one midline incision. The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual Tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the Tendon rupture. The distal and proximal Achilles Tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles Tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles Tendon stumps, the ipsilateral semitendinosus Tendon is harvested. The semitendinosus Tendon is passed through small incisions in the substance of the proximal stump of the Achilles Tendon, and it is sutured to the Achilles Tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus Tendon is sutured to the Achilles Tendon at each entry and exit point This minimally invasive technique allows reconstruction of the Achilles Tendon using the Tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles Tendon in the presence of large gap (greater than 6 centimetres).