Suture Anchor Versus Allogenic Tendon Suture in Treatment of Haglund Syndrome
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BACKGROUND:Haglund's deformity is an abnormal bony enlargement on the back of the heel. It can cause the impact of the posterior calcaneal bursa and Achilles tendon insertion, and finally result in pain. This syndrome is called Haglund syndrome. The purpose of this study was to explore the effect of the suture anchor and allogeneic tendon suture in the treatment of Haglund syndrome. MATERIAL AND METHODS:We retrospectively studied 20 patients with Haglund syndrome treated from January 2015 to December 2016. The patients were randomly divided into Group 1 (the suture anchor group) and Group 2 (the allogeneic tendon group), with 10 patients in each group and an average follow-up of 32 months after surgery. The AOFAS, VAS, and Arner-Lindholm scales were used to summarize the patient follow-up results and complications. RESULTS:In the 2 groups of patients, the postoperative AOFAS, VAS scores, and the Arner-Lindholm scale showed good results. However, the postoperative AOFAS score and VAS of the suture anchor group were better than those of the allogeneic tendon group, with shorter operation times. No Achilles tendon rupture or wound infection occurred during the entire postoperative period in either group. These results show the superiority of suture anchors. CONCLUSIONS:The higher AOFAS and VAS score and shorter operation time in the suture anchor group suggest it is the better alternative for treatment of Haglund syndrome.Cite
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We used a rat model to study the effects of immobilization of the calf muscle‐tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end‐to‐end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension‐ and load‐increasing without a significant increase in the risk of rerupture of the tendon.
Muscle Atrophy
Gastrocnemius muscle
Hindlimb
Achilles tendon rupture
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In this study, a modeling method was developed to estimate Achilles tendon forces in running. Owing to the common use of heel lift devices in the treatment of Achilles tendon injury, we investigated the influence of increased heel lift on Achilles tendon loading. The hypothesis was that heel lift manipulation can influence maximum Achilles tendon force. Responses to heel lift variation were found to differ among 3 elite runners demonstrating distinct running styles. A rearfoot and a midfoot striker demonstrated significant increases in maximum Achilles tendon force with increased heel lift, whereas a forefoot striker demonstrated no changes in maximum Achilles tendon force values with heel lift manipulation ( p < .05). Analysis of the factors contributing to the observed changes in maximum Achilles tendon force highlighted the influence of the moment arm of ground reaction force and the moment arm of the Achilles tendon about the ankle joint center. The finding that increased heel lift may increase maximum Achilles tendon force suggests that caution is advised in the routine use of this intervention. The different responses to heel lift increase between subjects highlight the importance of classifying subjects based on running style.
Lift (data mining)
Ground reaction force
Force platform
Weight-bearing
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Controlled laboratory study.Orthotic heel lifts are thought to lower tension in the Achilles tendon, but evidence for this effect is equivocal.To investigate the effect of a 12-mm, in-shoe orthotic heel lift on Achilles tendon loading during shod walking using transmission-mode ultrasonography.The propagation speed of ultrasound, which is governed by the elastic modulus and density of tendon and proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of 12 recreationally active men during shod treadmill walking at matched speeds (3.4 ± 0.7 km/h), with and without addition of a heel lift. Vertical ground reaction force and spatiotemporal gait parameters were simultaneously recorded. Data were acquired at 100 Hz during 10 seconds of steady-state walking. Statistical comparisons were made using paired t tests (α = .05).Ultrasound transmission speed in the Achilles tendon was characterized by 2 maxima (P1, P2) and minima (M1, M2) during walking. Addition of a heel lift to footwear resulted in a 2% increase and 2% decrease in the first vertical ground reaction force peak and the local minimum, respectively (P<.05). Ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with the addition of an orthotic heel lift (P<.05).Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12-mm orthotic heel lift, indicating that the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear observed in previous studies. These findings support the addition of orthotic heel lifts to footwear in the rehabilitation of Achilles tendon disorders where management aims to lower tension within the tendon.
Lift (data mining)
Ground reaction force
Biomechanics
Achilles tendon rupture
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Biomechanics
Muscle belly
Strain (injury)
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This study investigated the influence of heel lift interventions on the loading of the Achilles tendon for heel-toe runners. It was hypothesized that the peak Achilles tendon force and peak rate of loading would be reduced by the increase in heel lift, and that the peak Achilles tendon force would occur significantly later in stance. Achilles tendon forces were determined by calculating sagittal-plane ankle joint moments using inverse-dynamics techniques and dividing these moments by Achilles tendon moment arm lengths. Methods for estimating Achilles tendon moment arm length using skin markers were justified via MRI data for one participant. Seven participants underwent running trials under three heel lift conditions: zero, 7.5-mm, and 15-mm heel lift. Average magnitude and occurrence time of peak Achilles tendon force and peak rate of loading were determined for each condition over the 7 participants. Despite group reductions in peak Achilles tendon force and peak rate of loading for the increased heel lift conditions, statistical analysis (ANOVA) revealed no significant differences for these variables, p > 0.05. Individual participant observations highlighted varied responses to heel lift; both increases and decreases in peak Achilles tendon force were observed. For the group data, the time of peak impact force occurred significantly later in the 15-mm heel lift condition than in the zero heel lift, p < 0.05. It is suggested that the success of increased heel lift in treating Achilles tendon injury may be due to a later occurrence of peak Achilles tendon force in response to this intervention, reducing Achilles tendon average rate of loading. In addition, the individuality of Achilles tendon peak force changes with heel lift intervention highlights the need for individual participant analysis.
Lift (data mining)
Force platform
Biomechanics
Achilles tendon rupture
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Citations (20)
- Study Design
Controlled laboratory study
- Objective
To investigate the effect of a 12–mm in–shoe orthotic heel lift on Achilles tendon loading during shod walking using transmission–mode ultrasonography. - Background
Orthotic heel lifts are thought to lower tension in the Achilles tendon but evidence for this effect is equivocal. - Methods
The propagation speed of ultrasound, which is governed by the elastic modulus and density of tendon and is proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of twelve recreationally–active males during shod treadmill walking at matched speeds (3.4±0.7 km/h), with and without addition of a heel lift. Vertical ground reaction force and spatiotemporal gait parameters were simultaneously recorded. Data were acquired at 100Hz during 10s of steady–state walking. Statistical comparisons were made using paired t–tests (α=.05). - Results
Ultrasound transmission speed in the Achilles tendon was characterized by two maxima (P1, P2) and minima (M1, M2) during walking. Addition of a heel lift to footwear resulted in a 2% increase and 2% decrease in the first vertical ground reaction force peak and the local minimum, respectively (P<.05). Peak ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with addition of an orthotic heel lift (P<.05).
- Conclusions
Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12–mm orthotic heel lift, indicating the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear. These findings support the addition of orthotic heel lifts to footwear in the rehabilitation of Achilles tendon disorders where management aims to lower tension within the tendon.
- Level of Evidence
Therapy, level 2a
Lift (data mining)
Ground reaction force
Biomechanics
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Calf muscle
Triceps surae muscle
Muscle belly
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Objective: To provide the biochemical and histological foundation for the vascularized tendon transfer to the Achilles tendon defect.Methods:Twelve New Zealand adult rabbits were divided into two groups randomly.The Achilles tendon defects were repaired with vascularlized flexor digitorum longus tendon, and the contralateral Achilles tendon served as a free tendon control.The histological observation and biochemical tests were made at 12 weeks after operation.Results: In the experimental sides, the histological structure closed to the normal Achilles tendon and the transfer tendon regained 67.7% of the tensile strength of the normal Achilles tendon.The results of the control sides indicated that the tendon fibre were wrapped by the scar tissue histological, and that the tendon transfers regained 35.3% of the tensile strength.The difference between the experimental group and the control group was significant ( P 0.01).Conclusion: The vascularized tendon transfer is superior to the free tendon transfer in the repair of the Achilles tendon defect.
Tendon transfer
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