İhmal Edilmiş Aşil Tendon Rüptürlerinde Primer Onarim ve Plantaris Tendonu ile Ögmentasyon Tekniğinin Orta Dönem Sonuçları.
Öz
ÖZET
Amaç: İhmal edilmiş
Aşil tendon rüptürlerine uyguladığımız primer onarım ve plantaris tendonu ile
ögmentasyon tekniğinin klinik ve fonksiyonel sonuçlarını değerlendirmek.
Gereç ve yöntemler:
Bu çalışmada 2011-2014 yılları arasında ihmal edilmiş Aşil tendon rüptürü
nedeniyle, primer onarım ve plantaris tendonuyla ögmentasyon tekniği ile
cerrahi tedavi uyguladığımız yirmi hasta retrospektif olarak incelendi.
Hastalar son takiplerde klinik olarak Amerikan Ortopedik Ayak ve Ayak Bileği
Topluluğu (AOFAS) arka ayak skoru, Görsel Ağrı Skalası (VAS) skoru, baldır
çevresi uzunluğu, topuk yükseltme testi ve ayak bileği eklem hareket açıklığı
dereceleri ile değerlendirildi.
Bulgular: Yaralanma ile
ameliyat arasında geçen süre ortalama 7,8 (4-16) hafta olarak bulundu. Ameliyat
sırasında tendon güdükleri arasındaki ortalama defekt miktarı 44 (30-75) mm
olarak ölçüldü. Ortalama takip süresi 62 (56-84) aydı. Son takiplerde AOFAS
skoru ortalaması 93,6 (86-100) olarak bulundu ve VAS skoru tüm hastalarda
sıfırdı. Ortalama baldır çevresi uzunluğu, ayak bileği plantar fleksiyon ve
dorsifleksiyon dereceleri etkilenmemiş taraf ile karşılaştırıldığında istatistiksel
olarak anlamlı farklılık saptanmadı (p değerleri sırasıyla 0,40-0,59-0,68). Bir
hasta hariç tüm hastalar topuk yükseltme testini gerçekleştirebilmekteydi. Bir
hastada antibiyotik tedavisi ile iyileşen yüzeysel cilt enfeksiyonu gözlendi.
Hiçbir hastada derin ven trombozu, cilt nekrozu ve tekrar rüptür tespit
edilmedi.
Sonuç: İhmal edilmiş Aşil
tendon rüptürlerinde, primer onarım ve plantaris tendonu ile ögmentasyon
tekniği, orta dönemde, klinik ve fonksiyonel olarak başarılı sonuçlar ile
ilişkilidir.
Kaynakça
- REFERENCES1. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am 1999;81(7):1019-362. Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg Br 1987;69(3):416-20.3. Inglis AE, Scott WN, Sculco TP. Ruptures of the tendo achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg 1976;58(7):990-3.4. Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am 1975;57(2):253-5.5. Wapner KL, Pavlock GS, Hecht PJ, Naselli F, Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 1993;14(8):443-9.6. Gabel S, Manoli A. Neglected rupture of the Achilles tendon. Foot Ankle Int 1994;15(9):512–7.7. Maffulli N, Leadbetter WB. Free gracilis tendon graft in neglected tears of the achilles tendon. Clin J Sport Med 2005;15(2):56-61.8. Esenyel CZ, Tekin C, Cakar M, Bayraktar K, Saygili S, Esenyel M, et al. Surgical treatment of the neglected achilles tendon rupture with Hyalonect. J Am Podiatr Med Assoc 2014;104(5):434-43.9. McClelland D1, Maffulli N. Neglected rupture of the Achilles tendon: reconstruction with peroneus brevis tendon transfer. Surgeon 2004;2(4):209-13.10. Rush JH. Operative repair of neglected rupture of the tendo Achillis. Aust N Z J Surg 1980;50(4):420-2.11. M. Takao, M. Ochi. Repair of neglected Achilles Tendon Rupture using Gastrocnemius Fascial Fleps. Arch Orthop Trauma Surg 2003;123(9):471-4.12. El Shewy MT, El Barbary HM, Abdel-Ghani H. Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex. Am J Sports Med 2009;37(8):1570-7.13. Teuffer AP. Travmatic rupture of the Achilles tendon. Reconstruction by transplant and graft using the lateral peroneus brevis. Orthop Clin North Am 1974;5(1):89-93.14. Mann RA, Holmes GB Jr, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am 1991;73(2):214-9.15. Choksey A, Soonawalla D, Murray J. Repair of neglected achilles tendon ruptures with marlex mesh. Injury 1996;27(3):215-7.16. Parsons JR1, Weiss AB, Schenk RS, Alexander H, Pavlisko F. Long-term follow-up of achilles tendon repair with an absorbable polymer carbon fiber composite. Foot Ankle 1989;9(4):179-84.17. Hadi M, Young J, Cooper L, Costa M, Maffulli N. Surgical management of chronic ruptures of the Achilles tendon remains unclear: a systematic review of the management options. Br Med Bull 2013;108:95-114. 18. Lynn TA. Repair of the torn Achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am 1966;48(2): 268-72.19. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349–353.20. Yasuda T, Shima H, Mori K, Kizawa M, Neo M. Direct Repair of Chronic Achilles Tendon Ruptures Using Scar Tissue Located Between the Tendon Stumps. J Bone Joint Surg Am 2016;98(14):1168-75.21. Maffulli N, Oliva F, Costa V, Del Buono A. The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer. Bone Joint J 2015;97(3):353-7.22. Cuttica DJ, Hyer CF, Berlet GC. İntraoperative value of the thompson test. J Foot AnkleSurg 2015;54(1):99-101.23. Sürel YB, Zorer G, Çalıskan R, Balioğlu MB, Karlı M. Operative treatment of the achill tendon ruptures. Acta Ortop Traumatol Turc 1995;29:32-36.24. Ibrahim SA, Hamido F, Al Misfer ARK, Ghafar SA, Motaal MA, Khirat S. Chronic rupture of Achillis tendon operative management using two in one operation. Foot Ankle Surg 2007;13:140–42.25. Magnusson SP, Narici MV, Maganaris CN, Kjaer M. Human tendon behaviour and adaptation, in vivo. J Physiol 2008;586(1):71-81.26. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg Br 1985;67(3):432-7.27. Kosaka T, Yamamoto K. Long-term effects of chronic Achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer, on sports activities. West Indian Med J 2011;60(6):628-35.28. Incavo SJ, Alvarez RG, Trevino SG. Occurrence of the plantaris tendon in patients sustaining subcutaneous rupture of the Achilles tendon. Foot Ankle 1987;8(2):110-1.29. Saxena A, Bareither D. Magnetic resonance and cadaveric findings of the incidence of plantaris tendon. Foot Ankle Int 2000;21(7):570-2.30. Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. J Can Chiropr Assoc 2007;51(3):158-65.31. Delgado GJ, Chung CB, Lektrakul N, Azocar P, Botte MJ, Coria D, et al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology 2002;224(1):112-9.32. Li Q, Xu J, Zhang D. Vascularized plantaris tendon graft: anatomic study of the donor. J Reconstr Microsurg 2000;16(4):287-90.
Mid-Term Results of Primary Repair and Plantaris Tendon Augmentation Technique in Neglected Achilles Tendon Rupture.
Öz
ABSTRACT
Aim: To assess clinical and
functional outcomes of primary repair and plantaris tendon augmentation
technique employed in neglected Achilles tendon rupture.
Methods: We
retrospectively reviewed 20 patients underwent surgical treatment with primary
repair and plantaris tendon augmentation technique for neglected Achilles
tendon rupture between 2011 and 2014. At the last follow-up, the patients were
clinically assessed by American Orthopedic Foot & Ankle Society (AOFAS)
hindfoot score, Visual Analogue Scale (VAS) score, calf circumference,
single-limb heel rise test and range of motion in ankle.
Results: Mean time from
rupture to surgery was 7.8 weeks (range 4-16 weeks). The mean gap was 44 mm
(range 30-75 mm). Mean postoperative follow-up period was 62 months (range
56-84 months). At the last follow-up, mean AOFAS score was 93.6 (range 82-100)
while VAS score was found as zero in all patients. No significant difference
was detected in mean calf circumference and plantar flexion and dorsiflexion
range of ankle between involved site and contralateral intact site (p=0.40;
p=0.59 and p=0.68, respectively). One patient suffered from superficial skin
infection which was treated successfully with antimicrobial therapy. There were
no cases of deep-vein thrombosis, skin necrosis, or re-rupture.
Conclusion:
In neglected Achilles tendon rupture, primary repair and plantaris augmentation
technique is associated with successful clinical and functional outcomes at
mid-term.
Kaynakça
- REFERENCES1. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am 1999;81(7):1019-362. Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg Br 1987;69(3):416-20.3. Inglis AE, Scott WN, Sculco TP. Ruptures of the tendo achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg 1976;58(7):990-3.4. Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am 1975;57(2):253-5.5. Wapner KL, Pavlock GS, Hecht PJ, Naselli F, Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 1993;14(8):443-9.6. Gabel S, Manoli A. Neglected rupture of the Achilles tendon. Foot Ankle Int 1994;15(9):512–7.7. Maffulli N, Leadbetter WB. Free gracilis tendon graft in neglected tears of the achilles tendon. Clin J Sport Med 2005;15(2):56-61.8. Esenyel CZ, Tekin C, Cakar M, Bayraktar K, Saygili S, Esenyel M, et al. Surgical treatment of the neglected achilles tendon rupture with Hyalonect. J Am Podiatr Med Assoc 2014;104(5):434-43.9. McClelland D1, Maffulli N. Neglected rupture of the Achilles tendon: reconstruction with peroneus brevis tendon transfer. Surgeon 2004;2(4):209-13.10. Rush JH. Operative repair of neglected rupture of the tendo Achillis. Aust N Z J Surg 1980;50(4):420-2.11. M. Takao, M. Ochi. Repair of neglected Achilles Tendon Rupture using Gastrocnemius Fascial Fleps. Arch Orthop Trauma Surg 2003;123(9):471-4.12. El Shewy MT, El Barbary HM, Abdel-Ghani H. Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex. Am J Sports Med 2009;37(8):1570-7.13. Teuffer AP. Travmatic rupture of the Achilles tendon. Reconstruction by transplant and graft using the lateral peroneus brevis. Orthop Clin North Am 1974;5(1):89-93.14. Mann RA, Holmes GB Jr, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am 1991;73(2):214-9.15. Choksey A, Soonawalla D, Murray J. Repair of neglected achilles tendon ruptures with marlex mesh. Injury 1996;27(3):215-7.16. Parsons JR1, Weiss AB, Schenk RS, Alexander H, Pavlisko F. Long-term follow-up of achilles tendon repair with an absorbable polymer carbon fiber composite. Foot Ankle 1989;9(4):179-84.17. Hadi M, Young J, Cooper L, Costa M, Maffulli N. Surgical management of chronic ruptures of the Achilles tendon remains unclear: a systematic review of the management options. Br Med Bull 2013;108:95-114. 18. Lynn TA. Repair of the torn Achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am 1966;48(2): 268-72.19. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349–353.20. Yasuda T, Shima H, Mori K, Kizawa M, Neo M. Direct Repair of Chronic Achilles Tendon Ruptures Using Scar Tissue Located Between the Tendon Stumps. J Bone Joint Surg Am 2016;98(14):1168-75.21. Maffulli N, Oliva F, Costa V, Del Buono A. The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer. Bone Joint J 2015;97(3):353-7.22. Cuttica DJ, Hyer CF, Berlet GC. İntraoperative value of the thompson test. J Foot AnkleSurg 2015;54(1):99-101.23. Sürel YB, Zorer G, Çalıskan R, Balioğlu MB, Karlı M. Operative treatment of the achill tendon ruptures. Acta Ortop Traumatol Turc 1995;29:32-36.24. Ibrahim SA, Hamido F, Al Misfer ARK, Ghafar SA, Motaal MA, Khirat S. Chronic rupture of Achillis tendon operative management using two in one operation. Foot Ankle Surg 2007;13:140–42.25. Magnusson SP, Narici MV, Maganaris CN, Kjaer M. Human tendon behaviour and adaptation, in vivo. J Physiol 2008;586(1):71-81.26. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg Br 1985;67(3):432-7.27. Kosaka T, Yamamoto K. Long-term effects of chronic Achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer, on sports activities. West Indian Med J 2011;60(6):628-35.28. Incavo SJ, Alvarez RG, Trevino SG. Occurrence of the plantaris tendon in patients sustaining subcutaneous rupture of the Achilles tendon. Foot Ankle 1987;8(2):110-1.29. Saxena A, Bareither D. Magnetic resonance and cadaveric findings of the incidence of plantaris tendon. Foot Ankle Int 2000;21(7):570-2.30. Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. J Can Chiropr Assoc 2007;51(3):158-65.31. Delgado GJ, Chung CB, Lektrakul N, Azocar P, Botte MJ, Coria D, et al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology 2002;224(1):112-9.32. Li Q, Xu J, Zhang D. Vascularized plantaris tendon graft: anatomic study of the donor. J Reconstr Microsurg 2000;16(4):287-90.