Acute Achilles Tendon Rupture - Athletic Training at Iowa：急性跟腱断裂在爱荷华训练.pptVIP

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Acute Achilles Tendon Rupture - Athletic Training at Iowa：急性跟腱断裂在爱荷华训练.ppt

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Acute Achilles Tendon Rupture - Athletic Training at Iowa：急性跟腱断裂在爱荷华训练

Acute Achilles Tendon Rupture Paul Herickhoff, MD March 26, 2009 Background Largest, most powerful tendon in body Formed by gastrocnemius and soleus Incidence of rupture 18:100,000 Incidence is increasing As demonstrated by population based studies in Finland, Canada, Scotland and Sweden Presentation Adults 40-50 y.o. primarily affected (MF) Athletic activities, usually with sudden starting or stopping “Snap” in heel with pain, which may subside quickly Factors to consider 25% of patients have previous symptoms of Achilles inflammation Leppilahti et al. Clin Orthop 1998 Associated conditions: Ochronosis Steroid use Quinolones Inflammatory arthritis Diagnosis Weakness in plantarflexion Gap in tendon Positive Thompson test Imaging X-rays Indicated if fracture or avulsion fracture suspected Ultrasound or MRI Reveal tendon degeneration, if present Treatment Non-operative versus operative treatment controversial Several methods described for each Non-operative Cast immobilization Traditional recommendation is 8 weeks of immobilization Wallace recommended patellar tendon bearing orthosis for weeks 4-8 Functional brace with semi-rigid tape and polypropylene orthoses for duration of treatment also described Rerupture rate 8-39% reported Operative Open repair Locking stitch, +/- augmentation with plantaris or mesh Post-op care = Casting for 6-8 weeks Risks: Infection (4-21%), Rerupture (1-5%) Operative Percutaneous Bunnell stitch Weaker than open repair (Rerupture 0-17%) Risk of sural nerve injury (0-13%) Decreased infection risk Op vs. Non-op Wong et al Am J Sports Med 2002 Metanalysis 125 articles, 5370 patients Wound complication (14.6 vs 0.5%) Rerupture (1.5 perc,1.4 open vs 10.7%) Complication rates lowest in open repair and early mobilization, highest in percutaneous repair and early mobilization Op vs. Non-op Bhandari et al. Clin Orthop 2002 More stringent inclusion criteria than Wong 6 studies, 448 patients Wound infection (5% vs 0%) Rerupture (3% vs 13%) Risk Fac