AcuteAchillesTendonRuptureAthleticTrainingatIowa：急性跟腱斷裂在愛荷華訓(xùn)練課件

1、Acute Achilles Tendon RupturePaul Herickhoff, MDMarch 26, 2009第1頁，共15頁。BackgroundLargest, most powerful tendon in bodyFormed by gastrocnemius and soleusIncidence of rupture 18:100,000Incidence is increasingAs demonstrated by population based studies in Finland, Canada, Scotland and Sweden第2頁，共15頁。Pr

2、esentationAdults 40-50 y.o. primarily affected (MF)Athletic activities, usually with sudden starting or stopping“Snap” in heel with pain, which may subside quickly第3頁，共15頁。Factors to consider25% of patients have previous symptoms of Achilles inflammationLeppilahti et al. Clin Orthop 1998Associated c

3、onditions:OchronosisSteroid useQuinolonesInflammatory arthritis第4頁，共15頁。DiagnosisWeakness in plantarflexionGap in tendonPositive Thompson test第5頁，共15頁。ImagingX-raysIndicated if fracture or avulsion fracture suspectedUltrasound or MRIReveal tendon degeneration, if present第6頁，共15頁。TreatmentNon-operati

4、ve versus operative treatment controversialSeveral methods described for each第7頁，共15頁。Non-operativeCast immobilizationTraditional recommendation is 8 weeks of immobilizationWallace recommended patellar tendon bearing orthosis for weeks 4-8Functional brace with semi-rigid tape and polypropylene ortho

5、ses for duration of treatment also describedRerupture rate 8-39% reported第8頁，共15頁。OperativeOpen repairLocking stitch, +/- augmentation with plantaris or meshPost-op care = Casting for 6-8 weeksRisks: Infection (4-21%), Rerupture (1-5%)第9頁，共15頁。OperativePercutaneousBunnell stitchWeaker than open repa

6、ir (Rerupture 0-17%)Risk of sural nerve injury (0-13%)Decreased infection risk第10頁，共15頁。Op vs. Non-opWong et al Am J Sports Med 2002Metanalysis 125 articles, 5370 patientsWound complication (14.6 vs 0.5%) Rerupture (1.5 perc,1.4 open vs 10.7%)Complication rates lowest in open repair and early mobili

7、zation, highest in percutaneous repair and early mobilization第11頁，共15頁。Op vs. Non-opBhandari et al. Clin Orthop 2002More stringent inclusion criteria than Wong6 studies, 448 patientsWound infection (5% vs 0%)Rerupture (3% vs 13%)第12頁，共15頁。Risk Factors for Wound ComplicationBruggeman et al Clin Ortho

8、p 2004 and Pajala et al. JBJS 2002AgeTobaccoDiabetesFemale genderSteroid useTreatment delayLow energy injury (during ADLs)第13頁，共15頁。SummaryIncidence of Achilles tendon rupture increasingOperative repair associated with lower rerupture rate, but higher wound complication rate compared to non-opPercut

9、aneous repair has risk of nerve injuryReview risk factors before deciding treatment plan第14頁，共15頁。ReferencesBhandari, M et al. “Treatment of Achilles tendon ruptures: a systematic overview and metaanalysis.” Clin Orthop 400:190-200, 2002.Bruggeman, NB et al. “Wound complications after open Achilles

10、tendon repair: an analysis of risk factors.” Clin Orthop 427:63-66, 2004Chiodo, CP and MG Wilson. “Current Concepts Review: Acute Ruptures of the Achilles Tendon.” Foot Ank Int 27:305-13, 2006Leppilahti J et al. “Outcome and prognostic factors of Achilles rupture using a new scoring method. Clin Orthop 346:152-61, 2001.Pajala, A et al. “Rerupture and deep infection following treatment of total Achilles rupture.” JBJS 84-A: