The Effectiveness of Open Repair Versus Percutaneous Repair for an Acute Achilles Tendon Rupture

2016 ◽  
Vol 25 (4) ◽  
pp. 404-410 ◽  
Author(s):  
Heidi Krueger ◽  
Shannon David
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Supporting Evidence ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Men And Women ◽  
Percutaneous Repair ◽  
Tendon Ruptures

Clinical Scenario:There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior.Focused Clinical Question:Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included.Clinical Bottom Line:There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

scholarly journals Management of acute Achilles tendon ruptures

2018 ◽  
Vol 7 (10) ◽  
pp. 561-569 ◽  
Author(s):  
X. Yang ◽  
H. Meng ◽  
Q. Quan ◽  
J. Peng ◽  
S. Lu ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Open Repair ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Complication Rates ◽  
Functional Rehabilitation ◽  
Percutaneous Repair ◽  
Tendon Ruptures ◽  
Mini Open

ObjectivesThe incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.MethodsA PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.ResultsThe treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous repair, mini-open repair, and augmentative repair. Traditional open repair has lower re-rupture rates with higher risks of complications. Percutaneous repair and mini-open repair show similar re-rupture rates but lower overall complication rates when compared with open repair. Percutaneous repair requires vigilance against nerve damage. Functional rehabilitation combining protected weight-bearing and early controlled motion can effectively reduce re-rupture rates with satisfactory outcomes. Biological adjuncts help accelerating tendon healing by adhering rupture ends or releasing highly complex pools of signalling factors.ConclusionThe optimum treatment for complete rupture remains controversial. Both mini-open repair and functional protocols are attractive alternatives, while biotherapy is a potential future development. Cite this article: X. Yang, H. Meng, Q. Quan, J. Peng, S. Lu, A. Wang. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018;7:561–569. DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2.

scholarly journals The Effectiveness of Whole-Body-Vibration Training in Improving Hamstring Flexibility in Physically Active Adults

2015 ◽  
Vol 24 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Megan N. Houston ◽  
Victoria E. Hodson ◽  
Kelda K.E. Adams ◽  
Johanna M. Hoch
Keyword(s):  
Young Adults ◽  
Whole Body Vibration ◽  
Intervention Group ◽  
Whole Body ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Hamstring Flexibility ◽  
Active Adults

Clinical Scenario:Hamstring tightness is common among physically active individuals. In addition to limiting range of motion and increasing the risk of muscle strain, hamstring tightness contributes to a variety of orthopedic conditions. Therefore, clinicians continue to identify effective methods to increase flexibility. Although hamstring tightness is typically treated with common stretching techniques such as static stretching and proprioceptive neuromuscular facilitation, it has been suggested that whole-body-vibration (WBV) training may improve hamstring flexibility.Clinical Question:Can WBV training, used in isolation or in combination with common stretching protocols or exercise, improve hamstring flexibility in physically active young adults?Summary of Key Findings:Of the included studies, 4 demonstrated statistically significant improvements in hamstring flexibility in the intervention group, and 1 study found minor improvements over time in the intervention group after treatment.Clinical Bottom Line:There is moderate evidence to support the use of WBV training to improve hamstring flexibility in physically active young adults.Strength of Recommendation:There is grade B evidence that WBV training improves hamstring flexibility in physically active adults. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

The Effectiveness of Foot Orthotics in Improving Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2015 ◽  
Vol 24 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Michael L. Gabriner ◽  
Brittany A. Braun ◽  
Megan N. Houston ◽  
Matthew C. Hoch
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
Physically Active ◽  
Based Medicine ◽  
Level 2

Clinical Scenario:Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient’s postural control.Clinical Question:For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control?Summary of Key Findings:The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI.Clinical Bottom Line:There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control.Strength of Recommendation:There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

Immediate Effects of Proprioceptive Neuromuscular Facilitation Stretching Programs Compared With Passive Stretching Programs for Hamstring Flexibility: A Critically Appraised Topic

2017 ◽  
Vol 26 (6) ◽  
pp. 567-572 ◽  
Author(s):  
Kristian J. Hill ◽  
Kendall P. Robinson ◽  
Jennifer W. Cuchna ◽  
Matthew C. Hoch
Keyword(s):  
Effective Means ◽  
Current Evidence ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Static Stretching ◽  
Bottom Line ◽  
Physically Active ◽  
Hamstring Injuries ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Hamstring Flexibility

Clinical Scenario:Increasing hamstring flexibility through clinical stretching interventions may be an effective means to prevent hamstring injuries. However the most effective method to increase hamstring flexibility has yet to be determined.Clinical Question:For a healthy individual, are proprioceptive neuromuscular facilitation (PNF) stretching programs more effective in immediately improving hamstring flexibility when compared with static stretching programs?Summary of Key Findings:A thorough literature search returned 195 possible studies; 5 studies met the inclusion criteria and were included. Current evidence supports the use of PNF stretching or static stretching programs for increasing hamstring flexibility. However, neither program demonstrated superior effectiveness when examining immediate increases in hamstring flexibility.Clinical Bottom Line:There were consistent findings from multiple low-quality studies that indicate there is no difference in the immediate improvements in hamstring flexibility when comparing PNF stretching programs to static stretching programs in physically active adults.Strength of Recommendation:Grade B evidence exists that PNF and static stretching programs equally increase hamstring flexibility immediately following the stretching program.

Self-Mobilization Using a Foam Roller Versus a Roller Massager: Which Is More Effective for Increasing Hamstrings Flexibility?

2017 ◽  
Vol 26 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Danielle M. DeBruyne ◽  
Marina M. Dewhurst ◽  
Katelyn M. Fischer ◽  
Michael S. Wojtanowski ◽  
Chris Durall
Keyword(s):  
Therapeutic Benefit ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Duration Of Treatment ◽  
Bottom Line ◽  
Physically Active ◽  
Foam Rolling ◽  
Treatment Data ◽  
Active Adults ◽  
Level 2

Clinical Scenario:Increasing the length of the muscle–tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle–tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence.Clinical Question:Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults?Summary of Key Findings:The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size.Clinical Bottom Line:The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown.Strength of Recommendation:Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons

1993 ◽  
Vol 2 (2) ◽  
pp. 115-127 ◽  
Author(s):  
Gregory J. Steele ◽  
Rod A. Harter ◽  
Arthur J. Ting
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Plantar Flexion ◽  
Secondary Purpose ◽  
Percutaneous Repair ◽  
Study Results ◽  
Male Patients ◽  
Flexion Strength ◽  
Repair Group ◽  
Repair Techniques

The purpose of our study was to evaluate the functional outcomes of two methods of surgical treatment of acute closed raptures of the Achilles tendon, specifically, the primary open repair and the percutaneous repair techniques, utilizing (a) isokinetic plantar flexion strength, (b) midcalf girth, (c) ankle joint proprioception, and (d) ankle range of motion values. As a secondary purpose, the frequency of reruptures and postsurgical complications were compared between techniques. Twenty male patients (mean age, 43.8 ± 9.4 years) who sustained complete, closed ruptures of the Achilles tendon participated in this study. Results of pairedttests revealed significant differences between postsurgical and contralateral normal limbs for 6 of 12 variables. Results of the ANOVAs revealed no significant differences between the open repair group and percutaneous repair group for any of the evaluative parameters. The significant deficits in postoperative isokinetic plantar flexion strength and midcalf girth measurements, irrespective of surgical technique, suggest an incompleteness of rehabilitation or, more likely, the physiological inability to regain these characteristics postoperatively.

Šviežio Achilo sausgyslės plyšimo atviro ir minimaliai invazyvaus susiuvimo atokių rezultatų randomizuotas prospektyvus tyrimas

2021 ◽  
Author(s):  
◽  
Aleksas Makulavičius
Keyword(s):  
Achilles Tendon ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Percutaneous Repair ◽  
Tendon Ruptures

Outcomes of open and percutaneous repair of acute Achilles tendon ruptures. Prospective randomized study

The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 24 (5) ◽  
pp. 186-192
Author(s):  
Jennifer F. Mullins ◽  
Arthur J. Nitz ◽  
Matthew C. Hoch
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
The Other ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Dry Needling ◽  
Bottom Line ◽  
Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

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