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Paper 96: Differences of Surgically Treated Achilles Tendon Overuse Injuries in Finland and Italy
ABSTRACTS was performed as previously described (ref: 1). All patients were treated as outpatients. Data collection was performed by subjective questionnaire and the Mayo Clinic Elbow score. The questionnaire was administered in the office setting at follow up via a computer input system. Results: 25 patients (85%) were available for follow-up. The average Mayo Clinic score was 11.0 (range 5-12). The subjective pain rating (VAS) improved from 1.5 to 8.4 (range 7-10). Intra-operative findings showed 29% with significant intraarticular synovitis, 35% showed a type 1 lesion, 40% showed a type 2 lesion and 25% showed a type 3 lesion according to Baker et al.(ref: 2).Patients required an average of 3.8 weeks to return to regular activities and 7 weeks to return to full duty. No complications were reported. Conclusion: Arthroscopic release of the ECRB is an effective operative treatment for recalcitrant chronic lateral epicondylitis even in heavy manual laborers. Our results compare to previously published reports for other techniques. We feel that arthroscopic release of the ECRB is safe, effective and allows for excellent control of the associated pathology (i.e. synovitis, plica) that open or percutaneous techniques do not allow for. Ref: 1) Cohen M, Romeo AA; JASSH (1) 3 2001:172-177 2) CL Baker et al.; JSES (6) 2000: 475 ff. Paper 95: Pectoralis Major Muscle Rupture in Athletes ALBERTO CASTRO POCHINI, MD, BRAZIL, PRESENTING AUTHOR BENNO EJNISMAN, MD, BRAZIL CARLOS VICENTE ANDREOLI, BRAZIL GUSTAVO CARA MONTEIRO, BRAZIL MOISES COHEN, MD, PHD, BRAZIL ABSTRACT Objective: To present a case series of 30 athletes showing PMM rupture and to conduct a comparative study in 20 athletes, with 10 being submitted to surgical treatment and the other 10 not being submitted to surgical treatment, presenting PMM rupture by using clinical and functional (isokinetic dynamometer) criteria for evaluation. Materials and Methods: Thirty athletes with PMM rupture have been studied. The mean age was 32.27 years old (ranging from 23 to 47 years old), all of them were males. The average follow-up time was 645.10 days (ranging from 180 to 1,480 days). Injuries were diagnosed by means of anamnesis, physical tests and subsidiary tests. Functional evaluation suggested by Bak et al was used following the treatment of 30 patients and as a mean of evaluation in the comparative study with 20 patients. The isokinetic evaluation was performed in the
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20 patients in the study comparing surgical and nonsurgical treatment. Results: The comparative study evaluation in 20 patients revealed 70% of excellent outcomes, 20% good, and 10% bad for the cases submitted to surgery; and, 30% good, 30% fair, and 40% bad outcomes for the cases treated in a non-surgical way. The isokinetic evaluation in the comparative study with 20 patients with PMM rupture using cybex(R), the 60 degrees/s speed showed a debit of 53.8% (ranging from 12 to 191%) and of 13.7% (ranging from ⫺13 to 73%) for the group of athletes submitted to surgery. Conclusion: Total PMM rupture in athletes showed a better functional result with surgical treatment when compared to conservative treatment in 20 patients studied. We found association between anabolic steroid and pectoralis major muscle rupture. Paper 96: Differences of Surgically Treated Achilles Tendon Overuse Injuries in Finland and Italy SAKARI Y. ORAVA, MD, PHD, FINLAND, PRESENTING AUTHOR JANNE SARIMO, MD, PHD, FINLAND JOUKO ALANEN, FINLAND ABSTRACT During years 1990 - 2004 856 and 156 Achilles tendon overuse injuries were treated surgically in Finnish and Italian athletes and keep-fit athletes respectively. The mean age of the patients was 34 years (range 18 - 65 years) in Finnish patients and 29 years ( range 17 - 63 years) in Italian patients. There were 659 males and 197 females in the Finnish series and 127 men and 29 females in the Italian series. All patients were physcally active and suffered from a chronic overuse injury of Achilles tendon or posterior heel area.The patients represented of endurance sports in 80 per and 72 per cents respectively in the Finnish and Italian materails.The diagnoses were estimated according to the same classification during the study time. The percentage of the different main diagnoses in the Finnish (first mentioned) and Italian series were: chronic peritendinitis: 25 vs 14 per cent, tendinosis13 vs 5 per cent, partial overuse tear 25 vs 19 per cent, retrocalcaneal bursitis 33 vs 47 per cent, distal Achilles tendon calcification 3 vs 13 per cent and anomalous soleus muscle with peritendinitis 1 vs 2 per cent. In the group of chronic retrocalcaneal bursitis trere were real Haglund’s heel 6 per cent in Finnish material and 19 per cent in Italian material. There seems to be clear differences in chronic Achilles tendon ailments in physically active individuals between two countries, Finland and Italy. Reasons to different patterns of operative Achilles tendon overuse injury diagnoses can
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be explained by climate, racial and anatomical differences. Paper 97: Arthroscopic Subtalar Arthrodesis using Three Posterior Potals KEUN-BAE LEE, MD, KOREA, PRESENTING AUTHOR CHARLES L. SALTZMAN, MD, USA EUN KYOO SONG, MD, KOREA, SOUTH JIN CHOI, MD, KOREA, SOUTH ANNUNZIATO AMENDOLA, MD, USA ABSTRACT Introduction: Subtalar arthrodesis is reliable procedure for pain relief and improved function for patients with isolated subtalar arthritis. Arthroscopic subtalar arthrodesis was designed to improve upon traditional open methods by using a minimally invasive technique. We have developed a technique to accomplish the same goals using a posterior approach. Methods: A retrospective review of 15 feet in 14 patients that underwent posterior arthroscopic subtalar arthrodesis(PASTA) was carried out. The indications were painful, isolated arthrosis of the posterior facet of the subtalar joint with minimal or no deformity. The technique involves prone positioning, two posterolateral portals and one posteromedial portal, posterior talocalcaneal facet debridement, percutaneous cancellous allografting and internal screw fixation. Outcome measures included patient satisfaction, modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, union rate, time to union, and postoperative complications. Results: All patients were either discharged on the day of surgery or stayed one night in the hospital. 11 of the 14 patients were very satisfied, and three patients were satisfied with the results of their surgery. The average modified AOFAS ankle-hindfoot score (maximum 94 points) improved from 36 points preoperatively to 86 points at follow-up. All joints achieved fusion by ten weeks. No postoperative complications occurred. Conclusions: For surgeons familiar with posterior ankle or subtalar arthroscopy, PASTA with the patient prone offers complete visualization of the posterior talocalcaneal facet, high patient satisfaction, an excellent fusion rate, and minimal postoperative morbidity. Paper 98: Changes of Achilles Mid-portion Tendon Microcirculation After Repetitive Simultaneous Cryotherapy and Compression Using Standardized Cryo-compression Device (Cryo/Cuffâ,,¢) KARSTEN KNOBLOCH, MD, GERMANY, PRESENTING AUTHOR RUTH GRASEMANN, GERMANY MICHAEL JAGODZINSKI, MD, GERMANY
MARTINUS RICHTER, MD, PHD, GERMANY JOHANNES ZEICHEN, MD, GERMANY CHRISTIAN KRETTEK, GERMANY ABSTRACT Background: Cryotherapy and compression are shown to decrease pain and improve function. Nevertheless, the dosage and timing of these options remain unclear. Therefore we examined the effects of a standardized compression and cryotherapy device (Cryo/Cuffâ,,¢) prospectively on parameters of mid-portion Achilles tendon microcirculation during intermittent administration. Methods: Twenty-six subjects were included (32.3⫹/⫺ 12yrs, BMI 25.4⫹/⫺5) with three ten-minute applications of the device each followed by a 10 minute rewarming period and continuous real-time assessment of parameters of Achilles tendon mid-portion microcirculation using a laser-Doppler-spectrophotometrysystem (O2C, Germany). Results: Superficial tendon oxygen saturation dropped significantly from 35.9⫹/⫺21% to 13.5⫹/⫺15/15.9⫹/⫺ 16 and 11.1⫹/⫺11% (p⫽0.0001) during each period of cryo-compression respectively with significant increase during recovery period (55.4⫹/⫺29/65.2⫹/⫺26 and 65.7⫹/⫺27%, p⫽0.003) up to ⫹83% of the baseline level. At 8mm tendon depth, cryo-compression preserved local oxygen with -4% (p⫽0.001) of the baseline level and small, but significant increased oxygen saturation of up to ⫹13% (p⫽0.0001). Relative postcapillary venous tendon filling pressures were favourably reduced to 57⫹/⫺34%/67⫹/⫺27 and 64⫹/⫺38% (p⫽0.0004) superficially and deep (76⫹/⫺13%/79⫹/⫺11 and 78⫹/⫺ 18%, p⫽0.0002). Superficial capillary blood flow was reduced from 48.4⫹/⫺48 to 5⫹/⫺7/4⫹/⫺5 and 3⫹/⫺4 (⫺94%, p⫽0.0003) with increased flow during rewarming periods of up to 58⫹/⫺64/58⫹/⫺79 and 47⫹/⫺71 (⫹20%, p⫽0.265). Deep flow was reduced from 197⫹/⫺ 147 to 66.7⫹/⫺64/55⫹/⫺46 and 43⫹/⫺39 (⫺78%, p⫽0.0002) without increase during rewarming periods. Conclusion: Intermittent Cryo/Cuffâ,,¢ administration of 3x10min significantly decreased local Achilles tendon capillary blood flow by 90% with a subsequent small hyperaemia. Postcapillary venous filling pressures are reduced during Cryo/Cuffâ,,¢ favouring venous outflow. Deep Achilles tendon oxygen supply is not impaired by Cryo/Cuffâ,,¢ which is beneficial. Therefore, Cryo/ Cuffâ,,¢ exerts beneficial effects on the microcirculatory level of the mid-portion Achilles tendon with decreased capillary blood flow, preserved deep tendon oxygen saturation and facilitated venous capillary outflow.
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20 patients in the study comparing surgical and nonsurgical treatment. Results: The comparative study evaluation in 20 patients revealed 70% of excellent outcomes, 20% good, and 10% bad for the cases submitted to surgery; and, 30% good, 30% fair, and 40% bad outcomes for the cases treated in a non-surgical way. The isokinetic evaluation in the comparative study with 20 patients with PMM rupture using cybex(R), the 60 degrees/s speed showed a debit of 53.8% (ranging from 12 to 191%) and of 13.7% (ranging from ⫺13 to 73%) for the group of athletes submitted to surgery. Conclusion: Total PMM rupture in athletes showed a better functional result with surgical treatment when compared to conservative treatment in 20 patients studied. We found association between anabolic steroid and pectoralis major muscle rupture. Paper 96: Differences of Surgically Treated Achilles Tendon Overuse Injuries in Finland and Italy SAKARI Y. ORAVA, MD, PHD, FINLAND, PRESENTING AUTHOR JANNE SARIMO, MD, PHD, FINLAND JOUKO ALANEN, FINLAND ABSTRACT During years 1990 - 2004 856 and 156 Achilles tendon overuse injuries were treated surgically in Finnish and Italian athletes and keep-fit athletes respectively. The mean age of the patients was 34 years (range 18 - 65 years) in Finnish patients and 29 years ( range 17 - 63 years) in Italian patients. There were 659 males and 197 females in the Finnish series and 127 men and 29 females in the Italian series. All patients were physcally active and suffered from a chronic overuse injury of Achilles tendon or posterior heel area.The patients represented of endurance sports in 80 per and 72 per cents respectively in the Finnish and Italian materails.The diagnoses were estimated according to the same classification during the study time. The percentage of the different main diagnoses in the Finnish (first mentioned) and Italian series were: chronic peritendinitis: 25 vs 14 per cent, tendinosis13 vs 5 per cent, partial overuse tear 25 vs 19 per cent, retrocalcaneal bursitis 33 vs 47 per cent, distal Achilles tendon calcification 3 vs 13 per cent and anomalous soleus muscle with peritendinitis 1 vs 2 per cent. In the group of chronic retrocalcaneal bursitis trere were real Haglund’s heel 6 per cent in Finnish material and 19 per cent in Italian material. There seems to be clear differences in chronic Achilles tendon ailments in physically active individuals between two countries, Finland and Italy. Reasons to different patterns of operative Achilles tendon overuse injury diagnoses can
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be explained by climate, racial and anatomical differences. Paper 97: Arthroscopic Subtalar Arthrodesis using Three Posterior Potals KEUN-BAE LEE, MD, KOREA, PRESENTING AUTHOR CHARLES L. SALTZMAN, MD, USA EUN KYOO SONG, MD, KOREA, SOUTH JIN CHOI, MD, KOREA, SOUTH ANNUNZIATO AMENDOLA, MD, USA ABSTRACT Introduction: Subtalar arthrodesis is reliable procedure for pain relief and improved function for patients with isolated subtalar arthritis. Arthroscopic subtalar arthrodesis was designed to improve upon traditional open methods by using a minimally invasive technique. We have developed a technique to accomplish the same goals using a posterior approach. Methods: A retrospective review of 15 feet in 14 patients that underwent posterior arthroscopic subtalar arthrodesis(PASTA) was carried out. The indications were painful, isolated arthrosis of the posterior facet of the subtalar joint with minimal or no deformity. The technique involves prone positioning, two posterolateral portals and one posteromedial portal, posterior talocalcaneal facet debridement, percutaneous cancellous allografting and internal screw fixation. Outcome measures included patient satisfaction, modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, union rate, time to union, and postoperative complications. Results: All patients were either discharged on the day of surgery or stayed one night in the hospital. 11 of the 14 patients were very satisfied, and three patients were satisfied with the results of their surgery. The average modified AOFAS ankle-hindfoot score (maximum 94 points) improved from 36 points preoperatively to 86 points at follow-up. All joints achieved fusion by ten weeks. No postoperative complications occurred. Conclusions: For surgeons familiar with posterior ankle or subtalar arthroscopy, PASTA with the patient prone offers complete visualization of the posterior talocalcaneal facet, high patient satisfaction, an excellent fusion rate, and minimal postoperative morbidity. Paper 98: Changes of Achilles Mid-portion Tendon Microcirculation After Repetitive Simultaneous Cryotherapy and Compression Using Standardized Cryo-compression Device (Cryo/Cuffâ,,¢) KARSTEN KNOBLOCH, MD, GERMANY, PRESENTING AUTHOR RUTH GRASEMANN, GERMANY MICHAEL JAGODZINSKI, MD, GERMANY
MARTINUS RICHTER, MD, PHD, GERMANY JOHANNES ZEICHEN, MD, GERMANY CHRISTIAN KRETTEK, GERMANY ABSTRACT Background: Cryotherapy and compression are shown to decrease pain and improve function. Nevertheless, the dosage and timing of these options remain unclear. Therefore we examined the effects of a standardized compression and cryotherapy device (Cryo/Cuffâ,,¢) prospectively on parameters of mid-portion Achilles tendon microcirculation during intermittent administration. Methods: Twenty-six subjects were included (32.3⫹/⫺ 12yrs, BMI 25.4⫹/⫺5) with three ten-minute applications of the device each followed by a 10 minute rewarming period and continuous real-time assessment of parameters of Achilles tendon mid-portion microcirculation using a laser-Doppler-spectrophotometrysystem (O2C, Germany). Results: Superficial tendon oxygen saturation dropped significantly from 35.9⫹/⫺21% to 13.5⫹/⫺15/15.9⫹/⫺ 16 and 11.1⫹/⫺11% (p⫽0.0001) during each period of cryo-compression respectively with significant increase during recovery period (55.4⫹/⫺29/65.2⫹/⫺26 and 65.7⫹/⫺27%, p⫽0.003) up to ⫹83% of the baseline level. At 8mm tendon depth, cryo-compression preserved local oxygen with -4% (p⫽0.001) of the baseline level and small, but significant increased oxygen saturation of up to ⫹13% (p⫽0.0001). Relative postcapillary venous tendon filling pressures were favourably reduced to 57⫹/⫺34%/67⫹/⫺27 and 64⫹/⫺38% (p⫽0.0004) superficially and deep (76⫹/⫺13%/79⫹/⫺11 and 78⫹/⫺ 18%, p⫽0.0002). Superficial capillary blood flow was reduced from 48.4⫹/⫺48 to 5⫹/⫺7/4⫹/⫺5 and 3⫹/⫺4 (⫺94%, p⫽0.0003) with increased flow during rewarming periods of up to 58⫹/⫺64/58⫹/⫺79 and 47⫹/⫺71 (⫹20%, p⫽0.265). Deep flow was reduced from 197⫹/⫺ 147 to 66.7⫹/⫺64/55⫹/⫺46 and 43⫹/⫺39 (⫺78%, p⫽0.0002) without increase during rewarming periods. Conclusion: Intermittent Cryo/Cuffâ,,¢ administration of 3x10min significantly decreased local Achilles tendon capillary blood flow by 90% with a subsequent small hyperaemia. Postcapillary venous filling pressures are reduced during Cryo/Cuffâ,,¢ favouring venous outflow. Deep Achilles tendon oxygen supply is not impaired by Cryo/Cuffâ,,¢ which is beneficial. Therefore, Cryo/ Cuffâ,,¢ exerts beneficial effects on the microcirculatory level of the mid-portion Achilles tendon with decreased capillary blood flow, preserved deep tendon oxygen saturation and facilitated venous capillary outflow.