1. Insertional versus non-insertional tendoachilles tears: a comparative analysis of various predisposing factors and outcome following a repair.
- Author
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Ramakanth R, Sundararajan SR, Goud BH, Dsouza T, and Rajasekaran S
- Subjects
- Causality, Child, Child, Preschool, Humans, Pain, Retrospective Studies, Rupture surgery, Achilles Tendon injuries, Achilles Tendon surgery, Calcaneus injuries, Calcaneus surgery, Foot Diseases, Lacerations, Tendinopathy complications, Tendinopathy epidemiology
- Abstract
Background: Association of tendon degeneration, pre-existing posterior heel pain, Haglund's bump, retrocalcaneal spur, and mode of injury varies for the insertional and non-insertional type of tendoachilles tears (TA)., Purpose: The study compares the various predisposing factors that determine the distinct type of TA tear and the outcome following a repair., Methods: This is a retrospective study of the patients who underwent tendoachilles repair during January 2012-June 2018. Patients above 18 years with a minimum follow-up of two years were included. Patients with calcaneal tuberosity avulsions, prior surgeries, and open injuries were excluded. Patients were divided into groups 1 (insertional tears (IT)) and 2 (non-insertional tears (NIT)), and further subdivided based on the tendon degeneration (as D-degenerative and N-normal sub types) from ultrasound findings. AOFAS score and predisposing factors like degeneration, posterior heel pain, Haglund's bump, spur, and mechanism of injury were compared between the groups., Results: The study included N = 146 with a mean age of 51.6 years and mean follow-up of 38.6 (range 24 to 96) months. IT associated with degeneration (IT-D) had a trivial fall as the predominant mechanism (P < 0.001). All patients had significant postoperative improvement of scores with no significant difference between the groups (P = 0.59) and subgroups (P = 0.27).75.34% had degenerative tendon, of which 64.5% were in the IT group and the rest in the NIT group (P = 0.02). 51.4% patients had a Haglund bump in the IT group and n.s. (P = 0.9). Forty-seven percent of patients had pre-existing posterior heel pain, 68% in IT and 32% in NIT (P = 0.04). Subgroup analysis revealed 65% of patients were in the IT-D subgroup (P < 0.001)., Conclusion: Predisposing factors like posterior heel pain, tendon degeneration, and trivial trauma have a strong propensity for insertional TA tear. In contrast, the prominence of Haglund's bump does not predispose to a distinct type of TA tears. The outcome following a surgical repair-yields good results with no difference between the two groups., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)
- Published
- 2022
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