• 대한족부족관절학회지
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• 제14권2호
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• pp.109-114
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• 2010

Purpose: The purpose of this study was to report the surgical outcome of reconstruction of neglected chronic Achilles tendon ruptures with various methods including Achilles tendon allograft. Materials and Methods: Between October 2003 and November 2008, 8 consecutive neglected chronic Achilles tendon ruptures with the defect gap of more than 4 cm underwent surgical reconstruction including V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus transfer and Achilles tendon allograft. There were 7 males and 1 female who were evaluated at more than 18 months after surgery. At the time of followup, all patients were assessed with regard to postoperative complications, their self-reported level of satisfaction, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, 10 repetitive single heel rise, single leg hopping test, and ankle range of motion. Results: The AOFAS score increased from average 71.4 (50-87) to 96.4 (86-100). All patients were able to perform 10-repetitive single heel raise and single leg hopping at the latest follow up. No patient experienced wound complications and deep infection. Six patients were rated as 'excellent' and the other two as 'good'. Conclusion: Neglected chronic Achilles tendon ruptures could be successfully treated with careful selection of the reconstruction method according to the amount of defect gap. With an extensive defect, Achilles tendon allograft can be a good option when the reconstruction is not feasible otherwise.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.539-542
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• 2005

Reconstructions of soft tissue defect of the posterior ankle including Achilles the tendon should take into account not only coverage but functional outcome. Various methods of tendon transfer and tendon graft have been reported as a single-stage procedure. With advances and refinements in microsurgical techniques, several free composite flaps including tendon, fascia, or nerve have been used in single-stage reconstructions of large defects in this area minimizing further damage to the traumatized leg. However, when free flap is not feasible for some reasons, this cannot be accomplished successfully. Here we present a patient with Achilles tendon and circumferential large soft tissue defect. Because of circulatory compromise of the lower extremity, free flap reconstruction could not be applied. Instead, cross-leg composite flap of the dorsalis pedis flap including the extensor hallucis brevis musle and tendon, and tendon strips of the Second, third and fourth extensor digitorum logus were employed, Functional reconstruction of the tendon and resurfacing were obtained at the same time. The flap was detached 3 weeks postoperatively, and the transplanted flap has survived without any complications. By 3 months after surgery, full weight bearing, tip-toe standing and even walking without crutch assistance was possible. When functional reconstruction with the free flap is unattainable in the large defect of the posterior ankle including the Achilles tendon, cross-leg composite island flap of dorsalis pedis flap and tendon strips of the extensor digitorum longus tendon is a viable alternative.

• 대한족부족관절학회지
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• 제22권1호
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• pp.21-25
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• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Computers and Concrete
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• 제15권1호
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• pp.55-71
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• 2015

This paper presents a novel harmony search (HS)-based data-driven single input rule modules (SIRMs)-connected fuzzy inference system (FIS) for the prediction of stress in externally prestressed tendon. The proposed method attempts to extract causal relationship of a system from an input-output pairs of data even without knowing the complete physical knowledge of the system. The monotonicity property is then exploited as an additional qualitative information to obtain a meaningful SIRMs-connected FIS model. This method is then validated using results from test data of the literature. Several parameters, such as initial tendon depth to beam ratio; deviators spacing to the initial tendon depth ratio; and distance of a concentrated load from the nearest support to the effective beam span are considered. A computer simulation for estimating the stress increase in externally prestressed tendon, ${\Delta}f_{ps}$, is then reported. The contributions of this paper is two folds; (i) it contributes towards a new monotonicity-preserving data-driven FIS model in fuzzy modeling and (ii) it provides a novel solution for estimating the ${\Delta}f_{ps}$ even without a complete physical knowledge of unbonded tendons.

• 대한족부족관절학회지
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• 제13권1호
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• pp.23-27
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• 2009

Purpose: The purpose of this study was to evaluate the clinical outcome of neglected Achilles tendon rupture treated with reconstruction and augmentation with flexor hallucis longus (FHL) tendon using one incision technique. Materials and Methods: Between July 2006 and March 2008, eleven patients with neglected Achilles tendon rupture received surgical treatment. Through one incision technique, augmentation with auto FHL tendon transfer was performed using a Bio-Interference screw (Arthrex, Naples, FL) and followed by V-Y advancement (5 cases) or gastronemius fascial turn-down flap procedure (6 cases). After mean follow up of 20.7 months (range, 11.8-33.3 weeks), clinical outcomes were evaluated with Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, 10 repetitive double heel raise test, 10 repetitive single heel raise test and subjective satisfaction. Results: The length of the gap after debridement was $5.4{\pm}2.0$ cm. The VAS improved from $4.1{\pm}0.9$ to $1.5{\pm}0.8$ at last follow up (p<0.05). The AOFAS score increased from $38.9{\pm}12.2$ to $91.5{\pm}8.9$ at last follow up (p<0.05). Eight patients were satisfied with excellent results and three were satisfied with good results. All patients were able to perform 10 repetitive double heel raise and nine out of eleven patients were able to perform 10 repetitive single heel raise at last follow up. There were no complications including deep infection or re-rupture. Conclusion: Augmentation with FHL tendon transfer and reconstruction with V-Y advancement or turn-down flap through one incision technique appeared to be effective and safe. This technique is recommendable for the treatment of neglected Achilles tendon rupture.

• 대한토목학회논문집
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• 제14권6호
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• pp.1329-1339
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• 1994

본 논문은 복수 정착구가 서로 인접하여 설치되었을 경우의 정착부 거동 및 국부응력 분포특성을 규명함에 목적이 있으며, 이를 위하여 단일텐던 및 복수텐던이 설치된 프리스트레스 콘크리트부재에 대한 실험연구가 수행되었다. 위의 실험연구 결과 정착부 파괴는 단일 및 복수텐던 설치부재 모두 텐던을 따라가는 균열에 의해 시작되며, 먼저 정착된 텐던 정착부 주변의 인장응력은 인접해서 긴장되는 텐던의 압축응력 발생효과로 인하여 균열하중에 대한 저항성이 개선됨이 밝혀졌다. 본 논문에서는 복수텐던 부재의 정착부 주위의 변형도 분포와 균열하중 등을 단일텐던 부재의 경우와 비교분석하여 제시하였으며, 복수텐던부재의 파괴기구도 규명하였다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.179-179
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• 2008

For a partial tear of the subscapularis tendon, the presenting technique requires only the anterior portal for preparing the footprint and suture management, as well as the subclavian portal for placing the suture anchor and suture hook without inserting a cannula. It provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. A spinal needle was inserted through the subclavian portal in order to identify the appropriate angle for placing the suture anchor. A 3-mm incision was made for the subclavian portal and a biosuture anchor was placed on the footprint portion of the subscapularis tendon. In order to avoid crowding, each limb of both strands of the biosuture anchor were passed through the tendon- posteromedial side first, and anterolateral side second, using a switching technique with suture hook embedded with no.1 PDS. A suture tie was applied in a reverse sequence (the lateral strand first and the medial strand second) through the anterior cannula using a sliding technique.

• 대한족부족관절학회지
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• 제8권2호
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• pp.218-220
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• 2004

It is known that steroids increase the risk for tendon ruptures. Despite this local steroids are still used in the treatment of achilles tendinitis. 46-year-old women had occurred achilles tendon rupture after repeated local steroid injection. Intraoperatively, necrotic change were seen at both side of ruptured end. Like this, tendon rupture after repeated steroid injection often result in a large defect, which needed surgical repair. After debridement of ruptured end, tenorrhaphy with single Krackow method and plantaris tendon augmentation was done. The patient showed favorable result with return to range in a degree of activity levels.

• 대한족부족관절학회지
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• 제17권3호
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• pp.196-202
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• 2013

Purpose: To report the clinical results from using absorbable suture materials instead of nonabsorbable materials which have been used more commonly to repair Achilles tendon. Materials and Methods: We retrospectively reviewed 21 cases of acute Achilles tendon rupture, treated surgically from 2004 to 2011. Mean follow-up period is 6 months. We repaired Achilles tendon using size 1 Vicryl (Polyglactin 910, Ethicon) for core suture and size 3-0 Vicryl for epitendinous suture. At three months after surgery, we evaluated clinical results with single heel raise height by centimeters, differences of calf circumference and passive range of motion of ankle joint, compared to contralateral side. Also we recorded clinical results with subjective satisfaction grades. Results: At three months after surgery, 20 of 21 patients were able to perform single heel raise over 5 cm in height. Calf circumference differences were less than 1 cm in 12 cases, between 1 cm to 3 cm in 5 cases, more than 3 cm in 4 cases. There was no difference in range of passive motion in 19 cases. All patients satisfied with daily activity except 2 cases with mild discomfort. There was no complication such as rerupture, elongation or infection. Conclusion: We experienced excellent clinical results from repairing Achilles tendon with using absorbable suture materials in terms of functional outcomes and patient's satisfaction without any complication. So we may consider using absorbable suture materials instead of nonabsorbable materials to repair Achilles tendon.

• 대한족부족관절학회지
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• 제18권3호
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• pp.115-118
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• 2014

Purpose: The purpose of this study is to report on the result of repairing Achilles tendon using absorbable suture under nerve block. Materials and Methods: We retrospectively reviewed 20 patients with acute Achilles tendon rupture who were followed up for at least six months after the operation. We repaired Achilles tendon using two absorbable sutures using the Krackow technique for the proximal stump and the Kessler technique for the distal stump. A programmed postoperative management including non-weight bearing with a short leg cast for four weeks after the operation was applied for all patients. We evaluated clinical results using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) for satisfaction, range of motion of ankle, functional recovery rate, and the starting time of single heel raise. Results: The mean VAS score for satisfaction and AOFAS score was 9.2 and 93.0, respectively. The affected ankle showed a mean dorsiflexion rate of 90% and plantar-flexion rate of 94% compared to the uninjured side. The single heel raise could start at a mean of 3.5 months after the operation. Conclusion: Treatment of Achilles tendon rupture with absorbable suture material using the hybrid suture technique of proximal Krackow and distal Kessler showed sufficient stability and minimal chronic inflammatory reaction.