Most recent by Gregory C. Berlet, MD, FRCS(C), FAOA
VIDEO: Berlet discusses wear in patients with fully porous-coated stemmed tibial implants
Midsubstance repair is an alternative technique to treat Achilles tendon ruptures
Minimally invasive repairs are used for midsubstance Achilles tendon ruptures
Acute midsubstance Achilles tendon ruptures are an increasingly common injury among athletic patients that can lead to significant functional limitations and decreased quality of life. Management of these injuries remains controversial with no consensus in the literature regarding the role of surgical treatment or optimal repair technique. Recent literature has shown that surgical repair can result in faster and a 16% to 24% increased return of calf muscle strength, decreased tendon elongation and improved physical function and pain scores compared to nonoperative functional rehabilitation. Various surgical techniques have been described for midsubstance Achilles ruptures including open repair with Krackow locking sutures, limited incision repair using suture-passing jigs and percutaneous repair. The overall goal of minimally invasive Achilles repair techniques is to maximize the functional benefits of direct tendon repair while minimizing postoperative complications, such as delayed wound healing and infection.
Flexible syndesmotic fixation is new gold standard to restore syndesmosis anatomy
The distal tibiofibular syndesmosis uniquely contributes to ankle joint function by constraining the lateral articulation with the talus while its own conformation shifts throughout ankle range of motion. Altered syndesmotic alignment and constraint have been associated with diminished outcomes after surgery. Indeed, the incidence of postoperative syndesmotic malreduction has been variously reported and may be as high as 52%. Although the threshold parameters for diminished outcomes are not well defined, the acceptable tolerances are thought to be small.