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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 260 - 260
1 Jul 2011
Leduc S Clare MP Swanson S Walling AK
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Purpose: Insertional calcific Achilles tendinosis is a painful, frequently disabling, condition. The longitudinal and radial alignment of the angiosomes of the posterior region of the leg makes a straight posterior midline approach logical. The safety of the posterior midline approach and the outcome of a central tendon splitting approach associated with a Strayer procedure to treat this condition was evaluated.

Method: A retrospective review of a consecutive cohort of a single surgeon was performed. All patients had failed conservative treatment and all patients were primary cases. Forty-seven patients (48 heels) were treated over a 11-year period for chronic insertional Achilles tendinosis. All patients underwent a midline posterior splitting approach, debridment of the bursae, resection of the haglund deformity, partial Achilles detachment, debridement, reinsertion with bone anchor associated with a proximal gatrocnemius recession (strayer procedure) through a second midline incision. The average age was 59 years old (39–75), co-morbidities included four smokers and one diabetic patient. The average followup was 54 months (15–144). All patients answered pre-op and latest follow up AOFAS questionnaire, satisfaction rate and complications were reviewed.

Results: Satisfaction rate was 100%. AOFAS score improved significantly from 59 (36–80) preop to 97 (90–100) at the latest follow-up. Complications included one superficial infection and one sural nerve paresthesia. There were no major complications.

Conclusion: Achilles insertional tendinopathy treated by a posterior midline approach is a safe and reliable procedure. The procedure was associated with high patient satisfaction rate and excellent outcome.


The Journal of Bone & Joint Surgery British Volume
Vol. 73-B, Issue 5 | Pages 806 - 810
1 Sep 1991
Weightman B Swanson S Isaac G Wroblewski B

Laboratory wear testing of ultra high molecular weight polyethylene from 12 Charnley acetabular cups, removed after periods of up to 17.5 years showed that the large patient-to-patient variations in clinical penetration rate cannot be explained by batch-to-batch variation in the wear resistance of the material. Nor was there any evidence of a time-dependent degradation in wear resistance of the material.


The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 2 | Pages 256 - 261
1 May 1978
Bargren J Day W Freeman M Swanson S

Cadaveric knees replaced with the Geomedic, ICLH, Marmor and Total Condylar prostheses were tested in axial compression, in rotation and in hyperextension in order to observe the strength of fixation of the tibial components. In axial compression the strengths at failure varied widely, both with any one prosthesis and between prostheses. This is attributed largely to the strength of the cancellous bone of the tibia, which was measured in each case and also varied widely. Three natural knees failed at loads of 7300, 7600 and 8300 newtons respectively, whereas the strengths of replaced knees ranged from 3000 to 15750 newtons. At least one example of each design failed at less than 7300 newtons, suggesting little or no reserve of strength. The strength of fixation was greater when the tibial prosthesis was large enough to rest on the whole cross-section of the tibia. In rotation the three prostheses embodying rollers in troughs were stiffer than the Marmor which had a nearly flat tibial-bearing surface. The presence or absence of the cruciate ligaments had a negligible effect on torsional stiffness. In hyperextension, knees replaced with the ICLH, Marmor and Total Condylar prostheses failed by rupture of the posterior capsule at moments of about 60 newton-metres, compared with about 100 for natural knees. With the Marmor prosthesis the anterior cruciate ligament was avulsed at about 20 newton-metres compared with about 75 in natural knees, suggesting that in this respect the retention of the cruciate ligaments contributes little. None of the four knees tested after inserting a Geomedic prosthesis showed strengths as high as those replaced with the other three designs.