Aims

The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes.

Aims

In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method.

Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time

Aims

Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic posterior neurovascular and tendinous injury have been described from saw cuts. However, it is hypothesized that posterior ankle structures could be damaged by inserting tibial guide pins too deeply and be a potential cause of residual hindfoot pain.

Aims

To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle.

We describe three patients in whom the tibial nerve was used, in mistake for the plantaris tendon, to repair a ruptured calcaneal tendon. The tendon repair was successful in all cases, but despite attempted reconstruction of the nerve, no patient had any motor recovery although two regained some protective sensation

Carbon-fibre and polyester-fibre implants of comparable dimensions were used to replace the calcaneal tendon in 30 sheep. The neotendon produced in proximity to the polyester fibres was denser, more collagenous and more closely adherent than that in the carbon-based neotendon. Fragmentation of the carbon caused continuing cellular reaction which was associated with a poor collagen response

The interosseous route remains popular for tibialis posterior tendon transfer for drop-foot. It leaves a smaller range of movement than the circumtibial route, but lengthening the calcaneal tendon may improve this. The results of this present series indicate that, in order to predict a good functional result, the ankle must be held in at least 20 degrees of dorsiflexion at the time of tendon transfer

This experiment demonstrates that infiltration of hydrocortisone into rabbit calcaneal tendons has a direct effect on the tendon, producing necrosis of collagen at the site of injection. The repair of the lesion so produced is incomplete even after eight weeks, and is often complicated by dystrophic calcification. Similar morphological changes may account for spontaneous rupture of tendons in patients receiving steroid infiltration

The pathogenesis of flat foot and its operative correction for severe cases are reviewed. The importance of the medial plantar fascia in maintaining the structural integrity of the foot is emphasised. Reinforcement of an incompetent plantar fascia by separating the inner half of the calcaneal tendon and attaching it to the neck of the first metatarsal has given results in three patients that were satisfactory at two, six and seven years later

Aims

The study was undertaken to compare the efficacy of Woodcast splints and plaster-of-Paris casts in maintaining correction following sequential manipulation of idiopathic clubfeet.

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet

We report the results of transfer of the long toe flexors and lengthening of the calcaneal tendon in 33 patients with equinovarus deformity requiring orthoses after a stroke. Review of 29 patients more than two years after surgery showed that 21 were able to walk without an orthosis. Equinovarus deformity had recurred in six patients and hammer toe in 11, but walking ability without bracing was still better in seven of these. Results are improved by the release of the short toe flexors

1. Eleven cases of congenital flat foot were studied, five of which are illustrated. 2. Ten of these cases were treated in infancy and followed for at least three years. In two cases the follow-up period was ten years and fifteen years. 3. An essential component of the deformity is equinus of the calcaneus, and treatment consisted of correction of the forefoot deformity by repeated manipulation, followed later by elongation of the calcaneal tendon and capsulotomy of the ankle. 4. The importance of recognising the deformity and beginning treatment in infancy is stressed

The calcaneal tendons of rabbits were excised and either replaced with a carbon or polyester fibre implant, or left as controls. The strength of the neotendons and their mode of failure under tension were examined at intervals up to six months after operation. Return to near normal strength took six months to develop, suggesting that patients having ligament or tendon reconstructions should not resume normal activity for several months. Carbon fibre-based neotendons showed progressive elongation which, unless avoided by a sufficient period of immobilisation, would affect the functional result

1. Five cases of avulsion fracture of the calcaneus are reported. 2. The "beak" fracture of the calcaneus is thought to be a variant of the avulsion fracture and not a separate entity. 3. The variable attachment of the calcaneal tendon to the calcaneus is described, and its relationship to the different forms of avulsion fractures discussed. 4. Operative reduction and fixation are appropriate for young and active patients in order to restore full heel-cord function. 5. Attention is drawn to the risk of pressure necrosis of skin overlying a displaced fragment. Early operative correction may be required to prevent skin damage

Experiments have been performed on rabbits and sheep which demonstrate that pure carbon, in a flexible and filamentous form of great strength, can be used successfully to induce the formation of new tendons. A concept fundamentally different from that underlying the use of other artificial tendon replacements is involved, in which rapidly developing tendon-like tissue is induced to form around the implant. This gradually takes over the function of the implant. The early results in rabbits and the late results in sheep suggest that filamentous carbon may have a place in the replacement of the calcaneal tendon and the collateral ligaments of the knee