OKOJ

OKOJ, Volume 5, No. 2


Achilles Tendinopathies of the Foot and Ankle

Noninsertional Achilles tendinopathies are often related to overuse. Paratendonitis frequently occurs in active 20- to 30-year-old athletes involved in high impact activities. Tendinosis most often occurs as a degenerative process in middle-aged individuals.

Insertional tendinopathies have a bimodal distribution. They tend to occur most often in adults in their forties and fifties, often in obese patients as a result of tendon degeneration. Insertional tendinopathy can also develop in young athletic individuals, but this occurs far less commonly than noninsertional disease.

Achilles tendinopathy is also found in patients of all ages afflicted with medical conditions such as diabetes, systemic enthesopathies, or chronic renal failure.

This topic reviews the clinical presentation, nonsurgical options, and surgical techniques for management of noninsertional tendinopathies, including Achilles tendon débridement and flexor hallucis tendon transfer.

    • Keywords:
    • foot tendonitis

    • ankle tendonitis

    • foot tendinopathy

    • ankle tendinopathy

    • tendinosis

    • paratenonitis

    • tendinopathy

    • Achilles tendonitis

    • Achilles tendinopathy

    • Achilles tendon rupture

    • Achilles tendon injuries

    • Achilles debridement

    • flexor hallucis longus transfer

    • FHL transfer

    • Subspecialty:
    • Foot and Ankle

Elbow Arthroscopy

Arthroscopy is a minimally invasive, effective, and safe method for the diagnosis and treatment of a variety of traumatic, inflammatory, and degenerative elbow disorders. Thorough knowledge of topographic and neurovascular elbow anatomy, preferred portal locations, considered indications for definitive arthroscopic procedures, and potential complications are essential for maximizing the success rate and clinical outcomes of arthroscopic procedures on the elbow.

    • Keywords:
    • elbow arthroscopy

    • elbow arthroscopic surgery

    • topographic elbow anatomy

    • loose body removal

    • plica excision

    • lateral epicondylitis release

    • capsulotomy

    • osteocapsular arthroplasty

    • Subspecialty:
    • Sports Medicine

    • Shoulder and Elbow

Elbow Contractures

To individualize treatment approaches for patients with elbow contractures, surgeons must be aware of the treatment options and surgical procedures for release of the stiff elbow. Additionally, the anatomic structures that obstruct motion and the patient's needs must be considered. In selecting a treatment approach, surgeons must discern between pain caused by impinging osteophytes and pain caused by ulnohumeral joint arthritis. With proper procedure selection and rigorous postoperative rehabilitation, a reasonably functional range of motion can be achieved in most patients with elbow contractures.

    • Keywords:
    • elbow contracture

    • heterotopic ossification

    • elbow arthritis

    • posttraumatic contracture

    • elbow arthroscopy

    • distraction-interposition arthroplasty

    • total elbow arthroplasty

    • elbow impingement

    • elbow osteophyte

    • stiff elbow

    • Subspecialty:
    • Shoulder and Elbow

    • Hand and Wrist

Midsubstance Achilles Tendinopathy

Midsubstance Achilles tendinopathy is a chronic painful condition that can cause considerable mobility. An MRI scan is helpful in detecting the areas of the tendon that are affected by inflammation and degeneration so that these areas can be adequately excised. If nonsurgical treatment of 6 months or longer is not successful, flexor hallucis longus tendon transfer may be indicated.

Dr. Den Hartog illustrates this surgical procedure in a narrated step-by-step surgical techniques video. A case study of a patient with midportion Achilles tendinopathy is presented.

    • Keywords:
    • foot tendonitis

    • ankle tendonitis

    • foot tendinosis

    • ankle tendinosis

    • paratenonitis

    • tendinopathy

    • Achilles tendonitis

    • Achilles tendinopathy

    • Achilles tendon rupture

    • Achilles tendon injuries

    • MRI

    • cross-training

    • cryotherapy

    • nonsteroidal anti-inflammatory drugs

    • topical clyceryl trinitrate

    • ultrasound-guided injections

    • brisement

    • excision of degenerative tendon

    • percutaneous longitudinal tenotomies

    • augmentation of the debrided Achilles segment

    • flexor hallucis longus tendon transfer

    • Subspecialty:
    • Foot and Ankle

Surgical Technique: Arthroscopic Bankart and SLAP Lesion Repair

Dr. Brian Cole performs arthroscopic Bankart and SLAP (superior labrum from anterior to posterior) lesion repair on a 21-year-old male collegiate-level wrestler who had several previous dislocation and/or subluxation events. Arthroscopic shoulder stabilization was indicated because of the patient's recurrent instability and his inability to participate in athletics. After performing an examination under anesthesia and identifying the principle direction of instability as anteroinferior, Dr. Cole uses a double-cannula technique to first arthroscopically repair the patient's superior labral tear first and then the anteroinferior labral tear. Arthroscopic anchor placement is clearly illustrated.

    • Keywords:
    • shoulder arthroscopy

    • Bankart

    • shoulder lesion

    • SLAP lesion

    • superior labrum from anterior to posterior

    • Subspecialty:
    • Shoulder and Elbow

Periodical Links

Advertisements

Advertisement