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. 2018 Jun 7;13(1):142.
doi: 10.1186/s13018-018-0850-x.

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Kajetan Klos  1 , Boyko Gueorguiev  2 , John Bennet Carow  3 , Ali Modabber  4 , Sven Nebelung  5 , Bong-Sung Kim  6 , Klemens Horst  3 , Christian David Weber  3 , Matthias Knobe  7
Affiliations

Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Kajetan Klos et al. J Orthop Surg Res. .

Abstract

Background: Dorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon.

Methods: In 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon.

Results: Microperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p < 0.001), while SO2 was significantly higher at the proximal measurement point (MP 1; p < 0.001). In this area, the lateral approach was significantly superior to the medial approach regarding Flow (MP 1; p = 0.012). The Achilles tendon exhibited a significantly reduced microperfusion 5 cm proximal to the calcaneal tubercle (SO2 p = 0.001; Flow p = 0.048). Demographic factors, such as body mass index and age, had different effects. Microcirculation was partially superior in men and negatively affected by smoking.

Conclusions: Soft tissue microcirculation on the lateral and medial side of the healthy Achilles tendon was better than centrally on the tendon. Proximally, the lateral approach was better than the medial approach. These circumstances could provide advantages regarding the surgical approach. The Achilles tendon exhibited significantly reduced microperfusion at the typical side of degeneration and rupture. This circumstance could be a possible cause of degenerative processes.

Keywords: Achilles tendon; Doppler/white light spectroscopy; Hindfoot surgical approach; Humans; Microcirculation.

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Conflict of interest statement

Authors’ information

KK (M.D., Associate Prof.) Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Germany

BG (Prof.) AO Research Institute Davos, Davos, Switzerland

JBC (M.D.) Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany

AM (M.D., Associate Prof.) Department of Oral and Maxillofacial Surgery, University of Aachen Medical Center, Germany

SN (M.D., Associate Prof.) Department of Radiology, University of Aachen Medical Center, Germany

BSK (M.D., Associate Prof.) Department of Plastic Surgery, Reconstructive and Hand Surgery, University of Aachen Medical Center, Germany

KH (M.D., MHBA) Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany

CDW (M.D.) Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany

MK (M.D., Associate Prof., MME, MHBA) Department of Orthopaedic Trauma, University of Aachen Medical Center, Germany

Ethics approval and consent to participate

Institutional Review Board approval was granted before initiation of this study, and strict confidentiality guidelines were followed (Local Ethics Committee Reference Number EK 346/14). Participants provided informed consent for the use of their results in this study and for publication at the time of enrollment.

Ethics committee of the RWTH Aachen University Hospital, ethics approval EK 346/14.

Consent for publication

Consent for publication, including photographic images, was provided by the participants at the time of enrollment.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The six different measurement points. At the central points, the microperfusion was measured in 2- and 8-mm depth, whereas at the lateral and medial points it was measured in 2-mm depth only
Fig. 2
Fig. 2
Significant correlations between SO2 and the evaluated demographic factors as well as significant differences with regard to SO2 between all measurement points are illustrated for each measurement point. (A: all; NS: nonsmokers; S: smokers)
Fig. 3
Fig. 3
Significant correlations between Flow and the evaluated demographic factors and significant differences with regard to the Flow between all different measurement points are illustrated for each measurement point
See this image and copyright information in PMC

References

    1. Knobe M, Gradl G, Klos K, Corsten J, Dienstknecht T, Rath B, Sonmez TT, Hoeckle C, Pape HC. Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture? Int Orthop. 2014; 10.1007/s00264-014-2615-4. - PubMed
    1. Paavola M, Orava S, Leppilahti J, Kannus P, Jarvinen M. Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med. 2000;28(1):77–82. doi: 10.1177/03635465000280012501. - DOI - PubMed
    1. Cretnik A, Frank A. Incidence and outcome of rupture of the Achilles tendon. Wien Klin Wochenschr. 2004;116(Suppl 2):33–38. - PubMed
    1. Cretnik A, Kosir R, Kosanovic M. Incidence and outcome of operatively treated Achilles tendon rupture in the elderly. Foot Ankle Int. 2010;31(1):14–18. doi: 10.3113/FAI.2010.0014. - DOI - PubMed
    1. Amlang MH, Maffuli N, Longo UG, Stubig T, Imrecke J, Hufner T. Surgical treatment of Achilles tendon rupture. Unfallchirurg. 2010;113(9):712–720. doi: 10.1007/s00113-010-1809-5. - DOI - PubMed

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