Background: Large defects in chronic Achilles Tendon Ruptures are difficult to rapair. The purpose of this study was to evaluate the clinical and functional outcomes following reconstruction of the chronic large gaps in Achilles Tendon ruture using free semitendinosus interposition Tendon grafting.Methods: In a case series study, eleven male patients with mean age of 30±4 years and average defect size of 8.31±1.96 cm in their old Achilles Tendon underwent reconstruction during 6 years in a teaching hospital in Tehran-Iran. Ipsilateral semitendinosus free Tendon graft was used for reconstruction. The cases were evaluated by Ankle-Hindfoot Scale of American Orthopaedic Foot and Ankle Society (AOFAS), and the Achilles Tendon Rupture Score (ATRS) to with a mean follow-up of 25.36±3.3 months.Results: The pre-operative AOFAS and ATRS of 70.4±5.3 and 31.7±5.7 preoperatively improved to 91.8±4.8 and 88.7±4.2 values. The ankle dorsiflexion showed a significant decline-postoperative value of 13.5±4.2 degrees compared to preoperative of 17.2±3.9 degrees (p=0.04). All the cases except a professional athlete, returned to their previous activities.Conclusion: This technique offers good clinical and functional results in patients with large defects and is associated with no donnersite morbidity. We recommend this technique for the reconstruction of the chronic at Ruptures in patients with over 6 cm defects.

Objective: Quadriceps Tendon Ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps Tendon Ruptures are even more uncommon, and almost all reported cases in the literature are associated with an underlying disease. Case Presentation: A 62-year-old Caucasian male presented complaining of pain in the anterior-superior aspect of both knees following a fall while walking that same day, during which his knees were in a semi-flexed position. Physical examination revealed a loss of active knee extension in both limbs and a palpable gap between the superior pole of the patella and the quadriceps Tendon. MRI of both knees was performed two days after the injury, confirming bilateral quadriceps Tendon Ruptures. Twelve days after the initial injury, the patient underwent surgical intervention, and both injuries were addressed simultaneously using a transosseous tunnel technique. The transosseous technique consisted of three longitudinal and parallel tunnels drilled into the patella, and a modified Kessler suture was used to secure and reattach the quadriceps Tendon back to the superior pole of the patella. At the patient’s eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° flexion bilaterally. However, hypotrophy of the quadriceps muscle was noted bilaterally. Conclusion: Proper evaluation and treatment of these injuries are crucial to achieving good outcomes, as they can lead to significant knee pain and disabilities.

Ipsilateral fractures of the femur and tibia result in a flail knee joint condition referred to as “ floating knee” . Associated knee ligament injuries are common and have been reported to be frequently missed in initial evaluations. We report the diagnosis and treatment of the concomitant patellar Tendon Rupture during fixation of the distal femur and proximal tibia fractures in a patient who presented with floating knee and a history of osteomyelitis. This case further highlights the paramount importance of careful assessment of the knee in patients who present with floating knee injuries. We also recommend that MRI and ultrasonography be used to prevent ignored patellar Tendon Ruptures in such patients; particularly when physical exam is challenging or an intra-articular injury is present.

Background: Spontaneous Rupture of Tendon is a rare disease that often occurs following an underlying disease or drug usage. However, the association of this condition with primary hyperparathyroidism has rarely been reported.Case: In a case-study, two cases of spontaneous Tendon Rupture associated with primary hyperparathyroidism are reviewed. The first one is a middle-aged woman that due to bilateral patellar Tendon Rupture is operated for secondary repair and augmentation of Tendons. The second one is a middle-aged man with unilateral triceps brachii Tendon Rupture who has been operated for primary Tendon repair. Conclusion: Since paramount force is needed for Tendon Rupture, in spontaneous Tendon Rupture cases, patient evaluation for detecting underlying diseases and drug usage is necessary. In cases that the history of an underlying disease is not indicated, evaluation of serum level concentrations of Ca, P, ALP, and PTH is recommended for contraindication of primary hyperparathyroidism.

Background and Objective: There has been considerable debate regarding the best treatment of the Achilles Tendon Rupture. One of the nonoperative treatment method for Achilles Tendon Rupture is using the functional brace. The aim of this study was to evaluate the effect of the functional brace with/without patellar Tendon bearing on treatment of patients with Achilles Tendon Rupture.Materials and Methods: In this semi experimental study, 17 patients with Achilles Tendon Rupture were recruited and randomly allocated into 2 groups: functional brace with patellar Tendon bearing and functional brace without patellar Tendon bearing. Pain, plantar and dorsi flexion strength and the required time for progressively increased dorsi flexion position in orthoses to reach the neutral position were measured. Data analyzed with SPSS-13, independent t-test and Smironov-Kolomogrov.Results: Three patients were excluded during follow up and finally this study was done on 14 patients. The difference of the pain intensity and the plantar and dorsi flexion, in each group, before and after the intervention was significant (P<0.05), but the difference between two groups after intervention in all variables was not significant.Conclusion: This study showed that both brace with/without patellar Tendon bearing are effective on improvement of pain and the plantar flexion and dorsi flexion strength and also are effective in required time to reach the neutral position.

Background: Early detection and treatment of extensor mechanism Rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable. Objectives: The purpose of this study was to evaluate outcomes in the cases of late repaired patellar Tendon Rupture. Methods: This study included patients with chronic patellar Tendon Rupture who were operated at Shafa orthopedic hospital from 2006 to 2013. Results: A total of ten patients were evaluated, wirh 12 cases of chronic patellar Tendon Rupture. Patients had a mean age of 34. 4 years (range 18-58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3-132). The mean time of follow-up was 6. 2 years (range 3-9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles Tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22. 7/84. 5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases. Conclusions: Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar Tendon Rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Background: The Achilles Tendon is the largest Tendon in the body. Local infiltration is recognized to be cost-saving and effective in treating musculoskeletal pain. However, using corticosteroids in the long term can lead to adverse consequences such as osteoporosis, immunosuppressive effect, or Tendon Rupture. Case presentation: In this paper, we reported a case with bilateral Achilles Tendon Rupture following corticosteroid treatment. When Achilles Tendon Rupture occurs, surgical treatment is necessary to rehabilitate Achilles Tendon function and avoid severe complications. Conclusion: This report reviewed a case of bilateral Achilles Tendon Rupture following corticosteroid treatment precautions which should be considered.

Background: This study aimed to introduce a modified technique for minimally invasive Achilles Tendon (AT) Rupture repair using gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients. Methods: In a consecutive case series study, 24 patients with acute AT Rupture underwent modified minimally invasive AT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT Rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from all patients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calf atrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-Rupture. Results: After two years, the mean scores of AOFAS and ATRS were obtained at 83± 4 and 81. 9± 6. 3, respectively. Approximately 87. 5 % of the patients regained their previous level of activity. The mean VAS score was 7. 7± 0. 9 regarding the satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82. 7± 5. 8 and 87. 7± 4. 1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant. In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly, compared to that of the other side; however, the differences were not significant functionally. There was no patient with wound complications, nerve injury, or complaint about problem with footwear. Conclusion: Minimally invasive repair of acute AT Rupture using two mini-incisions and gift box sutures offers good functional and clinical outcomes without wound complications which can be usually observed following open repair of AT Ruptures.