Tendinosis and ruptures of the Achilles tendon are relatively common pathologies both in the world of sport and in the general population. the tendons of the human body, turns out to be very susceptible to injury. Over the last few years, the incidence of spontaneous and post-traumatic breakdowns has grown, with an incidence of 75% of breakdowns during physical activity probably due to the spread of physical fitness in the cultural population. The various etiological hypotheses are known among healthcare professionals, such as the side effect due to the use of corticosteroids and fluoro quinolone antibiotics, as well as the physiological and biomechanical effect of exercise-induced hyperthermia, and mechanical abnormalities of the foot. The diagnosis of an acute rupture can be made clinically. Several meta-analyzes on wound treatments have been published, but there is still no widely accepted consensus on what is the best operative and rehabilitative treatment for acute Achilles tendon rupture. Generally, management can be classified into operational and non-operational treatment. Commonly, open operative management has been used for athletes and for young and trained patients, percutaneous operation in those who did not wish to have open repair, and inoperative management for the elderly. In the literature, systematic reviews have concluded that operational management has a lower risk of re-breaking, but must be evaluated by balancing it with the risks associated with the intervention. Also recently, the beneficial effects of functional post-treatment with a mobile gauze / plaster cast or in a brace have been noted. The purpose of this thesis work is a discussion of the above concepts based on the direct experience in the studio and in the field of some patients representative of the various social and motor classes of a population restricted to the local context of the reported cases.
Le tendinosi e le rotture del tendine di Achille sono patologie relativamente comuni sia nel mondo dello sport che nella popolazione generale Infatti nonostante che il tendine di Achille, che si forma tramite l’unione di tendini di gastrocnemio e soleo, sia ritenuto il più forte tra i tendini del corpo umano, risulta essere molto suscettibile ad infortuni. Nel corso degli ultimi anni l’incidenza di rotture spontanee e post traumatiche è cresciuta, con una incidenza del 75% delle rotture durante un’attività fisica probabilmente a causa della diffusione nella popolazione cultura della forma fisica. Sono note tra gli operatori della sanità le diverse ipotesi eziologiche, quali l’effetto collaterale dovuto all’uso di corticosteroidi e antibiotici fluoro chinolonici, inoltre l’effetto fisiologico e biomeccanico dell’ipertermia indotta dall’esercizio, e anomalie meccaniche del piede. La diagnosi di una rottura acuta può essere fatta clinicamente. Diverse meta-analisi sui trattamenti delle lesioni sono state pubblicate, ma ancora non vi è un consenso largamente condiviso su quale sia il miglior trattamento operativo e riabilitativo in seguito ad rottura acuta del tendine di Achille. Generalmente, la gestione può essere classificata in trattamento operativo e non operativo. Comunemente, la gestione operativa aperta è stata utilizzata per gli atleti e per i pazienti giovani e allenati, la operazione percutanea in coloro che non desideravano avere una riparazione a cielo aperto, e gestione non operativa per gli anziani. In letteratura le recensioni sistematiche hanno concluso che la gestione operativa ha un rischio di ri-rottura più basso, ma deve essere valutata bilanciandola con i rischi associati all’intervento. Sempre recentemente si sono rilevati gli effetti benefici del post-trattamento funzionale con una garza/ingessatura mobile (mobile cast) o in un tutore. Lo scopo di questo lavoro di tesi è una discussione dei concetti sopra riportati in base alla esperienza diretta in studio e sul campo di alcuni pazienti rappresentativi delle varie classi sociali e motorie di una popolazione ristretta al contesto locale dei casi riportati.
ROTTURA DEL TENDINE D’ACHILLE dalla tendinosi al ritorno in campo
SAVOIA, COSIMO
2020/2021
Abstract
Tendinosis and ruptures of the Achilles tendon are relatively common pathologies both in the world of sport and in the general population. the tendons of the human body, turns out to be very susceptible to injury. Over the last few years, the incidence of spontaneous and post-traumatic breakdowns has grown, with an incidence of 75% of breakdowns during physical activity probably due to the spread of physical fitness in the cultural population. The various etiological hypotheses are known among healthcare professionals, such as the side effect due to the use of corticosteroids and fluoro quinolone antibiotics, as well as the physiological and biomechanical effect of exercise-induced hyperthermia, and mechanical abnormalities of the foot. The diagnosis of an acute rupture can be made clinically. Several meta-analyzes on wound treatments have been published, but there is still no widely accepted consensus on what is the best operative and rehabilitative treatment for acute Achilles tendon rupture. Generally, management can be classified into operational and non-operational treatment. Commonly, open operative management has been used for athletes and for young and trained patients, percutaneous operation in those who did not wish to have open repair, and inoperative management for the elderly. In the literature, systematic reviews have concluded that operational management has a lower risk of re-breaking, but must be evaluated by balancing it with the risks associated with the intervention. Also recently, the beneficial effects of functional post-treatment with a mobile gauze / plaster cast or in a brace have been noted. The purpose of this thesis work is a discussion of the above concepts based on the direct experience in the studio and in the field of some patients representative of the various social and motor classes of a population restricted to the local context of the reported cases.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
Per maggiori informazioni e per verifiche sull'eventuale disponibilità del file scrivere a: unitesi@unipv.it.
https://hdl.handle.net/20.500.14239/13654