Browsing by Author "Zanolli, Diego"
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Item Achilles tendoscopy for non insertional achilles tendinopathy. A preliminary study(2019) Wagner, Pablo; Wagner, Emilio; Ortiz, C.; Zanolli, Diego; Keller, A.; Maffulli, N.Background: To report the mid-term clinical results of endoscopic assisted surgery for patients suffering from chronic recalcitrant painful mid-portion Achilles tendinopathy who failed conservative management for at least 6 months. Methods: Descriptive and retrospective case series. Consecutive series of 11 patients, 6 men and 5 women, with a median age of 54 (range 40 – 67) years; 13 Achilles tendons with chronic recalcitrant painful mid-portion tendinopathy treated with tendinoscopy were included. Median follow-up of 87 (27-105) months. We report the symptoms duration, regular sports activity, treatment before surgery, complications and satisfaction after surgery, return to previous sport level, and postoperative VISA-A score. No tendon excision or transfer was performed at the time of surgery. All patients completed at least 20 sessions of supervised physical therapy and did not undertake impact sport activities for 6 months before surgery. Results: No postoperative complications were reported. Complete satisfaction was obtained in 10 out of 11 patients. The median postoperative VISA-A score was 100 (30-100) points. Conclusions: The mid-term results in patients with chronic painful mid-portion Achilles tendinopathy undergoing endoscopic debridement are satisfactory. Level of Evidence: IV.Item Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot(2018) Wagner, Emilio; Wagner, Pablo; Zanolli, Diego; Radkievich, Rubén; Redenz, Gunther; Guzmán, RodrigoBackground: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). Methods: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. Results: The CT transfer showed the highest gliding resistance (P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. Conclusion: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.Item Interosseous membrane window size for tibialis posterior tendon transfer—Geometrical and MRI analysis(Elsevier, 2016) Wagner, Pablo; Ortiz, Cristián; Vela, Omar; Arias, Paul; Zanolli, Diego; Wagner, EmilioBACKGROUND: Tibialis posterior (TP) tendon transfer through the interosseous membrane is commonly performed in Charcot-Marie-Tooth disease. In order to avoid entrapment of this tendon, no clear recommendation relative to the interosseous membrane (IOM) incision size has been made. OBJECTIVE: Analyze the TP size at the transfer level and therefore determine the most adequate IOM window size to avoid muscle entrapment. METHODS: Eleven lower extremity magnetic resonances were analyzed. TP muscle measurements were made in axial views, obtaining the medial-lateral and antero-posterior diameter at various distances from the medial malleolus tip. The distance from the posterior to anterior compartment was also measured. These measurements were applied to a mathematical model to predict the IOM window size necessary to allow an ample TP passage in an oblique direction. RESULTS: The average tendon diameter (confidence-interval) at 15cm proximal to the medial malleolus tip was 19.47mm (17.47-21.48). The deep posterior compartment to anterior compartment distance was 10.97mm (9.03-12.90). Using a mathematical model, the estimated IOM window size ranges from 4.2 to 4.9cm. CONCLUSION: The IOM window size is of utmost importance in trans-membrane TP transfers, given that if equal or smaller than the transposed tendon oblique diameter, a high entrapment risk exists. A membrane window of 5cm or 2.5 times the size of the tendon diameter should be performed in order to theoretically diminish this complication.Item Percutaneus repair in acute Achilles tendon rupture. Our experience in Chile(Andrés Keller, Pablo Mococain, Emilio Wagner, Pablo Wagner, Diego Zanolli, Percutaneus repair in acute Achilles tendon rupture. Our experience in Chile,Fuß & Sprunggelenk, Volume 17, Issue 4, 2019, Pages 204-209,ISSN 1619-9987, https://doi.org/10.1016/j.fuspru.2019.10.001, 2019) Keller, Andrés; Wagner, Emilio; Wagner, Pablo; Zanolli, Diego; Clínica Alemana de Santiago, Universidad del Desarrollo de Santiago; Mococain, PabloBackground. There is still no consensus in the literature regarding the ideal treatment of acute Achilles tendon ruptures. Materials & Methods. We conducted a selective literature review and analyzed our own results. Results. Open surgery offers good functional results, but presents high rates of surgical wound complications. Conservative treatment is also described as a good option, but rerupture rates are significantly higher than with surgical treatment. On the other hand, percutaneous treatment offers great functional outcomes with minimal soft tissue damage, making it for us our treatment of choice in this type of injury. Outlook. In Chile, we have been developing some modifications to the original technique described by the Dresden Group in order to increase tensile forces of the repair and offer our patients a quicker and safer recovery.