| 1. |
- Hodgson, L., et al.
(author)
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Interassociation consensus recommendations for pitch-side emergency care and personal protective equipment for elite sport during the COVID-19 pandemic
- 2021
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In: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 55:10, s. 531-538
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Journal article (peer-reviewed)abstract
- The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.
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| 2. |
- Carmont, Michael R, 1972
(author)
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Achilles tendon rupture: the evaluation and outcome of percutaneous and minimally invasive repair
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Acute Achilles tendon rupture is common and has increasing incidence. This is thought to be due to increasing activity and sports participation in middle age. Sustaining an Achilles tendon rupture means a long rehabilitation period and many patients do not achieve full recovery of strength and function. One of the reasons for this reduced function is considered to be due to tendon elongation. The reasons for the lack of recovery has been discussed in earlier studies comparing operative and non-operative treatments. Operative treatment can be divided into open, minimally-invasive and percutaneous technique. Proponents for operative treatment consider open technique to prevent tendon elongation and reduce the re-rupture rate compared with non-operative treatment. Percutaneous repair is considered to lead to an increasing incidence of iatrogenic nerve damage and reduced repair strength compared with open repair but is considered to be advantageous because of lower risk of infections and wound problems. The purpose of this dissertation was to evaluate and optimise the results of percutaneous and minimally-invasive technique for an Achilles tendon rupture. Moreover, evaluation instruments were developed and an already existing validated questionnaire was culturally adapted in English to be used in the United Kingdom. Achilles Tendon Resting Angle (ATRA) is an indirect measure of tendon elongation. The method has been developed and validated in one of the studies in the dissertation. ATRA has subsequently been used to evaluate the clinical outcomes. The ATRA angle increases after an Achilles tendon rupture, then decreases after operative intervention to finally increase again during the first rehabilitation phase. The ATRA angle was shown to correlate with patient-reported symptoms and function as measured by heel rise height one year after injury. Thus, ATRA can provide an indication of function achieved after treatment of an Achilles tendon rupture. Achilles Tendon Total Rupture Score (ATRS) is a validated patient-reported questionnaire for evaluating limitations and physical activity after an Achilles tendon rupture. ATRS was originally developed for a Swedish population but has now been translated and culturally adapted to an English population in one of the studies. ATRS has also been used for evaluating patient-reported outcomes. Percutaneous and minimally-invasive operative techniques have been evaluated in 169 patients treated for an Achilles tendon rupture. Percutaneous technique was found to be more cost-effective in comparison to open procedure, with similar results regarding function and patient-reported symptoms. Minimally invasive repairs produced similar outcome to percutaneous repair but with a lower complication rate. Based on these results, minimally invasive repair is recommended for the operative treatment of an acute Achilles tendon rupture. In order to compare the strength of different suture materials after repair of the Achilles tendon, a cadaveric study was performed, in which the tendon was cyclically loaded. The result from this study shows that repair with non-absorbable suture has better strength in comparison to an absorbable one. However, there is still a lack of knowledge of why a patient suffering from an Achilles tendon rupture does not fully recover. Further studies involving how treatment and rehabilitation can be optimised is of value.
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| 3. |
- Carmont, Michael R, 1972, et al.
(author)
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Achilles Tendon Ruptures in Basketball
- 2020
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In: Basketball Sports Medicine and Science. Laver L., Kocaoglu B., Cole B., Arundale A.J.H., Bytomski J., Amendola A. (eds). - Berlin, Heidelberg : Springer. - 9783662610701 ; , s. 481-489
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Book chapter (other academic/artistic)abstract
- Basketball is a springing, jumping, and sprinting sport with players repetitively jumping to play shots and to make and receive passes or work sudden sprints together with the start–stop nature of the game. In the United States, sporting activity was responsible for 68% tendon ruptures, of which basketball was the most commonly involved sport, accounting for 48% of sports-related ruptures. There has been considerable debate as to whether operative or nonoperative treatment leads to the best outcome. Operative treatment may reduce the resultant calf muscle weakness, tendon elongation, predictability of outcome, and re-rupture rate compared with nonoperative treatment. Patients undergoing minimally invasive surgery are significantly more likely to report a satisfactory subjective outcome compared with open surgery. The overall rate of return to play (RTP) in all sports following Achilles tendon rupture has been estimated to 80%. However, for players in the National Basketball Association (NBA) who sustained an Achilles tendon rupture, more than a third (36.8%) either did not return to play or started in fewer than 10 games for the remainder of their career. Twenty-one percent of ruptures led to retirement. The mean time to return to play was 10.5 months, and the rate of return to play was lower in the NBA, 61–71%, compared with that of the National Football League players, 64–71%. Achilles tendon rupture in elite basketball players continues to be a serious, potentially career ending, injury.
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| 4. |
- Carmont, Michael R, 1972, et al.
(author)
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Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture.
- 2020
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In: Orthopaedic journal of sports medicine. - : SAGE Publications. - 2325-9671. ; 8:3
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Journal article (peer-reviewed)abstract
- Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management.To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair.Cohort study; Level of evidence, 3.From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI.A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was -4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI (R2 = 0.19; P < .001; n = 120).Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.
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| 5. |
- Carmont, Michael R, 1972, et al.
(author)
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Arthroscopic plasty of the discoid meniscus
- 2016
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In: Knee Surgery: Soft Tissue (Volume 1). Nicola Maffulli, François M Kelberine, Henrique Jones (red.). - : Jaypee. - 9781909836372
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Book chapter (other academic/artistic)
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| 6. |
- Carmont, Michael R, 1972, et al.
(author)
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Cross cultural adaptation of the Achilles tendon Total Rupture Score with reliability, validity and responsiveness evaluation.
- 2012
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - 1433-7347. ; 21:6, s. 1356-1360
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Journal article (peer-reviewed)abstract
- PURPOSE: The Achilles tendon Total Rupture Score (ATRS) was developed because of the need for a reliable, valid and sensitive instrument to evaluate symptoms and their effects on physical activity in patients following either conservative or surgical management of an Achilles tendon rupture. Prior to using the score in larger randomized trial in an English-speaking population, we decided to perform reliability, validity and responsiveness evaluations of the English version of the ATRS. Even though the score was published in English, the actual English version has not be validated and compared to the results of the Swedish version. METHODS: From 2009 to 2010, all patients who received treatment for Achilles tendon rupture were followed up using the English version of the ATRS. Patients were asked to complete the score at 3, 6 and 12months following treatment for Achilles tendon rupture. The ATRS was completed on arrival in the outpatient clinic and again following consultation. RESULTS: The outcomes of 49 (13 female and 36 male) patients were assessed. The mean (SD) age was 49 (12) years, and 27 patients had treatment for a left-sided rupture, 22 the right. All patients received treatment for ruptured Achilles tendons: 38 acute percutaneous repair, 1 open repair, 5 an Achilles tendon reconstruction using a Peroneus Brevis tendon transfer for delayed presentation, 1 gracilis augmented repair for re-rupture and 4 non-operative treatment for mid-portion rupture. The English version of ATRS was shown to have overall excellent reliability (ICC=0.986). There was no significant difference between the results with the English version and the Swedish version when compared at the 6-month- or 12-month (n.s.) follow-up appointments. The effect size was 0.93. The minimal detectable change was 6.75 points. CONCLUSIONS: The ATRS was culturally adapted to English and shown to be a reliable, valid and responsive method of testing functional outcome following an Achilles tendon rupture.
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| 7. |
- Carmont, Michael R, 1972, et al.
(author)
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Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft
- 2021
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In: Video Journal of Sports Medicine. - : SAGE Publications. - 2635-0254. ; 1:5
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Journal article (peer-reviewed)abstract
- Background:Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.Indications:The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.Technique Description:The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.Discussion/Conclusion:Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.
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| 8. |
- Carmont, Michael R, 1972, et al.
(author)
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Free Hamstring Open Augmentation for Delayed Achilles Tendon Rupture
- 2017
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In: The Achilles Tendon An Atlas of Surgical Procedures. Editors: Thermann, H., Becher, C., Carmont, M.R., Karlsson, J., Maffulli, N., Calder, J., van Dijk, C.N.. - : Springer. - 9783662540749
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Book chapter (peer-reviewed)
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| 9. |
- Carmont, Michael R, 1972, et al.
(author)
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Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study
- 2017
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In: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 5:8
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Journal article (peer-reviewed)abstract
- Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Methods: Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was -13.1 degrees (6.6 degrees) (dorsiflexion) following injury; this was reduced to 7.6 degrees (4.8 degrees) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6 degrees (7.4 degrees) (neutral) and -7.0 degrees (5.3 degrees) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively). Conclusion: Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.
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| 10. |
- Carmont, Michael R, 1972, et al.
(author)
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Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: A retrospective cohort study
- 2024
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In: Journal of ISAKOS. - 2059-7754 .- 2059-7762.
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Journal article (peer-reviewed)abstract
- Introduction: Achilles tendon ruptures (ATRs) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. Methods: The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. Results: From February 2009 to August 2023, 556 patients presented with an ATR. Of these, 37 (6.7 %) patients were diagnosed with a MT tear. At final follow-up, at 12 months following injury, the MT group reported an Achilles tendon total rupture score (ATRS) of mean (standard deviation (SD)) of 83.6 (3.5) (95 % confidence interval (CI) 81.8, 85.4) and median (inter-quartile range (IQR)) ATRS of 86 points (78–95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59–95) (p = 0.673). Functional evaluation, however, revealed statistically significant differences in mean (SD) heel-rise height index MT group 79 % (25) (95%CI 65.9, 92.1) and MS group 59 % (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. Conclusions: When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. Level of evidence: IV.
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