Nikolaos Gougoulias

• MD, PhD, CCST Orthopaedics, EFAS certif.
• Consultant at General Hospital of Katerini Greece

Purpose The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots. Methods All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group...

The purpose of this study is to explore the use of damage control techniques in the emergency surgical management of polytrauma patients - those with traumatic injuries affecting at least two anatomical regions - at a District General Hospital in Greece. We conducted a retrospective review of medical records from patients who visited the orthopedic...

Introduction We investigated the mid-term outcomes of supramalleolar osteotomies regarding “survivorship” [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required. Material and methods PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMO...

Purpose: Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus-Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and provides new blood supply to the tendon, but als...

Femoral neck fractures in transfemoral amputees are not common and management is associated with surgical technique and post-operative rehabilitation challenges. A 61-year-old Caucasian, male, above-knee amputee (following mangled extremity trauma 8 months before) who mobilized with a prosthesis presented to the emergency department with a right fe...

The present study reports the outcomes of revision surgery using a Cincinnati incision with tendon debridement and calcaneoplasty for insertional Achilles tendinopathy (IAT) in a cohort of patients at 24-month follow-up. Patients undergoing revision surgery following failed previous surgery for IAT were prospectively recruited. Patients were assess...

Bicortical fixation of medial malleolus fractures provides increased interfragmentary compression and resistance to pull out. Achieving bicortical fixation with two 3.5 mm screws can be challenging especially with smaller fractures. We present a simple technique where two 2.7 mm screws are utilized for fixation of medial malleolus fractures. Level...

Background Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after perc...

Background Advances in foot and ankle arthroscopy over the last 2 decades have allowed for subtalar joint arthrodesis to be performed arthroscopically. The potential advantages of the arthroscopic technique include higher fusion rates, lower complications, reduced perioperative morbidity, and accelerated rehabilitation. Arthroscopic arthrodesis may...

Soft tissue ankle equinus and anterior/posterior translation of the talus are commonly encountered malalignment situations seen with end-stage ankle arthritis. These malalignments are important to recognize and correct at the time of primary total ankle replacement. The decision to perform an Achilles tendon lengthening or a gastrocnemius-soleus le...

Despite the advances in operative management, displaced intra-articular calcaneal fractures (DIAFCs) are often associated with long term sequelae, permanent disability, a considerable reduction in quality of life, and a high socio-economic cost. Randomized controlled trials have shown that patient reported outcomes of surgery are no better than tho...

Introduction Nonoperative management of calcific insertional Achilles tendinopathy (CIAT) may fail in 10–30% of patients, and various operative procedures have been described to manage those. Methods A modified Zadek (dorsal closing wedge) calcaneal osteotomy, without removing the calcific deposits and without detaching the insertion of the Achill...

Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy). Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus. Non-operative management of ankle fractures in patients with complicated diabetes results in an even...

Background When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic techniques have been proposed, and platelet-rich plasma (PRP) injections have been proposed as an adjunct to aid tendon healing. Methods Thirty-six patients with mid-portion...

Background Minimally invasive repair of acute Achilles tendon ruptures has been performed for several years, resulting in reduced morbidity as compared with open repair. Hypothesis A minimally invasive technique can be used to manage Achilles tendon ruptures in patients presenting between 14 and 30 days from injury. Study Design Cohort study; Lev...

Background Surgical management may be indicated for patients with insertional Achilles tendinopathy (IAT) after failure of nonoperative management, and various surgical techniques have been described. Hypothesis We present the technique and results of modified dorsal closing wedge calcaneal osteotomy, performed in a cohort of 28 consecutive patien...

Introduction: Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleu...

Aims Lateral ankle ligament instability is a common and often debilitating condition affecting service personnel. This study aimed to assess the outcome of surgical repair utilising a modified Broström-Gould technique for patients in whom conservative therapies had failed. Methods Military patients who underwent ankle surgery at Frimley Park Hospi...

The terminology ‘Morton’s neuroma’ may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve. Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of...

Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures. Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures. Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especi...

Stable fractures of the ankle can be safely treated non-operatively. It is also gradually being recognised that the integrity of the ‘medial column’ is essential for the stability of the fracture. It is generally thought that bi- and tri-malleolar fractures are unstable, as are pronation external rotation injuries resulting in an isolated high fibu...

Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-...

Background It is thought that arthroscopic ankle fusion offers improved outcomes over open fusion in terms of functional outcomes, time to fusion, length of stay and fewer complications. However, there are doubts about whether correction of established severe deformity can be achieved using the arthroscopic approach. Methods A retrospective review...

Background: Surgical management of chronic Tendo Achillis (TA) ruptures usually requires tendon grafting procedures. Several techniques have been described. We examined the outcome of three different less invasive (incisions length less than 3 cm) tendon transfer techniques in the management of patients with a chronic rupture of the TA. Methods:...

Attempts at total ankle replacement (TAR) have existed for at least 55 years. Time has essentially eliminated constrained, cemented, first-generation prostheses. Although some two-component, more anatomical designs are still used and with varying success, it seems that three-component mobile-bearing ankle prostheses are the predominant design utili...

Soft-tissue ankle equinus and anterior–posterior translation of the talus are commonly encountered malalignment situations seen with end-stage ankle arthritis. These malalignments are important to recognize and correct at the time of primary total ankle replacement. The decision to perform a tendo-Achilles lengthening or a gastrocnemius-soleus leng...

Total ankle replacement remains an option for varus and valgus ankles, provided that it results in a balanced, neutrally aligned ankle. Accurate preoperative assessment of the deformity is essential for appropriate selection of adjuvant procedures. Osteotomies performed proximal (tibial), within (malleolar), or distal to (calcaneal, metatarsal) the...

Introduction: enduro is an off road motorcycling event. It is a fast, exciting adventure sport with increasing numbers of participants and competitions. Materials and methods: we performed search of PubMed, Medline, CINAHL, and Embase databases using the following keywords 'Enduro injuries', 'off-road motorcycle injuries' and 'Enduro sport'. We...

Background: Surgery for midfoot arthritis is challenging and technically demanding, especially in the presence of deformity. Methods: Thirty patients (30 feet) with symptomatic midfoot arthritis and deformities, underwent arthrodesis, along with adjuvant procedures to realign the hindfoot and forefoot where needed. Results: Union was achieved...

Background Distinguishing stable Supination-External Rotation (SER) 2 from unstable SER 4 ankle fractures, using standard radiographs, is controversial. Examination under anaesthesia (EUA), gravity-stress (GS) and weight-bearing (WB) radiographs can aid surgical decision-making. We evaluated the effect of three methods of fracture stability assessm...

Patients with a preexisting hindfoot deformity, who undergo resection (with or without soft tissue interposition) of a tarsal coalition, may present with recurrent pain and worsening planovalgus deformity. This is due to the secondary effect of soft tissue contractures (lateral ligaments, peroneal tendons, calf muscles) "pulling" the foot into more...

Purpose The role of ankle arthroscopy in managing the consequences of ankle fractures is yet to be fully established. This study aims to assess this procedure in terms of the accuracy of preoperative diagnosis, re-operation rate and patient-reported outcomes. Methods Sixty-six patients were identified [mean age 40 years (SD 13 years)] who had under...

We describe the endoscopic management of a large talar cyst using synthetic allograft gel. Three and a half years later the patient has returned to sport and repeat MRI demonstrates no further collapse of the cyst.

Ankle fractures are common injuries. Currently their incidence lies between 100 and 200 fractures per 100,000 people-years. Isolated lateral malleolus fractures are the most common, accounting for approximately 70 % of all ankle fractures. Several classifications have been proposed, none of which appear to adequately cover the whole spectrum of the...

We describe the surgical technique and outcome of a proximal closing wedge osteotomy of the lesser metatarsals, to treat medial or lateral subluxation of the MTP joints, with toe deviation, when dorsiflexion (MTPJ dorsal subluxation) deformity is not present. The principle of surgical correction, is the shift of the metatarsal head in the direction...

Most posterior hindfoot procedures have been described with the patient positioned prone. This affords excellent access to posterior hindfoot structures but has several disadvantages for the management of the airway, the requirement for an endotracheal tube in all patients, difficulty with ventilation and an increased risk of pressure injuries, esp...

Attempts at ankle replacement have existed for at least 50 years. Time has essentially eliminated constrained, cemented, first-generation ankle replacements. Although some two-component, more anatomic, designs are still used with varying success, three-component "mobile bearing" ankle prostheses are winning the race of evolution. Not only have impl...

It has been shown in the rat, that during the first five postnatal days, motoneurons are particularly vulnerable to excitotoxic cell death and glutamate receptors play a significant role in this time-dependent process. Various categories of glutamate blockers (MK-801, Mg, PNQX, DAP-5) have various actions on the respective receptors. Furthermore, t...

Morton's neuroma is a mechanically induced degenerative neuropathy. We compared clinical and MRI findings in 76 feet treated operatively for Morton's neuroma and 40 feet with different pathologies (controls). In the 'treatment group' web space tenderness (WST) was positive in 95%, foot squeeze (SQU) in 88%, plantar percussion (PLP) in 61%, and toe...

The etiology of congenital idiopathic talipes equinovarus deformity is unclear. Studies on populations, families, and twins have suggested a genetic component. However, the mode of inheritance does not fit classic patterns. The intrauterine posture and environmental and developmental causative factors have also been associated with the deformity. N...

Neglected patella tendon ruptures require reconstruction using tendon grafts. The LARS ligament has been successfully used in cruciate and collateral knee ligament reconstruction. We present a technique using LARS ligament for the reconstruction of a chronic patella tendon rupture in a low-demand patient. The result after 1-year follow-up was deeme...

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following dat...

Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. Case series; Level o...

Peritendinous adhesions that form after the repair of lacerated digital flexor tendons cause stiffness and functional impairment. In the healing process, tendon regeneration and scarring are, probably, the two sides of the same coin. Surgeons, physical therapists, and basic scientists have explored new surgical and rehabilitation methods, pharmacol...

Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value. Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery. Cohort study (prognosis); Level of evidence, 2. One hundred sixty-five track and field athletes with acute, fi...

Introduction: Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value.

Injury to young athletes may determine different residual symptoms, depending on the site of damage. This counters the beneficial aspects related to youth sports activities if an athlete must drop out because of the residual effects of injury. Injuries to the physis can result in limb deformities and leg length discrepancy. Articular damage may lea...

Muscle hydatidosis is rare, accounting only for 3-5% of all cases. We present a case series of 9 patients (8 male, one female, mean age 59.3 years, range 48-75 years) with primary echinococcosis of skeletal muscles. The cysts presented as soft tissue masses in 8 patients, whereas in one, the cyst was an incidental finding on a CT scan performed for...

A management protocol for ankle and foot osteomyelitis and the outcome in 84 patients treated in a unit with special interest in musculoskeletal infection, is presented. Patients' mean age was 50.7+/-16.5 years and mean follow-up 31.5+/-18.2 months. Systemic antibiotics were administered initially empirically, and later according to cultures. Surgi...

Injuries can counter the beneficial effects of sports participation at a young age if a child or adolescent is unable to continue to participate because of residual effects of injury. This paper reviews current knowledge in the field of long-term health outcomes of youth sports injuries to evaluate the evidence regarding children dropping out of sp...

The optimal management of calcaneal fractures is controversial, as correlation between anatomical restoration and outcome has not been proven, and complications after surgery are frequent. MEDLINE, EMBASE, CINAHL, Google scholar, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched u...

The concept of minimally invasive total knee arthroplasty surgery evolved to reduce quadriceps muscle strength loss and improve clinical outcome following total knee replacement. We performed a systematic review of the published literature on Minimally Invasive Total Knee Arthroplasty (MITKA) and analyzed the reported surgical outcomes. Twenty-eigh...

Stability is a key issue in treating supination-external rotation ankle fractures, but we do not know how it affects functional outcome and subsequent development of radiographic osteoarthritis. With a systematic literature review, we identified 11 clinical studies (Level IV evidence) published in peer-reviewed journals reporting on at least 10 ank...

Unlabelled: Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at leas...

Several modifications in surgical techniques and various pharmacological and non pharmacological modalities have been introduced to prevent adhesions formation in surgery on flexor tendons of the hand. However, most studies have been carried out in animals with very few human trials. Only early postoperative rehabilitation is supported by clinical...

Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints. We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or l...

Open tibial fractures in adults have been extensively studied. In children, however, only a small number of case series provide data on management and outcome of these injuries. It is not clear whether open tibial fractures in children 'behave' in a similar fashion to those in adults, and clear guidelines regarding their management do not exist. Pr...

Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial fractures in children...

Epidural bleeding as a complication of catheterization or epidural catheter removal is often associated with perioperative thromboprophylaxis especially in adult reconstructive surgery. We report on a case of a 19 years old male athlete that underwent anterior cruciate ligament reconstruction, receiving low molecular weight heparin for thromboproph...

Despite advances in knowledge and refinements of technique, the management of flexor tendon injuries within the digital sheath continues to present a formidable challenge. This in turn has led to a massive expansion in search of modified surgical therapies and various adjuvant therapies, which could prevent adhesion formation without compromising d...

The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previou...

The current study provides an overview of history and evolution in total ankle arthroplasty. We conducted a comprehensive literature search without limitations to language. Information from any source, providing evidence of the use ankle of prostheses (e.g. biomechanical testing, cadaveric implantations or clinical use) was evaluated. Data regardin...

Ultrasound is widely used for imaging purposes and as an adjunct to physiotherapy. Low-intensity pulsed ultrasound (LIPUS), having removed the thermal component found at higher intensities, is used to improve bone healing. However, its potential role in soft-tissue healing is still under investigation. We searched on Medline using the keywords: low...

Placement of the femoral tunnel performing ACL reconstruction can be performed using a transtibial technique. Theoretically, this procedure bears the risk of a vertical placement of the femoral tunnel in the intercondylar notch. We assessed tunnel positioning radiographically using the transtibial technique. Postoperative anteroposterior and latera...

Current methods of fracture care use various adjuncts to try and decrease time to fracture union, improve fracture union rates and enhance functional recovery. Intermittent pneumatic compression (IPC), one such modality, is used in the management of both fractures and soft-tissue injuries. A search of PubMed, Medline, CINAHL, DH data and Embase dat...

Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres), tendon augmentation is required. We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision. The first inc...

Giant-cell tumors of the distal ulna are frequently recurrent and difficult to treat. A Darrach-type resection can lead to functional impairments of the wrist and hand. A case of a 42-year-old man, who underwent a distal ulna arthroplasty for recurrent giant-cell tumor of the distal ulna, is presented. The patient had two previous operations in an...

Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity. The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles h...

Sciatic nerve injury in neonatal rats results in significant reduction in the number of surviving motoneurons and impairs muscle development. We examined the possible neuroprotective effects of daily in vivo administration of 1,4,7,8,9,10-hexahydro-9-methyl-6-nitropyrido[3,4-f]quinoxaline-2,3-dione (PNQX), an AMPA/kainate receptor antagonist, on sc...

Sciatic nerve injury in neonatal rats impairs muscle recovery and significantly reduces the number of surviving motoneurons. We examined the rate of motoneuron death after sciatic nerve crush in neonatal rats, as well as the neuroprotective effect of systemic MgSO4 administration, by assessing the number of horseradish peroxidase -labelled motoneur...

The purpose of this study was to elucidate the effect of deafferentation on spinal motoneurons. We studied the effects of spinal cord transection and/or dorsal rhizotomy upon the contractile properties of EDL and soleus muscle, as well as on the number of motoneurons corresponding to these muscles. Neonatal Wistar rats were randomly divided into fo...

We examined the time course of the functional alterations in two types of muscles following sciatic nerve crush in neonatal rats and the neuroprotective effect of Mg2+. The nerve crush was performed on the 2nd postnatal day. MgSO4*7H2O was administered daily for two weeks. Animals were examined for the contractile properties and for the number of m...

A case of synchronous primary adenocarcinomas of the small and large bowel in a patient, thoroughly investigated for abdominal discomfort, is presented. Primary tumors of the small bowel are rare, and the diagnosis of primary ade-nocarcinoma of the small bowel in the presence of primary adenocarcinomas of the large bowel requires a high degree of s...

Spontaneous extraperitoneal “rupture” of the rectum is an extremely rare event not previously documented in the lit-erature. We report the case of a 70 year-old lady who pre-sented with intense lower abdominal pain. No predispos-ing or provoking factors were found in our patient despite detailed questioning apart from chronic constipation. A sudden...