Percutaneous Repair of Acute Achilles Tendon Ruptures: The Maffulli Procedure

Clinical Scenario:There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior.Focused Clinical Question:Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures?Summary of Search, “Best Evidence” Appraised, and Key Findings:The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included.Clinical Bottom Line:There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

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Isokinetic Strength and Endurance After Percutaneous and Open Surgical Repair of Achilles Tendon Ruptures

Foot & Ankle International ◽

10.1177/107110070502600404 ◽

2005 ◽

Vol 26 (4) ◽

pp. 286-290 ◽

Cited By ~ 48

Author(s):

David Goren ◽

Moshe Ayalon ◽

Meir Nyska

Keyword(s):

Achilles Tendon ◽

Ankle Joint ◽

Open Surgery ◽

Endurance Performance ◽

Isokinetic Strength ◽

Percutaneous Repair ◽

Significant Difference ◽

Average Work ◽

Tendon Ruptures ◽

Considerable Controversy

Background: Reports on complete spontaneous Achilles tendon ruptures and associated treatment have become more frequent in the literature in the past two decades, as has the request for treatments that enable the finest possible functional recovery. The best available treatment is a matter of considerable controversy in the literature. The purpose of this study was to compare the isokinetic strength and endurance of the plantarflexor muscle-tendon unit in subjects who sustained rupture of the Achilles tendon and underwent either open surgery or closed percutaneous repair of the Achilles tendon. Methods: Twenty patients (18 males, 2 females) with spontaneous ruptures of the Achilles tendon were included in this study. Ten patients were treated by open surgery, and 10 patients were treated percutaneously. All patients had ruptured their Achilles tendon more than 6 months before the study, and all of the ruptures occurred 3.5 years or less before the day of the testing. All patients underwent an oriented physical examination. An isokinetic Biodex dynamometer (Biodex Medical System, Shirley, NY) was used to measure ankle joint angle, and in plantarflexion to calculate the torque at the ankle joint (Newton/meter), and the average work (jouls) for both maximal power and endurance. Each measurement was compared to the normal ankle. Results: Biodex dynamometer evaluations at 90 deg/sec demonstrated a significant difference of maximal voluntary plantarflexor torque, endurance performance and range of motion at the ankle joint between the involved and uninvolved sides in patients treated by either mode of treatment. Yet, no statistically significant differences were revealed for the parameters mentioned above between the subjects that were treated either percutaneously or by an open surgery. Conclusions: In functional terms, the biomechanical outcomes of open surgery and percutaneous repair for acute ruptures of the Achilles tendon are both effective.

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Percutaneous Repair Followed by Accelerated Rehabilitation for Acute Achilles Tendon Ruptures

Journal of Orthopaedic Surgery ◽

10.1177/230949901502300320 ◽

2015 ◽

Vol 23 (3) ◽

pp. 352-356 ◽

Cited By ~ 6

Author(s):

Louay Al-Mouazzen ◽

Karthig Rajakulendran ◽

Ali Najefi ◽

Nurul Ahad

Keyword(s):

Achilles Tendon ◽

Percutaneous Repair ◽

Accelerated Rehabilitation ◽

Tendon Ruptures

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Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-001-0258-7 ◽

2001 ◽

Vol 10 (2) ◽

pp. 130-133 ◽

Cited By ~ 24

Author(s):

Akın Turgut ◽

İzge Günal ◽

Gökhan Maralcan ◽

Nusret Köse ◽

Erol Göktürk

Keyword(s):

Clinical Study ◽

Achilles Tendon ◽

Percutaneous Repair ◽

Tendon Ruptures

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Percutaneous repair of Achilles tendon ruptures with Tenolig: Quantitative analysis of postural control and gait pattern

The Foot ◽

10.1016/j.foot.2012.09.001 ◽

2012 ◽

Vol 22 (4) ◽

pp. 303-309 ◽

Cited By ~ 7

Author(s):

S. Mezzarobba ◽

S. Bortolato ◽

A. Giacomazzi ◽

G. Fancellu ◽

R. Marcovich ◽

...

Keyword(s):

Quantitative Analysis ◽

Postural Control ◽

Achilles Tendon ◽

Gait Pattern ◽

Percutaneous Repair ◽

Tendon Ruptures

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Management of acute Achilles tendon ruptures

Bone and Joint Research ◽

10.1302/2046-3758.710.bjr-2018-0004.r2 ◽

2018 ◽

Vol 7 (10) ◽

pp. 561-569 ◽

Cited By ~ 19

Author(s):

X. Yang ◽

H. Meng ◽

Q. Quan ◽

J. Peng ◽

S. Lu ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Complication Rates ◽

Functional Rehabilitation ◽

Percutaneous Repair ◽

Tendon Ruptures ◽

Mini Open

ObjectivesThe incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.MethodsA PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.ResultsThe treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous repair, mini-open repair, and augmentative repair. Traditional open repair has lower re-rupture rates with higher risks of complications. Percutaneous repair and mini-open repair show similar re-rupture rates but lower overall complication rates when compared with open repair. Percutaneous repair requires vigilance against nerve damage. Functional rehabilitation combining protected weight-bearing and early controlled motion can effectively reduce re-rupture rates with satisfactory outcomes. Biological adjuncts help accelerating tendon healing by adhering rupture ends or releasing highly complex pools of signalling factors.ConclusionThe optimum treatment for complete rupture remains controversial. Both mini-open repair and functional protocols are attractive alternatives, while biotherapy is a potential future development. Cite this article: X. Yang, H. Meng, Q. Quan, J. Peng, S. Lu, A. Wang. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018;7:561–569. DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2.

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Favorable Outcome of Percutaneous Repair of Achilles Tendon Ruptures in the Elderly

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-009-0944-1 ◽

2009 ◽

Vol 468 (4) ◽

pp. 1039-1046 ◽

Cited By ~ 63

Author(s):

Nicola Maffulli ◽

Umile Giuseppe Longo ◽

Mario Ronga ◽

Anil Khanna ◽

Vincenzo Denaro

Keyword(s):

Achilles Tendon ◽

The Elderly ◽

Favorable Outcome ◽

Percutaneous Repair ◽

Tendon Ruptures

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Delayed (14-30 Days) Percutaneous Repair of Achilles Tendon Ruptures Offers Equally Good Results As Compared With Acute Repair

The American Journal of Sports Medicine ◽

10.1177/0363546520908592 ◽

2020 ◽

Vol 48 (5) ◽

pp. 1181-1188 ◽

Cited By ~ 3

Author(s):

Nicola Maffulli ◽

Alessio D’Addona ◽

Gayle D. Maffulli ◽

Nikolaos Gougoulias ◽

Francesco Oliva

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Invasive Technique ◽

Suture Repair ◽

Distal Stump ◽

Percutaneous Repair ◽

Tendon Ruptures ◽

Repair Group

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; Level of evidence, 3. Methods: We prospectively recruited 21 consecutive patients who presented between 14 and 30 days after the index injury, and we compared them with 21 patients who were matched according to sex, age (±2 years), and level of activity, who presented within 14 days of the index injury. All patients underwent the same minimally invasive procedure under local anesthesia: a core suture repair consisting of a modified Bunnell suture in the proximal stump and a modified Kessler suture in the distal stump. Results: At 12 months after minimally invasive repair, patients with delayed treatment had a median Achilles tendon rupture score of 91 (SD, 2.4; range, 87-96) as compared with 91 (SD, 2.2; range, 86-96) in patients treated acutely, who presented at a median 2.4 days (range 1-6 days) from the injury. There were no significant differences between groups in terms of mean (SD) Achilles tendon resting angle: delayed repair group, −3.9° (2.0); acute repair group, −3.7° (1.9) ( P = .69). No patient in either group developed a wound infection. One patient in the acute group experienced an iatrogenic sural nerve injury. Conclusion: Patients with Achilles tendon rupture treated by percutaneous repair 14 to 30 days after injury achieved similar results at 1 year as patient treated <14 after injury.

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