Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study

Category: Trauma; Ankle; Sports Introduction/Purpose: Achilles tendon rupture repair has undergone several changes in the last ten years, aiming to minimize complications while maximizing clinical and functional outcomes. Selecting a less invasive approach instead of traditional open incision has shown through various studies to generate excellent results and significantly reduce post-operative infections. Choice of patient positioning during operative repair has also shown to be of great impact, with prone positioning being associated with elevated surgical times and anesthetic requirements, thus secondary affecting clinical outcomes. Other complications associated with prone positioning include neuropraxia and increased risk of iatrogenic ophthalmologic insults as compared to the supine position. This case report evaluates clinical outcomes of patients following treatment of Achilles rupture with a novel Medial Mini- Open Supine Achilles Repair Technique. Methods: Patients were selected for case series inclusion after undergoing novel Medial Mini-Open Supine Achilles Repair Technique for acute achilles rupture. Retrospective medical record review for demographic, perioperative and functional data was completed for each patient, with means, range and standard deviations calculated when appropriate. Patients were then followed postoperatively to monitor recovery. At a final follow up visit scheduled no sooner than six months post operatively, outcomes were assessed with three separate Patient-Reported Outcomes Measurement Information System (PROMIS) surveys; Physical Function, Pain Interference and Depression. Two separate Foot and Ankle Ability Measure (FAAM) assessments, ADLs and Sport, were also completed. Patients were also assessed for physical pain/discomfort using the Visual Analog Scale (VAS). Results: Eighteen patients were included in this study; fifteen male, three female. Mean age was 37.5 years (+-12, range= 20-68). Mean duration of surgery was 31.0 minutes (+- 7.0). Follow up duration averaged 11.8 months (range 6.0-13.5). All patients completed three Patient-Reported Outcomes Measurement Information System (PROMIS) studies and two Foot and Ankle Ability Measure (FAAM) surveys. Mean score for the PROMIS Physical Function survey was 52.3 (+-11.5), for Pain Interference, mean= 50.0 (+-7.30), and for Depression, mean=39.5 (+- 6.96). FAAM Sport survey showed a mean=71.3 (+-29.4), with ADLs form responses showing a mean of 90.7 (+-12.7). All patients reported 0/10 pain on Visual Analog Scale (VAS), and overall satisfaction with their outcomes. Conclusion: In reviewing data collected thus far, the Medial Mini-Open Supine Achilles Repair technique shows promise to serve as a viable option for achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. No complications have been reported at this time; patients have demonstrated excellent outcomes in physical exam in postoperative clinic visits. All patients have expressed satisfaction with their results at final visit.

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High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-009-0727-y ◽

2009 ◽

Vol 17 (10) ◽

pp. 1234-1238 ◽

Cited By ~ 77

Author(s):

Katarina Nilsson-Helander ◽

Anders Thurin ◽

Jon Karlsson ◽

Bengt I. Eriksson

Keyword(s):

Prospective Study ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

High Incidence ◽

A Prospective Study

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Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04802-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yong Li ◽

Qiang Jiang ◽

Hua Chen ◽

Hongkui Xin ◽

Qing He ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Control Group ◽

Repair System ◽

Percutaneous Repair ◽

Repair Group ◽

Mini Open

Abstract Background To reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture. Methods From January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated. Results The mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000). Conclusions Acute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy. Study design Case-control studies, Level of evidence, 3.

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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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Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture—A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10112370 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2370

Author(s):

Łukasz Paczesny ◽

Jan Zabrzyński ◽

Marcin Domżalski ◽

Maciej Gagat ◽

Miron Termanowski ◽

...

Keyword(s):

High Resolution ◽

Achilles Tendon ◽

Nerve Injury ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Long Term Results ◽

Sonographic Guidance

Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.

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Percutaneous Repair for the Treatment of Rupture of the Achilles Tendon: A Study of 20 Cases

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1030 ◽

2015 ◽

Vol 2 (2) ◽

pp. 51-59

Author(s):

Gautam D Salunkhe

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Asia Pacific ◽

Long Term Results ◽

Percutaneous Technique ◽

Percutaneous Repair ◽

Acute Rupture ◽

A Minor

ABSTRACT Background Despite many techniques used for repair of the ruptured Achilles tendon, uncertainty of healing of the surgical wound remains a problem. This mainly determines the success of the surgery. The long-term results generally result in healing of the rupture, but poor healing of the wound occurs repeatedly. This causes apprehension in advising surgery over a conservative approach. Objectives To study the outcome of 20 cases of acute rupture of the Achilles tendon treated by the percutaneous technique. Materials and methods From March 2004 to March 2012, 20 cases of acute Achilles tendon rupture were treated by percutaneous repair by the method of Ma and Griffith. Modifications were used in distal end and delayed repairs. Immobilization was used after surgery. Postoperative complications were observed, and results assessed using the Leppilahti score after 6 months. Follow-up was done for 2 years. Results Percutaneous repair had significantly good results in 95% cases. There were two cases of sural nerve hypoesthesia, which was a minor problem and in no way hampered the longterm result. There were no re-ruptures. Patient satisfaction was high in terms of final result and cosmesis. Conclusion Percutaneous repair is a safe and reliable method for repair of the Achilles tendon rupture. It has a minor complication rate, and is advisable over open surgery. How to cite this article Salunkhe GD. Percutaneous Repair for the Treatment of Rupture of the Achilles tendon: A Study of 20 Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):51-59.

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PO 18150 - Comparison between the open and minimally invasive repair techniques in acute Achilles tendon injuries

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1021 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. S32

Author(s):

João Paulo Primo de Araujo ◽

Marcus Vinicius Mota Garcia Moreno ◽

Janice De Souza Guimarães ◽

Marilton Jorge Torres Gomes ◽

Túlio Eduardo Marçal Vieira ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Functional Outcomes ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Invasive Technique ◽

Repair Technique ◽

Repair Techniques

Objective: Our study compares the functional outcomes of patients who underwent open repair of the Achilles tendon with those of patients treated with the minimally invasive technique using the percutaneous Achilles repair system (PARS) over a 1-year minimum follow-up period and presents the complication rates for the 2 techniques. Methods: Between 2011 and 2016, 31 patients were reviewed; of these, 20 were included in the study (10 PARS X 10 open repair technique). Patients with chronic Achilles tendon rupture, insertional or bilateral, and patients with a history of surgery or previous ankle pathology that could mask functional outcomes were excluded from the study. The open repair technique was performed via a posteromedial incision to the ankle to repair the tendon and was combined with myotendinous transfer of the flexor hallucis longus tendon, which was fixed with a Biotenodesis screw. The minimally invasive technique was performed using the PARS of the company Arthrex through a small transverse incision at the site of the Achilles tendon rupture. Functional outcomes and complications were collected after at least 1 year of follow-up. Results: Both groups had similar American Orthopedic Foot and Ankle Society (AOFAS) scores (PARS: 95.3±5.1, open: 96.5±5.1; p=0.604), demonstrating similar functional outcomes. The PARS group had a higher number of complications than the open repair group (PARS: 20% x open: 10%), but the difference was not significant (p=0.383). Conclusion: For the treatment of acute Achilles tendon injuries, the PARS and open repair techniques had similar functional outcomes after 1 year of follow-up.

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