Review of Achilles Tendon Reattachment using Double-Row Knotted and Knotless Techniques in the Management of Insertional Achilles Tendinopathy

2021 ◽  
Author(s):  
Aaron T. Scott ◽  
Christina Sigur Long ◽  
Todd J. Jaramillo ◽  
Daniel L. Lara ◽  
Anthony J. Marois ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Double Row ◽  
Insertional Achilles Tendinopathy

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

2021 ◽  
pp. 193864002110336
Author(s):  
LT Thomas J. Kelsey ◽  
LT Kyle W. Mombell ◽  
CDR Todd A. Fellars
Keyword(s):  
Achilles Tendon ◽  
Suture Anchor ◽  
Maximum Load ◽  
Achilles Tendinopathy ◽  
Catastrophic Failure ◽  
Double Row ◽  
Average Load ◽  
Load To Failure ◽  
Insertional Achilles Tendinopathy ◽  
Repair Techniques

Background In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Methods Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. Results The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure ( P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). Conclusion This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

scholarly journals Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Ze Zhuang ◽  
Yang Yang ◽  
Kishor Chhantyal ◽  
Jianning Chen ◽  
Guohui Yuan ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Daily Activities ◽  
Symptom Improvement ◽  
Aofas Score ◽  
Double Row ◽  
Bone Contact ◽  
Patient Reported ◽  
Insertional Achilles Tendinopathy

Background. To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. Methods. 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. Results. No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. Conclusions. Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

Biomechanical Comparison of All-Soft Suture Anchor Single-Row vs Double-Row Bridging Construct for Insertional Achilles Tendinopathy

2020 ◽  
pp. 107110072095902
Author(s):  
Eric Lakey ◽  
Pam Kumparatana ◽  
Daniel K. Moon ◽  
Joseph Morales ◽  
Sophia Elizabeth Anderson ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Early Mobilization ◽  
Achilles Tendinopathy ◽  
Matched Pair ◽  
Clinical Failure ◽  
Suture Anchors ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Insertional Achilles Tendinopathy

Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.

scholarly journals Effects of Achilles Tendon Moment Arm Length on Insertional Achilles Tendinopathy

2020 ◽  
Vol 10 (19) ◽  
pp. 6631
Author(s):  
Takuma Miyamoto ◽  
Yasushi Shinohara ◽  
Tomohiro Matsui ◽  
Hiroaki Kurokawa ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Moment Arm ◽  
Healthy Individuals ◽  
Suture Bridge ◽  
Significant Difference ◽  
The Moment ◽  
Insertional Achilles Tendinopathy ◽  
Suture Bridge Technique

Insertional Achilles tendinopathy (IAT) is caused by traction force of the tendon. The effectiveness of the suture bridge technique in correcting it is unknown. We examined the moment arm in patients with IAT before and after surgery using the suture bridge technique, in comparison to that of healthy individuals. We hypothesized that the suture bridge method influences the moment arm length. An IAT group comprising 10 feet belonging to 8 patients requiring surgical treatment for IAT were followed up postoperatively and compared with a control group comprising 15 feet of 15 healthy individuals with no ankle complaints or history of trauma or surgery. The ratio of the moment arm (MA) length/foot length was found to be statistically significant between the control group, the IAT group preoperatively and the IAT group postoperatively (p < 0.01). Despite no significant difference in the force between the control and preoperative IAT groups, a significantly higher force to the Achilles tendon was observed in the IAT group postoperatively compared to the other groups (p < 0.05). This study demonstrates that a long moment arm may be one of the causes of IAT, and the suture bridge technique may reduce the Achilles tendon moment arm.

Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy

2021 ◽  
pp. 107110072110038
Author(s):  
Marut Arunakul ◽  
Waroot Pholsawatchai ◽  
Preeyaphan Arunakul ◽  
Akaradech Pitakveerakul
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Accelerated Program ◽  
Suture Bridge ◽  
Sf 36 ◽  
Prospective Comparative Study ◽  
Insertional Achilles Tendinopathy

Background: No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients. Methods: We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Functional outcomes were measured by a visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM), and Short Form Health Survey (SF-36) at 3, 6, and 12 months postoperatively. The differences in outcomes were analyzed using multiple linear regression. Results: Eighteen and 31 patients underwent the conventional and accelerated protocols, respectively; their corresponding mean ages were similar, 53 and 57 years, as were all other baseline characteristics. The mean scores (conventional vs accelerated group) for VAS for pain, FAAM, and SF-36 in the conventional group at 3 months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points ( P < .05 for each comparison). There were no statistically significant differences between the groups at 6 and 12 months postoperatively. All patients could perform the single heel raise test at 6 months, and none experienced complications. Conclusion: In this small study, short-term functional outcomes were better in the accelerated group. More data are needed before the accelerated program can be recommended. Level of Evidence: Level II, prospective comparative study.

scholarly journals Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199295
Author(s):  
Changgui Zhang ◽  
Jin Cao ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Bone Marrow ◽  
Surgical Treatment ◽  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Bone Marrow Oedema ◽  
High Signal ◽  
Retrocalcaneal Bursitis ◽  
Retrocalcaneal Bursa ◽  
Insertional Achilles Tendinopathy

Objective To analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT). Methods This retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores. Results Thirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT. Conclusion Surgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.

scholarly journals Tensile mechanical changes in the Achilles tendon due to Insertional Achilles tendinopathy

2020 ◽  
Vol 112 ◽  
pp. 104031
Author(s):  
Ibrahima Bah ◽  
Ninoshka R.J. Fernandes ◽  
Ruth L. Chimenti ◽  
John Ketz ◽  
A. Samuel Flemister ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Insertional Achilles Tendinopathy

scholarly journals Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

2020 ◽  
Vol 6 (1) ◽  
pp. e000769
Author(s):  
Håkan Alfredson ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Weight Bearing ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Full Weight Bearing ◽  
Bone Pathology ◽  
Level Of Evidence ◽  
Pain Mechanisms ◽  
Painful Condition ◽  
Insertional Achilles Tendinopathy

BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

Sign in / Sign up

Export Citation Format

Share Document