Surgical Repair of Ruptured Achilles Tendon in Sportsmen and Sedentary Patients: A Longitudinal Ultrasound Assessment

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

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Surgical Repair of Symptomatic Chronic Achilles Tendon Rupture Using Synthetic Graft Augmentation

Foot & Ankle Orthopaedics ◽

10.1177/2473011416s00283 ◽

2016 ◽

Vol 1 (1) ◽

pp. 2473011416S0028

Author(s):

Ahmed Shoaib ◽

Viren Mishra

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture ◽

Synthetic Graft

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Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00235 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0023

Author(s):

James Rush Jones ◽

Haley McKissack ◽

Aaradhana J. Jha ◽

Leonardo V. M. Moraes ◽

Jun Kit He ◽

...

Keyword(s):

Achilles Tendon ◽

Operating Room ◽

Prone Position ◽

Supine Position ◽

Surgical Repair ◽

Traditional Approach ◽

Perioperative Period ◽

Perioperative Outcomes ◽

Open Approach ◽

Mini Open

Category: Sports Introduction/Purpose: Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position. Methods: Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant. Results: A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups. Conclusion: The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

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