Chronic Achilles Tendon Repair with Flexor Hallucis Longus Tendon Harvested Using a Minimally Invasive Technique

Objective: To compare the functional results of patients submitted to open repair of the Achilles tendon in relation to those treated with the minimally invasive technique using PARS, with a minimum period of 1 year, as well as the complication index of the two techniques. Methods: Between 2011 and 2016, 31 patients were reviewed, including 20 cases (10 PARS X 10 Open technique). Patients with chronic Achilles tendon rupture, insertional or bilaterial, patients with a history of surgery or previous ankle pathology that could mask the functional results were excluded. The open technique was performed through a posteromedial incision to the ankle, repairing the tendon associated with the myotendinous transfer of the flexor hallucis longus, which was fixed with a biotenodetic screw. The minimally invasive technique was performed with the PARS (percutaneous Achilles repair system) of the company Arthrex, through a small transverse incision on the site of rupture of the Achilles tendon. Functional outcomes and complications were collected after at least 1 year of follow-up. Results: Both groups presented similar AOFAS scores (PARS: 95.3 ± 5.1, Open: 96.5 ± 5.1, P=0.604), showing similar functional results. Regarding the complications, the PARS obtained a greater number of complications in relation to the Open technique (PARS: 20% X Open: 10%), but without statistical relevance (P=0.383). Conclusion: We conclude that for the treatment of acute Achilles tendon injuries, the PARS and Aberta techniques have similar functional results after 1 year of follow-up. Level of Evidence IV; Therapeutic Studies; Cases Series.

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Dual Purpose Use of Flexor Hallucis Longus Tendon for Management of Chronic Achilles Tendon Ruptures

Foot & Ankle Specialist ◽

10.1177/1938640018803695 ◽

2018 ◽

Vol 12 (4) ◽

pp. 345-349

Author(s):

Mohammed A. Khalid ◽

William M. Weiss ◽

Michael Iloanya ◽

Vinod K. Panchbhavi

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Case Series ◽

Invasive Technique ◽

Flexor Hallucis Longus ◽

Aofas Score ◽

Excellent Outcome ◽

Longus Tendon ◽

Tendon Ruptures

Background: Chronic Achilles tendon ruptures are uncommon and increase long-term morbidity when untreated. There is no standard treatment for this condition. Methods: Chronic Achilles tendon rupture was repaired in 10 patients by harvesting the flexor hallucis longus tendon (FHL) using a minimally invasive technique. It was then transferred to the calcaneus and the remnant used to bridge the gap for reconstructing the Achilles tendon itself. The patients were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Scale. Results: Patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. Average follow-up time was 30.9 months (range = 17-43 months). The average postoperative AOFAS score was 78.5 (range = 54-94). The average postoperative score for pain was 33.5 out of 40; for function, 38.7 out of 50; and for alignment, 6.3 out of 10. A single surgical site infection requiring Incision and Drainage (I&D) was the only operative complication noted. No patient developed a significant deformity of the hallux after transfer. Conclusions: FHL transfer using a minimally invasive harvest for the treatment of chronic Achilles tendon ruptures produces good to excellent outcome measures as judged by an AOFAS score of 75 or greater while minimizing risk to the medial neurovascular bundle. Levels of Evidence: Case series, Level IV: Retrospective

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Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00161 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Daniel Bohl ◽

Eric Barnard ◽

Kamran Movassaghi ◽

Kamran Hamid ◽

Adam Schiff

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Suture Material ◽

Tendon Repair ◽

Wound Complications ◽

Transverse Incision ◽

Longitudinal Incision ◽

Achilles Tendon Repair ◽

Deep Suture ◽

No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

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Minimally Invasive Achilles Tendon Repair Using the Achillon Repair System

Techniques in Foot & Ankle Surgery ◽

10.1097/01.btf.0000235234.20325.f7 ◽

2006 ◽

Vol 5 (3) ◽

pp. 171-174 ◽

Cited By ~ 4

Author(s):

Andrew J. Elliott ◽

John G. Kennedy ◽

Martin O'Malley

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Repair ◽

Repair System ◽

Achilles Tendon Repair

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Achilles tendon repair by a minimally invasive technique using Tenolig®

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1194 ◽

2020 ◽

Vol 14 (3) ◽

pp. 269-273

Author(s):

Vinicius Oliveira ◽

Sérgio Prata

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Postoperative Infection ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Case Series ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Aofas Score ◽

Functional Scores

Objective: To assess the degree of postoperative satisfaction of patients with acute Achilles tendon rupture who underwent surgical reconstruction by a minimally invasive technique using Tenolig®. Methods: A retrospective observational study was conducted with 18 patients with acute Achilles tendon rupture diagnosed by a positive Thompson test who underwent surgery. Outcomes were assessed using the American arthopaedic Foot and Ankle Society (AOFAS) score and the Foot Function Index (FFI). Furthermore, quantitative variables were descriptively treated, and patients’ age was correlated with FII and AOFAS score using Spearman’s correlation coefficient at a significance level of 5%. Results: Patients underwent surgery from one to six days after injury and were discharged one day later. Only one patient had a superficial postoperative infection. Patients’ AOFAS scores ranged from 75 to 100 points, and FFI ranged from 0 to 20%. The patient withsuperficial postoperative infection had an AOFAS score and a FFI of 75 points and 20%, respectively. Conclusion: Percutaneous repair of complete Achilles tendon rupture with Tenolig® resulted in high functional scores and a low rate of complications. Level of Evidence IV; Therapeutic Studies; Case Series.

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