scholarly journals Open Achilles Tendon Rerupture: A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Michael E. Doany ◽  
Megan C. Paulus
Keyword(s):  
Achilles Tendon ◽  
Soft Tissues ◽  
Surgical Repair ◽  
Rare Complication ◽  
Tendon Repair ◽  
Review Of The Literature ◽  
Open Wound ◽  
Surgical Incision ◽  
Repair Technique ◽  
Subcutaneous Tissues

In this report, we describe a rare case of open rerupture of an Achilles tendon following primary surgical repair. The rerupture occurred 12 weeks postoperatively and was associated with a transverse open wound perpendicular to the original surgical incision. This complication was successfully managed utilizing the preexisting transverse wound and a minimally invasive repair technique, minimizing further risk to the soft tissues overlying the tendon. This rare complication has only been described a few times in the literature and is likely associated with adhesions between the tendon repair and the subcutaneous tissues.

scholarly journals Rates of Acute and Delayed Achilles Repair

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Alastair Younger ◽  
Sam Si-Hyeong Park ◽  
Andrea Veljkovic ◽  
Murray Penner ◽  
Kevin Wing
Keyword(s):  
British Columbia ◽  
Achilles Tendon ◽  
Patient Outcomes ◽  
Surgical Repair ◽  
Recent Literature ◽  
Tendon Repair ◽  
Poor Patient ◽  
Delayed Repair ◽  
Before And After ◽  
Tendon Ruptures

Category: Sports, Trauma Introduction/Purpose: The need for repair of the ruptured achilles tendon has been discussed extensively in recent literature. A landmark paper in 2010 (Willits JBJS) outlined that the re-rupture rates were similar in surgical and non surgically treated Achilles tendon ruptures. However concern has to be raised as to the strength of the muscle tendon complex if the tendon is too long, potentially increasing the rate of late repair. This paper analyses the rate of acute achilles tendon repair and delayed repair before and after the 2010 publication of the Willits paper. Methods: Using the published billings from the Province of British Columbia, the rates per year of surgical repair of achilles tendon and delayed repair were determined. The population of British Columbia has increased over the years from 3.9 million in 1997 to 4.7 million in 2016. The rates of acute and chronic surgery were plotted prior to 2010, and since 2010. The rates were fitted against time using a linear and binomial plot. The rates in the years before and after 2010 were compared with ANOVA and the change of rate in time compared with Pearson’s correlation. Results: The rate of acute repair increased from 271 repairs in 1997 to over 400 repairs per year in 2009. The rate of acute repair has since dropped to just over 300 repairs per year. This is reflected in the enclosed binomial plot. There was a significant increase until 2010 (p<0.001), and a significant decrease since 2010 p<0.05). An average of 374 repairs per year (95% CI 349 to 398) were performed before 2010, decreasing to 328 since (95% CI 294 to 360), p<0.05. The rate of late repair has increased from 48 per year (CI 40 to 56) to 80 (CI 70 to 91) since 2010. The rate of late repair increased both prior to (r2 prior to 2010 .5, p<0.01) and since 2010. Conclusion: The landmark 2010 paper has resulted in a reduction of acute repair. However the increase in late repair is concerning and indicates that the muscle tendon weakness observed in the 2010 paper on strength testing at 1 year review in the non surgical group may be causing an increased rate of late repair. Further evaluation and development of both surgical and non surgical technique is required if the need for late repair is going to be avoided that likely reflects poor patient outcomes.

scholarly journals Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096596
Author(s):  
Daniel Carpenter ◽  
Katherine Dederer ◽  
Paul Weinhold ◽  
Joshua N. Tennant
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Return To Sport ◽  
Biomechanical Analysis ◽  
Absorbable Suture ◽  
Operative Repair ◽  
Repair Technique ◽  
Achilles Tendon Repair

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

scholarly journals Variability and Quality of Physical Therapy Protocols after Surgical Repair for Achilles Tendon Rupture Available Online for Patient and Therapist Education

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Zilan Lin ◽  
Ray Boaz ◽  
George Wolf ◽  
Eric Makhni ◽  
Christopher Gross
Keyword(s):  
Physical Therapy ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Physical Therapists ◽  
Weight Bearing ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Time Line

Category: Sports, Trauma Introduction/Purpose: The Internet has gained popularity in patient education and communication with physical therapists. Orthopaedic practices post information on physical therapy exercises and post-surgical caution online. This includes the case for rehabilitation after Achilles tendon repair. Therefore, it is important to assess the consistency within the online available protocols and determine if they retain current evidence-based principles. The purpose of the current study was to evaluate the consistency and quality of online physical therapy protocols after Achilles tendon surgical repair available to patients and physical therapists. Methods: Protocols were searched on Google by using the term “(achilles AND repair) AND (rehabilitation OR physical therapy) AND (protocol OR guidelines)” on three different computers. Methodical protocols on rehabilitation after Achilles tendon rupture repair from the first 100 websites with each search were collected. Duplicated protocols and non-operative treatment protocols were excluded. A comprehensive, custom scoring system was created to assess the source and each rehabilitation components of the protocols, including ankle immobilization, weight bearing status, range of motion, strengthening exercises, proprioceptive activities, functional return, as well as the time line for each component. Results: Fifty-three protocols were included in the current study (35.8% academic). Orthopaedic surgeon-affiliated websites accounted for 86.8% (Fig. 1). Thirty-six studies (67.9%) advised non-weight-bearing immediately after surgery. The timeline of weight bearing advancement varies among protocols and is illustrated in Fig.2. Forty-four protocols (83.0%) mentioned utilization of heel lifts throughout the protocol with different recommendations on specific timing (Fig.3). Non-ankle specific exercises were recommended in forty-three (81.1%) protocols. Considerable variation existed in the types and time line of recommended exercises, including the ones for range of motion, strength, proprioception, overall function, and functional return (Figs 4-8). Conclusion: Considerable variation existed in many components of physical therapy protocols for Achilles tendon repair after rupture, which subsequently could lead to confusion and misinterpretation among patients, and even therapist. Greater effort should be paid to create more evidence-based protocols that are both easy for patients and physical therapists to understand and execute.

scholarly journals Predictors of Functional Outcomes following Operative Treatment of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0041
Author(s):  
Ryan G. Rogero ◽  
Andrew Fisher ◽  
Daniel Corr ◽  
Joseph T. O’Neil ◽  
Daniel J. Fuchs ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Surgical Repair ◽  
Multivariable Analysis ◽  
Tendon Repair ◽  
Mechanism Of Injury ◽  
Female Sex ◽  
History Of ◽  
Tendon Ruptures

Category: Trauma; Ankle; Hindfoot Introduction/Purpose: Previous studies involving operative and nonoperative management of Achilles tendon ruptures have attempted to determine if patient factors influence treatment outcomes, with female sex, older age, and greater body mass index associated with inferior results. However, to our knowledge, no previous study has attempted to identify predictors of functional outcomes in patients exclusively undergoing surgical repair of acute Achilles tendon ruptures. The purpose of this study is to determine if any injury or patient variables were predictive of functional outcomes following operative management of acute Achilles tendon ruptures. Methods: A retrospective review of patients undergoing primary open repair of acute Achilles tendon ruptures with a single fellowship-trained orthopaedic foot & ankle surgeon at a single surgical location from 2010-2016 was performed. Patients <18 years of age, those who underwent surgical repair >21 days from the date of injury, and those whose repair required a V-Y advancement were excluded. Patient demographics (age, sex, BMI), comorbidities (diabetes mellitus, depression, anxiety), mechanism of injury (sports versus non-sports), and date of injury were collected. Postoperative chart notes were reviewed to document patient noncompliance. Included patients >=2 years removed from surgery were contacted to complete the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales, and visual analog scale (VAS) for pain. Multivariable regression analysis was performed to determine significant independent predictors of functional outcomes. Regression coefficients with 95% confidence intervals [95% CI] and p-values were reported for significant findings. Results: Of the 195 Achilles tendon repairs meeting the inclusion criteria, 140 (71.8%) were contacted to complete 2-year follow-up and analyzed. No patients (0%) experienced tendon re-ruptures. On multivariable analysis, female sex was independently associated with lower FAAM-Sports score (-10.11 [-19.73, -0.50]) and a lower Single Assessment Numeric Evaluation (SANE) score from the FAAM-Sports subscale (-13.79 [-26.28, -1.30]; p=0.0325). A history of anxiety was related to a lower FAAM-ADL score (-29.02 [-45.68, -12.36]; p=0.0009), FAAM-Sports score (-33.41 [-64.46, -2.37]; p=0.0368), and a higher VAS pain score (19.83 [4.43, 35.23]; p=0.0128). Age, BMI, a history of depression or diabetes mellitus, mechanism of injury, timing of repair, and patient compliance were not independently predictive of functional outcomes. Conclusion: Females and patients with anxiety have significantly poorer functional outcomes following acute Achilles tendon repair. To our knowledge, this is the first study to investigate and identify variables predictive of patient functionality in a population of surgically managed acute Achilles tendon ruptures. Further study is indicated to determine whether these factors are also predictive of outcomes of Achilles tendon ruptures treated non-surgically, and how this may affect surgical indications in this patient population.

scholarly journals Evaluation of Anatomic Relationship between Sural Nerve and Instrumentation during Mini-open Achilles Tendon Repair: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0025
Author(s):  
Kurt M. Krautmann ◽  
Gary W. Stewart
Keyword(s):  
Achilles Tendon ◽  
Sural Nerve ◽  
Surgical Repair ◽  
Open Repair ◽  
Adult Population ◽  
Tendon Repair ◽  
Wound Complications ◽  
Lateral Edge ◽  
Relationship Of ◽  
Mini Open

Category: Sports Introduction/Purpose: The Achilles tendon is one of the most commonly ruptured tendons in the adult population, and there is still no consensus on optimal treatment. While surgical repair may result in a lower re-rupture rate and quicker functional return, it also comes with risk of wound complications and sural nerve injury. If surgical repair is chosen, the surgeon may choose a traditional open procedure, a mini-open technique, or a percutaneous approach. The main advantage of the mini open repair method is the reduced wound complications that comes with a much smaller incision, while still maintaining similar re-rupture rates. The purpose of this study was to determine the relationship of the sural nerve to the Arthrex PARS jig and repair sutures. Methods: Cadaveric dissection was performed on 10 unpaired above knee amputation specimens. After severing the Achilles tendon and inserting the jig for a mini open repair, the sural nerve was dissected out to determine the rate of nerve puncture by the passed sutures. The jig was then removed to determine if the nerve was bound by the passing sutures or wrapped during suture locking. Results: The sural nerve was punctured 9 times out of the total of 50 sutures passed for an 18% puncture rate. All 9 punctures occurred in 4 specimens (Image 1), with the remaining 6 cadavers sustaining no punctures. Of the 6 unpunctured cadavers, 5 had all sutures passing anterior to the sural nerve, but in close proximity. One cadaver had all sutures passing posterior to the sural nerve. In all cadavers, removal of the jig and locking of the sutures left the sural nerve free with the sutures well fixed within the Achilles tendon. The sural nerve was also found to be within 1 cm of the lateral edge of the mini-open transverse incision in all cadavers. Conclusion: The Arthrex PARS jig was successful in preventing binding of the sural nerve during mini-open Achilles repair, but the sutures are often passed directly through the nerve during the procedure. The sural nerve is also at risk at the lateral edge of the mini-open incision used to insert the jig, and must be carefully protected during dissection down to the tendon.

scholarly journals Surgical repair of a proximal patellar tendon avulsion in a dog utilizing triple patellar bone tunnels and modified tendon repair technique

2018 ◽  
Vol 8 (3) ◽  
pp. 256 ◽  
Author(s):  
Matthew D. Johnson ◽  
Diego Rafael Sobrino ◽  
Daniel Dean Lewis ◽  
Justin Shmalberg
Keyword(s):  
Patellar Tendon ◽  
Surgical Repair ◽  
Tendon Repair ◽  
Repair Technique ◽  
Bone Tunnels ◽  
Tendon Avulsion

Adverse Events Following Minimally Invasive Achilles Tendon Repair

2020 ◽  
pp. 193864002095089 ◽  
Author(s):  
Alexander J. Idarraga ◽  
Daniel D. Bohl ◽  
Eric Barnard ◽  
Kamran Movassaghi ◽  
Kamran S. Hamid ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Repair ◽  
Wound Complications ◽  
Transverse Incision ◽  
Longitudinal Incision ◽  
Repair Technique ◽  
Achilles Tendon Repair ◽  
No Tourniquet

Background The rate of wound complications following traditional open Achilles tendon repair is reported at 7.6%. The purpose of this study is to characterize the rate of wound and other early complications following a specific minimally invasive Achilles tendon repair technique, and to identify any factors associated with increased risk. Methods The postoperative courses of 99 patients who underwent minimally invasive Achilles tendon repair by 2 surgeons at separate academic medical centers were retrospectively reviewed. Mean follow-up was 8.1 months (range 3.0-24.6 months). Repair technique was similar in all cases with the exception that 71 procedures used a longitudinal incision and a tourniquet, while 28 procedures used a transverse incision and no tourniquet (surgeon preference). The rates of complications were compared between patients with differing baseline and procedural characteristics. Results Of the 99 patients included in the study, 2 (2.0%) developed wound complications. 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 (2.8% vs 0%; P = 1.000). Four patients (4.0%) developed sural neuropraxia. One patient developed deep venous thrombosis. There were no cases of rerupture. At final follow-up, all 99 patients had intact Thompson tests and well-healed wounds. Conclusions The rate of wound complications following minimally invasive Achilles tendon repair is low at 2.0%. Patients should be counseled that although risk for wound complications may be lower with this minimally invasive technique, there are risks for sural neuropraxia and deep suture reaction. Levels of Evidence: Level III, Retrospective study

Sign in / Sign up

Export Citation Format

Share Document