Delayed (14-30 Days) Percutaneous Repair of Achilles Tendon Ruptures Offers Equally Good Results As Compared With Acute Repair

2020 ◽  
Vol 48 (5) ◽  
pp. 1181-1188 ◽  
Author(s):  
Nicola Maffulli ◽  
Alessio D’Addona ◽  
Gayle D. Maffulli ◽  
Nikolaos Gougoulias ◽  
Francesco Oliva
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Invasive Technique ◽  
Suture Repair ◽  
Distal Stump ◽  
Percutaneous Repair ◽  
Tendon Ruptures ◽  
Repair Group

Background: Minimally invasive repair of acute Achilles tendon ruptures has been performed for several years, resulting in reduced morbidity as compared with open repair. Hypothesis: A minimally invasive technique can be used to manage Achilles tendon ruptures in patients presenting between 14 and 30 days from injury. Study Design: Cohort study; Level of evidence, 3. Methods: We prospectively recruited 21 consecutive patients who presented between 14 and 30 days after the index injury, and we compared them with 21 patients who were matched according to sex, age (±2 years), and level of activity, who presented within 14 days of the index injury. All patients underwent the same minimally invasive procedure under local anesthesia: a core suture repair consisting of a modified Bunnell suture in the proximal stump and a modified Kessler suture in the distal stump. Results: At 12 months after minimally invasive repair, patients with delayed treatment had a median Achilles tendon rupture score of 91 (SD, 2.4; range, 87-96) as compared with 91 (SD, 2.2; range, 86-96) in patients treated acutely, who presented at a median 2.4 days (range 1-6 days) from the injury. There were no significant differences between groups in terms of mean (SD) Achilles tendon resting angle: delayed repair group, −3.9° (2.0); acute repair group, −3.7° (1.9) ( P = .69). No patient in either group developed a wound infection. One patient in the acute group experienced an iatrogenic sural nerve injury. Conclusion: Patients with Achilles tendon rupture treated by percutaneous repair 14 to 30 days after injury achieved similar results at 1 year as patient treated <14 after injury.

scholarly journals A New Minimally Invasive Technique for Repairing Achilles Tendon Rupture:A Biomechanical Study

2019 ◽  
Author(s):  
Peng zhao ◽  
Dawei Sun ◽  
Yaru Xiong ◽  
Ribo Zhuo
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Research Group ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Biomechanical Study ◽  
New Technique ◽  
Invasive Technique ◽  
Invasive Treatment ◽  
Cyclical Loading

AbstractIntroductionThe incidence of Achilles tendon rupture shows a gradually increasing trend, which is mainly managed by minimally invasive treatment due to its advantages, such as low wound infection rate. At present, the firmness of the commonly applied minimally invasive suture method for Achilles tendon remains controversial. Our research group has developed a novel suture method for Achilles tendon, which has achieved favorable clinical outcomes. Therefore, this experiment aimed to explore the optimal approach to repair Achilles tendon rupture through comparing the biomechanical strength of the commonly used Achilles tendon suture methods currently.Materials and methods6 fresh frozen human cadaveric Achilles tendon specimens were sutured by three kinds of technique, and were tested through the cyclical loading after repair.ResultsResults of cyclical loading showed that, the repair using the new technique was stronger after 10 cycles, 1000 cycles, and rupture. Moreover, the new technique had displayed superior anti-deformation strength to that of the Ma-Griffith technique.ConclusionsOur experimental results demonstrate that, the new technique proposed by our research group can attain comparable biomechanical properties to those of the Krachow technique. However, the sample size in this study is small, and further clinical trials are warranted.

scholarly journals Achilles tendon repair by a minimally invasive technique using Tenolig®

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.

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

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.

scholarly journals Management of acute Achilles tendon ruptures

2018 ◽  
Vol 7 (10) ◽  
pp. 561-569 ◽  
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.

scholarly journals Clinical Outcomes in Patients With Minimally Invasive Surgical Approach Combined With Plantar Tendon Transfer Repairing Neglected Achilles Tendon Rupture Compared to the Conventional Approach of V-Y Tendon Plasty: A Retrospective Study With Two Years Follow-Up

2021 ◽  
Author(s):  
Feiyu Cai ◽  
Kai Liu ◽  
Yanshi Liu ◽  
Biao Luo ◽  
Pengfei Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Neglected Achilles Tendon Rupture ◽  
Group A ◽  
Group B

Abstract Background Unlike acute Achilles tendon rupture (AATR), neglected Achilles tendon rupture (NATR) requires usually tendon grafting procedures for repair tendon defects caused by removing scar tissue. The conventional open surgery of V-Y tendon plasty and minimally invasive technique with plantar tendon transfer had been described, but the long-term efficacy between the two techniques still needs further certification. Methods Between February 1, 2008, and July 31, 2018. All of 46 patients with neglected Achilles tendon rupture, 25 patients in group A (21 males and 4 females; age, 34.28 ± 6.97 years) underwent the conventional operation of V-Y tendon plasty, and 21 patients in group B (14 males and 7 females; age, 35.29 ± 7.42 years) were treated by the minimally invasive technique. Two years follow-up was performed for the functional recovery with examinations of the Achilles tendon rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hind-Foot Scale Score, dorsiflexion, calf circumference, and heel raise test. Results Patient characteristics between the two groups were similar. The functional score of ATRS and AOFAS in Group B was higher than patients in group A at postoperative months 3, 6, and 12, while there is no difference at month 24. In group A, there were three patients exposed to soft tissue infections (two superficial infections and one deep infection) and one case with tendon exposure. In group B, a patient with tendon re-rupture was observed. There was no difference in dorsiflexion and calf circumference at follow-up two years and the much better recovery in heel raise test group B than A. Conclusions Two different techniques produced a significant functional improvement, and return to sports. However, this study demonstrated that the minimally invasive technique was recommended for patients with a tendon defect less than 6 cm and who have an urgent demand to return to the sports.

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

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.

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

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

scholarly journals Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer

Joints ◽  
2017 ◽  
Vol 05 (04) ◽  
pp. 212-216 ◽  
Author(s):  
Federico Usuelli ◽  
Riccardo D'Ambrosi ◽  
Luigi Manzi ◽  
Cristian Indino ◽  
Jorge Villafañe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Graft ◽  
Semitendinosus Tendon ◽  
Invasive Technique ◽  
Return To Sports ◽  
Endurance Test ◽  
Sports Activity

Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7–7.2) months after the surgery. No patient reported complications or reruptures. Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence Level IV, therapeutic case series.

Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture

2018 ◽  
Vol 39 (12) ◽  
pp. 1464-1472 ◽  
Author(s):  
Jordi Vega ◽  
Jesus Vilá ◽  
Jorge Batista ◽  
Francesc Malagelada ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Wound Breakdown ◽  
Tendon Ruptures

Background: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture. Methods: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes. Results: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered. Conclusion: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons. Level of Evidence: Level IV, retrospective case series.

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