Mini-open Repair for Acute Achilles Tendon Rupture: Ring Forceps vs the Achillon Device

Background: Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. Purpose: To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results: The AOFAS score ( P = .669), Achilles Tendon Total Rupture Score ( P = .753), and length of incision ( P = .305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P < .001). The maximum height of the SLHR ( P = .042) and the number of SLHRs ( P = .043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s ( P = .185) and 120 deg/s ( P = .271). There was no significant difference in the occurrence of postoperative complications between the groups ( P = .093). Conclusion: The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

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Percutaneous versus Open Repair of the Ruptured Achilles Tendon

The American Journal of Sports Medicine ◽

10.1177/0363546504271501 ◽

2005 ◽

Vol 33 (9) ◽

pp. 1369-1379 ◽

Cited By ~ 113

Author(s):

Andrej Čretnik ◽

Miloš Kosanović ◽

Vladimir Smrkolj

Keyword(s):

Achilles Tendon ◽

Local Anesthesia ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Functional Results ◽

Level Of Evidence ◽

Significant Difference ◽

American Orthopaedic

Background Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains. Purpose To compare the results of percutaneous and open Achilles tendon repair. Study Design Cohort study; Level of evidence, 2. Methods The results of 132 consecutive patients with acute complete Achilles tendon rupture who were operated on exclusively with modified percutaneous repair under local anesthesia from 1991 to 1997 and followed up for at least 2 years were compared to the results of 105 consecutive patients who were operated on exclusively with open repair under general or spinal anesthesia in the same period. Results There were significantly fewer major complications in the group of percutaneous repairs in comparison with the group of open repairs (4.5% vs 12.4%; P = .03), particularly necrosis (0% vs 5.6%; P = .019), and a lower total number of complications (9.7% vs 21%; P = .013). There were slightly more reruptures (3.7% vs 2.8%; P = .680) and sural nerve disturbances (4.5% vs 2.8%; P = .487) in the group of percutaneous repairs, with no statistically significant difference. Functional assessment using the American Orthopaedic Foot and Ankle Society scale and the Holz score showed no statistically significant difference. Conclusion The results of the study support the choice of (modified) percutaneous suturing under local anesthesia as the method that brings comparable functional results to open repair, with a significantly lower rate of complications.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04802-8 ◽

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.

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Arthroscopic, Single-Incision, and Double-Incision Approaches to Flexor Hallucis Longus Tendon Transfer Following Achilles Tendon Rupture: A Literature Review

Journal of the American Podiatric Medical Association ◽

10.7547/18-046 ◽

2021 ◽

Vol 111 (3) ◽

Author(s):

Ashley V. Mosseri ◽

Phillip Calaj ◽

Dominick J. Casciato ◽

Bibi N. Singh

Keyword(s):

Postoperative Complications ◽

Achilles Tendon ◽

Tendon Transfer ◽

Tendon Rupture ◽

Single Incision ◽

Achilles Tendon Rupture ◽

Athletic Injury ◽

Flexor Hallucis Longus ◽

Longus Tendon ◽

Significant Difference

Achilles tendon rupture is a common athletic injury that results in a painful and antalgic gait. Flexor hallucis longus tendon transfer through arthroscopic, single-incision, or double-incision techniques is used as a treatment approach to address this rupture; however, no studies have compared postoperative complications between these three techniques. A systematic search of published articles was conducted using keywords “Achilles rupture,” “flexor hallucis tendon,” “transfer,” and “recovery.” Articles were then selected based on their title, abstract, and content following full-text review. From each article's reported surgical outcomes, a comparison was made between arthroscopic and single- and double-incision postoperative complications using a χ2 test with significance set at a value of P < .05 followed by post hoc analysis. The arthroscopic approach maintained the lowest rate of postoperative complications, followed by the single- and double-incision techniques. A significant difference in the number of postoperative complications was found between all incisional approaches. The pairwise comparisons, however, could not identify which incisional approaches significantly differed between each other. A reduction in postoperative complications places arthroscopy and the single-incision techniques as the preferred approaches for flexor hallucis longus tendon transfer following an Achilles tendon rupture. Although current literature shows arthroscopy to be superior to single- and double-incision methods, this review demonstrates the need for a greater number of published cases using arthroscopy to establish significance regarding postoperative complications.

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Management of acute Achilles tendon ruptures

Bone and Joint Research ◽

10.1302/2046-3758.710.bjr-2018-0004.r2 ◽

2018 ◽

Vol 7 (10) ◽

pp. 561-569 ◽

Cited By ~ 19

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.

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Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation

Muscles Ligaments and Tendons Journal ◽

10.11138/mltj/2017.7.3.554 ◽

2017 ◽

Vol 7 (3) ◽

pp. 554 ◽

Cited By ~ 1

Author(s):

Marco Turati

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Open Versus ◽

Isokinetic Evaluation ◽

Mini Open ◽

Repair Techniques

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Achillon versus modified minimally invasive repair treatment in acute Achilles tendon rupture

Journal of Orthopaedic Surgery ◽

10.1177/2309499020908354 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902090835

Author(s):

Jun-Yi Liu ◽

Wei-Feng Duan ◽

Sheng Shen ◽

Ye Ye ◽

Yong-Qiang Sun ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Complication Rate ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Operation Time ◽

Accelerated Rehabilitation ◽

Significant Difference ◽

Specialized Equipment

Purpose: To date, the best treatment of acute Achilles tendon rupture (AATR) is still inconclusive. Achillon seems to be a promising approach with satisfactory function and low complication rate. We hypothesize a modified minimally invasive repair (MMIR), which provides direct visualization of proximal tendon stump without specialized equipment that could provide comparable results. This trial is aimed to evaluate the functional and surgical outcomes of MMIR comparing with Achillon. Methods: From February 2013 to February 2017, 114 patients with AATR were enrolled in this trial, underwent an alternative operation (Achillon or MMIR), and accelerated rehabilitation protocol. Forty-four patients took the Achillon and the other 70 patients took the MMIR at their subjective choice. One hundred eleven full follow-up data were obtained including Achilles tendon total rupture score (ATRS), time back to work, rerupture rate, overall complication rate, and operation time. Results: There was no significant difference between groups in demographic characters. There was no statistical difference between both groups regarding to time return to work and ATRS at 3rd, 6th, 12th, and 24th month, respectively. Five reruptures and two Achilles tendons tethering to skins were found in the Achillon group, and two reruptures and one sural nerve injury in the MMIR group. No wound infection and dehiscence occurred. Overall complication rate in the Achillon group is higher (16.3% vs. 4.4%, p = 0.044). The operation time of Achillon is less than MMIR (34.84 vs. 39.71, p < 0.001). Conclusion: Both techniques combining with accelerated rehabilitation showed to be reliable and effective. MMIR is safer and more economical, and Achillon is faster.

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Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2016.04.016 ◽

2016 ◽

Vol 55 (5) ◽

pp. 971-975 ◽

Cited By ~ 7

Author(s):

Ersin Taşatan ◽

Tuluhan Yunus Emre ◽

Demet Tekdöş Demircioğlu ◽

Bahtiyar Demiralp ◽

Vecihi Kırdemir

Keyword(s):

Prospective Study ◽

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Long Term Results ◽

Repair Technique ◽

A Prospective Study ◽

Mini Open

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Achilles Tendon Open Repair Augmented with Volar Turndown Tendon Flap and Deep Posterior Crural Fasciotomy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00127 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0012

Author(s):

Hamza Özer ◽

Hakan Selek ◽

Gülcan Harput ◽

Ali Öznur ◽

Gül Baltacı

Keyword(s):

Muscle Strength ◽

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Major Complication ◽

Posterior Compartment ◽

Gastrocnemius Flap ◽

Significant Difference ◽

End To End

Objectives: The aim of the study was to investigate the outcomes after open repair of Achilles tendon rupture with augmented volar turndown gastrocnemius flap and deep posterior crural fasciotomy. Methods: Twenty-three (22male/1female) patients with acute Achilles tendon injury were operated. Open end to end repair and augmentation with a volar turndown gastrocnemius flap and fasciotomy of the deep posterior compartment was performed in each patient. Home physiotherapy program was instructed for each patient. Muscle strength, balance and jump performance were assessed. Results: All patients returned to their preinjury activity level and repairs healed without any major complication. One patient had serous drainage who did not require surgical intervention (4,3%). There was no significant difference between involved and uninvolved leg in terms of concentric and eccentric muscle strength (p=0.82 and p=0.53, respectively). In Y balance test, there was no significant difference between involved and uninvolved legs in anterior (p=0.06), posteromedial (p=0.97) and posterolateral (p=1.00). In addition, there were no significant differences between leg in vertical jump (p=0.16) and one leg hop (p=0.15) tests. AOFAS Hindfoot score was 98.6±2.3 (93-100). Conclusion: Open end to end repair of the Achilles tendon rupture with augmentation and fasciotomy of the deep posterior compartment healed without any major complication. Fasciotomy of the deep posterior compartment decreased the tension at the skin repair site while decompressing the supeficial compartment anteriorly. Additionally, the augmented bulky repair construct of the Achilles tendon cambered volarly through the deep posterior compartment and decreased irritation sense during and after tendon healing.

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