Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures

Category: Sports; Other Introduction/Purpose: Achilles tendon ruptures are a common sporting injury, mostly occurring in men over the age of 40. Operative repair of Achilles tendon can lead to earlier return to activity and improved function in the active population. Mini-open repairs have recently been described for effective treatment of Achilles tendon ruptures. We aim to describe our unique mini- open Achilles tendon repair technique and to report our clinical outcomes. Methods: We retrospectively reviewed charts of patients from January 2010 and July 2019 who underwent a 3cm mini-open Achilles tendon repairs, without additional targeting devices, for closed acute Achilles tendon ruptures. Patients were followed up for a minimum of one year. We recorded pre- and postoperative Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS) scores. Subgroup analysis were performed for acute repairs (< 2 weeks) and subacute (2-6 weeks). Two-sided student’s t-test to compare preoperative and postoperative outcomes for continuous variables. Chi-square analyses were used to determine the strength of correlation between categorical variables. A p-value of < .05 was considered significant for all statistical analyses. Results: A total of 33 patients met the inclusion criteria and are included in this study. The mean age of our cohort was 43.8 years old (range 22-78) and 78.8% of patients were male. The mean length of follow-up was 4.4 years (range 1.0-9.8 years). The mean time from injury to surgery was 15.6 days (1-45 days). Patients reported a mean return to their previous level of activity at a mean of 5.6 months (range 1.7-22.1). The mean pre- and postoperative outcomes scores improved significantly for both the acute and subacute repair groups (p < 0.05). There were no significant differences for postoperative outcomes scores between the acute and subacute Achilles repair groups (p > 0.05). There were no reported complications in our patient cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There were no significant difference in outcomes for acute versus subacute repairs. Our mini-open Achilles tendon repair, which required no additional targeting instrumentation, has shown favorable mid-term results.

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Anatomic Relationship of the Sural Nerve when Performing Achilles Tendon Repair using the Percutaneous Achilles Repair System, a Cadaveric Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00351 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0035

Author(s):

Roddy McGee ◽

Troy S. Watson ◽

Adam Eudy ◽

Candice L. Brady ◽

Cheryl Vanier ◽

...

Keyword(s):

Achilles Tendon ◽

Sural Nerve ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Wound Complications ◽

Repair System ◽

Achilles Tendon Repair ◽

Open Versus ◽

Relationship Of ◽

Percutaneous Achilles Repair

Category: Sports; Trauma Introduction/Purpose: Minimally-invasive techniques for Achilles tendon repair are gaining popularity by orthopedic surgeons due to the reports of similar re-rupture rates with open versus percutaneous techniques with less wound complications and quicker recovery with percutaneous methods. The goal of the study was to quantify the relationship of the sural nerve to the Percutaneous Achilles Repair System (PARS) during Achilles tendon repair and identify sural nerve violations utilizing this system. Methods: The PARS was placed into ten lower extremity cadaveric specimens after simulation of an Achilles tendon rupture. After placement of the PARS jig and passage of the needles, careful dissection was performed in order to identify whether the sural nerve was violated and the distance of the sural nerve in relation to the passed needles was recorded. Results: Of the 10 cadaveric specimens, none had violation of the sural nerve during percutaneous needle passage. Zero of the 50 (0%) needles directly punctured the substance of the sural nerve, however, one needle was found to have come into close proximity separating the sural nerve and small saphenous vein but when the suture was passed and the PARS jig removed, the nerve was found remain intact with no evidence of entrapment. Conclusion: This study demonstrated the potential risk for sural nerve injury when using the PARS for Achilles tendon repair.

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Clinical Outcomes of Acute Achilles Tendon Rupture Repair Utilizing Supine Positioning

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00364 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0036

Author(s):

Ryan Rogero ◽

David Beck ◽

Joseph Larwa ◽

Daniel Fuchs ◽

Steven M. Raikin

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Supine Position ◽

Functional Outcomes ◽

Open Repair ◽

Tendon Repair ◽

Complication Rates ◽

Achilles Tendon Repair ◽

Functional Scores ◽

Tendon Ruptures

Category: Sports, Trauma Introduction/Purpose: With no consensus regarding the optimal technique for repair of Achilles tendon ruptures, identifying techniques which minimize complications and maximize functional outcomes is essential. Previous studies on Achilles repair performed in the supine position have demonstrated low complication rates, avoidance of issues related to anesthesia set-up of prone positioning, and decreased operating room times, though these studies have included relatively low patient numbers and lacked functional outcomes. The purpose of this study is to evaluate the clinical outcomes of a large cohort of patients undergoing acute Achilles tendon repair in the supine position. Methods: We conducted a retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with supine positioning by one fellowship-trained foot & ankle surgeon at a single outpatient surgical location from 2010-2016. During each procedure, a longitudinal incision was made just medial to the tendon extending approximately 3.5 cm both proximally and distally from the level of the rupture. Exclusion criteria included age <18 years old, repair >21 days from date of injury, and undergoing any additional procedures other than concomitant tendon transfers. Postoperative chart notes were reviewed to identify any complications experienced by patients, and surgical site records were reviewed for tourniquet times. Patients were contacted and asked about their satisfaction with surgical outcome and to complete the Foot & Ankle Ability Measure (FAAM)- Activities of Daily Living (ADL) and –Sports subscales, as well as the Visual Analog Scale (VAS) for pain. Results: Two-hundred eleven patients, including 31 (14.7%) females, were included in the study, with a mean age of 40.9 years and mean BMI of 28.8 kg/m2. Patients had an average of duration from injury to surgery of 8.5 days (range, 1-21 days) and mean tourniquet time of 35.5 minutes (range, 16-77 minutes). Four patients (1.9%) experienced a postoperative complication, including 2 superficial wound infections and 2 deep vein thromboses. There were no sural nerve-related injuries or tendon re-ruptures. At an average of 56.8 months postoperatively (range 24-99 months), patients reported a mean VAS pain of 0.6 ± 1.3/10 and mean FAAM-ADL and FAAM-Sports scores of 93.9 ± 12.4/100 and 84.7 ± 19.6/100, respectively. Additionally, 91.4% reported being satisfied with the outcome of the surgery. Conclusion: With an extremely low complication rate, mid- to long-term functional scores comparable to other reported Achilles tendon repair techniques, and high rate of patient satisfaction, open repair of Achilles tendon ruptures performed in a supine position offers surgeons a safe and effective treatment method.

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Biomechanical Evaluation of Achilles Tendon Midsubstance Repair: The Effects of Anchor Angle and Position

Foot & Ankle Specialist ◽

10.1177/19386400211009360 ◽

2021 ◽

pp. 193864002110093

Author(s):

Ingrid K. Stake ◽

Jon W. Miles ◽

Brenton W. Douglass ◽

Grant J. Dornan ◽

Thomas O. Clanton

Keyword(s):

Achilles Tendon ◽

Sagittal Plane ◽

Repair System ◽

Suture Anchors ◽

Postoperative Rehabilitation ◽

Repair Technique ◽

Significant Difference ◽

Failure Loads ◽

Ultimate Failure ◽

Tendon Ruptures

Background The percutaneous knotless repair technique for Achilles tendon ruptures utilizes a Percutaneous Achilles Repair System (PARS) device for suturing the proximal tendon and 2 suture anchors for fixing the sutures into the calcaneus. Determining the best position of the suture anchors may optimize the strength of this repair. Methods Twelve pairs of human ankle cadaveric specimens were randomly assigned to receive suture anchors placed at 45°, 90°, or 135° from the sagittal plane. The anchors were tensioned according to a protocol representing progressive, postoperative rehabilitation. Load, number of loading cycles, displacement, and mode of failure were recorded. Results With the anchors placed at 45°, 90°, and 135°, the ultimate failure loads were mean 265 ± 64 N, 264 ± 75 N, and 279 ± 40 N, and the total number of loading cycles were mean 459 ± 166, 466 ± 158, and 469 ± 110, respectively. The effect of anchor angle on failure load, number of loading cycles, and displacement was not statistically significant. Visually, the anchors at 45° and 90° demonstrated sutures cutting through the bone. Conclusion We found no statistically significant difference in pullout strength between the 3 different anchor angles. Sutures cutting through the bone may be a concern with acute anchor angles. This suggests that a 135° anchor angle may result in a lower risk of tendon elongation with the percutaneous knotless repair technique. Levels of Evidence Cadaveric laboratory study

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Comparison between the open and minimally invasive repair technique in acute Achilles tendon injuries

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.789 ◽

2018 ◽

Vol 12 (4) ◽

pp. 265-70 ◽

Cited By ~ 1

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 Results ◽

Tendon Injuries ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Flexor Hallucis Longus ◽

Repair System ◽

Open 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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