The Effect of Obesity on Achilles Rupture Repair

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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The Effect of Obesity on Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00457 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0045

Author(s):

Niall Smyth ◽

Jeffery Hillam ◽

Jonathan Kaplan ◽

Amiethab Aiyer

Keyword(s):

Wound Healing ◽

Achilles Tendon ◽

Univariate Analysis ◽

Tendon Repair ◽

Wound Complication ◽

Improvement Program ◽

Wound Healing Complication ◽

Achilles Tendon Repair ◽

Increased Risk ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Obesity is increasingly common and has been highlighted as a comorbidity that may negatively impact outcomes following orthopaedic surgery. Operative versus nonoperative treatment of Achilles tendon ruptures continues to be controversial, as operative treatment may slightly reduce the likelihood of rerupture but carries the inherent surgical risks. To further delineate the patients who are at risk of postoperative complications it is of value to determine whether obese patients are particularly vulnerable. The purpose of this study was to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods: Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The patients were divided into two cohorts (obese and nonobese), and peri and postoperative factors were evaluated for association with obesity. Results: A total of 2128 patients were identified, of which 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 minutes versus 56.1 minutes. The only postoperative complication that was associated with obesity was wound healing complication, based on univariate analysis. Multivariate analysis demonstrated obesity was not associated with an increased risk of wound healing complication, infection, deep venous thrombosis, or other systemic complication. Conclusion: A large segment of the patient population undergoing Achilles tendon repair is obese. In the current study, although obesity increased the likelihood of developing a wound complication following Achilles tendon repair based on univariate analysis, it was not significantly associated with any other complication.

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The Clinical Outcomes After a Novel Mini-Open Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00095 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0009

Author(s):

Craig C. Akoh ◽

Amanda N. Fletcher ◽

Selene G. Parekh ◽

Akhil Sharma

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Tendon Repair ◽

Postoperative Outcomes ◽

Categorical Variables ◽

Foot And Ankle ◽

Achilles Tendon Repair ◽

Tendon Ruptures ◽

The Mean ◽

Mini Open

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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Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00459 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0045

Author(s):

Brian D. Steginsky ◽

Mallory Suhling ◽

Eric Giza ◽

Christopher D. Kreulen ◽

B. Dale Sharpe ◽

...

Keyword(s):

Surgical Technique ◽

Achilles Tendon ◽

Functional Outcomes ◽

Tendon Repair ◽

Surgical Techniques ◽

Wound Complications ◽

Distal Stump ◽

Achilles Tendon Repair ◽

Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

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Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism

Foot & Ankle Specialist ◽

10.1177/1938640016679706 ◽

2016 ◽

Vol 10 (5) ◽

pp. 415-420 ◽

Cited By ~ 9

Author(s):

Mark J. Bullock ◽

William T. DeCarbo ◽

Mark H. Hofbauer ◽

Joshua D. Thun

Keyword(s):

Venous Thromboembolism ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Achilles Tendinopathy ◽

Flexor Hallucis Longus ◽

Achilles Tendon Repair ◽

Elective Repair ◽

High Incidence ◽

Tendon Ruptures

Background. Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods. One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results. Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion. In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE. Levels of Evidence: Prognostic, Level III: Case Control Study

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Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520909389 ◽

2020 ◽

Vol 48 (7) ◽

pp. 1720-1726 ◽

Cited By ~ 3

Author(s):

Kelechi R. Okoroha ◽

Najib Ussef ◽

Toufic R. Jildeh ◽

Lafi S. Khalil ◽

Laith Hasan ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Achilles Tendon ◽

Controlled Trial ◽

Tendon Repair ◽

Repair Site ◽

Randomized Controlled ◽

Achilles Tendon Repair ◽

Tendon Lengthening ◽

Accelerated Rehabilitation ◽

Tendon Ruptures

Background: Early weightbearing protocols after Achilles tendon repair promote mobilization, yet little is known about their effect on tendon lengthening. Purpose: To evaluate tendon lengthening after Achilles tendon repair with accelerated rehabilitation. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients undergoing primary repair for acute Achilles tendon ruptures consented to have tantalum beads placed within the tendon. Patients were randomized into either a traditional (weightbearing at 6 weeks) or accelerated (graduated weightbearing at 2 weeks) rehabilitation group. The primary outcome of the study was postoperative tendon elongation as measured by radiostereometric beads. Secondary outcomes included Achilles Tendon Total Rupture Score (ATRS) and Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (PROMIS PI-SF) score. Results: All 18 patients included in the final analysis were found to have significant tendon lengthening after surgery, with a mean lengthening of 15.9 mm. No significant differences were found in overall lengthening between the traditional and accelerated rehabilitation groups (15.3 ± 4.5 vs 16.4 ± 4.7 mm, respectively; P = .33) at final follow-up. The repair site in each group was found to lengthen more than the intratendinous site (traditional group, 13.2 vs 2.1 mm; accelerated group, 16.8 vs −0.4 mm); however, no difference in lengthening was seen between groups ( P = .82 and P = .31, respectively). The greatest amount of lengthening occurred between 2 and 6 weeks, and the least amount of lengthening occurred between 6 and 12 weeks, with no difference between the traditional and accelerated groups at these time points ( P = .84 and P = .38, respectively). No differences were noted in ankle range of motion (dorsiflexion, P = .16; plantarflexion, P = .08) or outcome scores (ATRS, P = .56; PROMIS PI-SF, P = .54). Conclusion: This study’s findings demonstrate that all patients undergoing operative repair of Achilles tendon ruptures had lengthening after surgery. No difference was found in tendon lengthening (repair site or intratendinous) at any time point between patients undergoing traditional versus accelerated rehabilitation postoperatively. The greatest amount of lengthening was found to occur between 2 and 6 weeks postoperatively, and tendon lengthening decreased significantly after 6 weeks. Registration: NCT04050748 (ClinicalTrials.gov identifier).

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Value of Supine Positioning in Repair of Achilles Tendon Ruptures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00407 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0040

Author(s):

Ryan Rogero ◽

David Beck ◽

Kristen Nicholson ◽

Rachel Shakked ◽

David Pedowitz ◽

...

Keyword(s):

Achilles Tendon ◽

Operating Room ◽

Functional Outcomes ◽

Short Form ◽

Tendon Repair ◽

Optimal Method ◽

Achilles Tendon Repair ◽

Procedure Cost ◽

Tendon Ruptures

Category: Hindfoot Introduction/Purpose: The optimal method of Achilles tendon repair remains undefined. Few previous studies have quantified the financial expenses of Achilles tendon repairs in relation to functional outcomes in order to assess the overall value of the accepted repair techniques. The purpose of this study is to demonstrate the value of supine positioning during open repair (OS) of acute Achilles tendon ruptures through the quantification of operative times, costs, and outcomes in comparison to the commonly performed percutaneous prone (PP) repair technique. Methods: A retrospective review was conducted on 67 patients undergoing OS and 67 patients undergoing PP primary Achilles tendon repair with two surgeons at four surgical locations. Total operating room usage times and operating times were collected from surgical site records. Total operating room times were used to estimate the costs of room usage and anesthesia, while costs of repair equipment were collected from the respective manufacturers. Patients undergoing OS repair completed the Foot and Ankle Ability Measure (FAAM) questionnaire, with activities of daily living (ADL) and sports subscales, Short Form-12 (SF-12), with mental (MCS) and physical (PCS) health subcategories, and the visual analog scale (VAS) for pain preoperatively and at final follow-up. Results: Even with a significantly longer mean surgical time (P=.035), OS repairs had a shorter duration of total operating room time when compared to that of PP repairs (58.4 versus 69.7 minutes, P<.001). Estimated time-dependent costs were lower in OS repairs ($739 versus $861 per procedure, P<.001), while the estimated average total per procedure cost was also lower for OS repairs ($801 versus $1,910 per procedure, P<.001). For patients undergoing OS repair, FAAM-ADL (P<.001), FAAM-Sports (P<.001), SF-12-PCS (P<.001) all increased and VAS grades (P<0.001) decreased from time of initial encounter to final follow-up and were comparable to reported outcomes in the current literature. The complication rate in OS repairs (6.0%) was lower than PP repairs (11.9%), with revisions only occurring in the latter technique. Conclusion: Performing open Achilles tendon repair in the supine position offers substantial value, or “health outcomes achieved per dollar spent”, to providers due to decreased total operating room times and costs with satisfactory functional outcomes.

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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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Retrospective Comparison of Complications with Open versus Minimally Invasive Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00445 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0044

Author(s):

Seth C. Shoap ◽

Christina Freibott ◽

Hans Polzer ◽

J. Turner Vosseller

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Open Repair ◽

Tendon Repair ◽

Open Group ◽

Invasive Group ◽

Patient Demographics ◽

Achilles Tendon Repair ◽

Open Standard ◽

Tendon Ruptures

Category: Sports; Other Introduction/Purpose: Despite the relatively high frequency of Achilles ruptures, there is no clear consensus on the optimal treatment method. The debate has traditionally been framed by the tension between the risk for rerupture seen with nonoperative treatment and the risk for wound issues seen with operative treatment. Studies have demonstrated conflicting results when comparing complications associated with each treatment. The current study analyzed complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair by a single surgeon. Methods: We conducted a retrospective chart review of patients that had Achilles tendon repair performed by the senior author between July 1st 2011 and January 22nd 2020. The senior author’s preferred operative technique transitioned from an open standard procedure to a minimally invasive procedure within this time frame, and patients were divided accordingly. Patient demographics, medical history, social history, surgical details, and additional surgeries were recorded. Patient outcomes and any complications were also recorded. Complications included any wound related issues or infection, erythema, DVT, wound breakdown, drainage, equinus contracture, and calcaneus stress reaction. Pain, swelling and/or tenderness were not considered complications. Independent sample t-tests and chi-square analyses were conducted to assess for differences in patient demographics and operative outcomes between the minimally invasive and open procedure treatment groups. Results: Of the 127 included patients, 75.6% were male with an average age of 41.85 (+-14.02). 30 (23.6%) patients had the minimally invasive approach, while 97 (76.4%) had the open approach. 82.7% were non-smokers, and the average BMI was 31.47(+-29.84). A majority of injuries (63.8%) occurred while playing sports. There were 10 complications, all of which were wound-related and all of which were in the open group (p=0.06). There were no revision surgeries in the minimally invasive group, and 10 in the open group (p=0.06). There were no recorded reruptures in either group. Conclusion: This study sought to determine the complication profile of two operative treatments for Achilles tendon ruptures, open standard and minimally invasive repair. Recent literature has suggested that minimally invasive repair results in superior outcomes to open repair. Our study found that both repeat surgery and complications trended towards a higher rate following open repair compared to minimally invasive repair, although the difference was not statistically significant (p=0.06). It is notable, however, that there were fewer total patients in the minimally invasive group and that there was not a single wound complication in the minimally invasive group.

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Achilles Tendon Repair With Modified Giftbox Technique Using Nonabsorbable Suture Loops

Video Journal of Sports Medicine ◽

10.1177/2635025421992782 ◽

2021 ◽

Vol 1 (1) ◽

pp. 263502542199278

Author(s):

Timothy L. Miller ◽

Eric Welder

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Complication Rates ◽

Nonabsorbable Suture ◽

Achilles Tendon Repair ◽

Tendon Ruptures ◽

The Mean ◽

Mean Time ◽

Standard Techniques ◽

Mini Open

Background: Achilles tendon ruptures occur most commonly in male individuals aged between 30 and 60 years. Indications: Surgical options for treatment of acute midsubstance Achilles tendon ruptures in the athletically active population include open, mini-open, and percutaneous techniques. Surgical Technique: The giftbox suture configuration has been popularized by multiple authors. Here, a modified giftbox technique for Achilles tendon repair is shown in detail and uses nonabsorbable suture loops, a novel method for primarily repairing complete Achilles tendon ruptures. Results: This mini-open technique has demonstrated, at a minimum of 1-year follow-up, outcomes that are comparable with previously reported Achilles tendon repair procedures with no re-ruptures and low overall complication rates in the first 60 patients who have undergone this procedure. The mean time to release to unrestricted activity following repair by this technique is 24.3 weeks, which is earlier than most standard techniques. Conclusion: Achilles tendon repair using the modified gift box technique with nonabsorbable suture loops is a safe and reliable technique for repair of midsubstance tendon ruptures in athletically active patients. The mean time to release to unrestricted activity following repair by this technique is earlier than most standard techniques.

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Outcomes of Plantaris Tendon Augmentation in Acute Achilles Tendon Rupture Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00409 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Ryan G. Rogero ◽

Daniel Corr ◽

Andrew Fisher ◽

Joseph T. O’Neil ◽

Daniel J. Fuchs ◽

...

Keyword(s):

Achilles Tendon ◽

Functional Outcomes ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Complication Rates ◽

Plantaris Tendon ◽

Achilles Tendon Repair ◽

Patient Variables ◽

Tendon Ruptures

Category: Trauma; Ankle; Hindfoot; Sports Introduction/Purpose: Given the lack of consensus regarding the optimal surgical treatment for acute Achilles tendon ruptures, identifying techniques to maximize functional outcomes is crucial. Augmentation of Achilles tendon repair with the plantaris tendon is an established surgical technique that is thought to improve outcomes by reinforcing the repair site as well as decreasing soft tissue adhesions, though no studies have specifically looked at outcomes of its use. The purpose of this study is to compare the outcomes of acute Achilles tendon repairs managed with and without plantaris tendon augmentation. Methods: A retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with a single fellowship- trained foot & ankle surgeon from 2010-2016 was performed. Patients <18 years of age, those whose procedures were >21 days from the date of injury, or whose repair was augmented with a flexor hallucis longus (FHL) tendon transfer or V-Y advancement were excluded. Operative report review determined if repair included plantaris augmentation. Augmentation involved weaving the tendon through the Achilles above and below the rupture site creating a box type biologic augmentation. Patients were contacted at >=2 years postoperatively to complete the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales, visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the surgical outcome using a 5- point Likert scale. Mann-Whitney U, Chi-squared and Fisher’s exact tests were performed to compare patient variables and postoperative outcomes. Results: One hundred twenty-eight patients undergoing repair of an acute Achilles tendon rupture were included, including 59 (46.1%) with plantaris tendon augmentation and 69 (53.9%) without. The two patient cohorts did not differ in any preoperative patient variables (p>0.0892). Patients with and without plantaris augmentation did not experience any significant difference in the rate of postoperative complications (p=1.000), including a 0% re-rupture rate in each group. Additionally, at an average follow-up of 57.1 months, the groups did not differ in FAAM-ADL score (p=0.7116), FAAM-Sports score (p=0.4024), the Single Assessment Numeric Evaluation (SANE) as part of the FAAM-Sports subscale (p=0.2572), VAS pain (p=0.1885), or outcome satisfaction (p=0.7317). Conclusion: Our study demonstrates that plantaris tendon augmentation does not improve patient functional outcomes following acute Achilles tendon repair, but also is not associated with increased complication rates. Further studies, including either higher-level prospective, randomized clinical studies or biomechanical evaluation of the technique, are indicated to justify this adjunctive procedure. [Table: see text]

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