Limited Open Achilles Tendon Repair in Supine Position With Modified Ring Forceps: A Technique Tip

2019 ◽  
Vol 12 (6) ◽  
pp. 563-568
Author(s):  
Seth W. O’Donnell ◽  
Brian Velasco ◽  
Brianna Whitehouse ◽  
John Y. Kwon ◽  
Christopher P. Miller
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Supine Position ◽  
Tendon Repair ◽  
Effective Technique ◽  
Achilles Tendon Repair ◽  
Room Time ◽  
Mini Open ◽  
Operating Room Time ◽  
Repair Techniques

We present a modification to prior Achilles tendon repair techniques that utilizes readily available noncommercial instrumentation, mini-open incisions, and supine positioning, thus maximizing surgical efficiencies and reducing complications. In our experience, this is a safe and effective technique that minimizes anesthetic requirements and operating room time. Levels of Evidence: Level V, expert opinion

scholarly journals A Supine Achilles Tendon Repair Decreases Total Operating Room and Anesthesia Time Without Sacrificing Outcomes

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
David Beck ◽  
Steven Raikin ◽  
David Pedowitz ◽  
Benjamin Zmistowski
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Prone Position ◽  
Supine Position ◽  
Tendon Repair ◽  
Operating Rooms ◽  
Set Up ◽  
Anesthesia Time ◽  
Room Time ◽  
Operating Room Time

Category: Ankle, Sports, Trauma Introduction/Purpose: Achilles tendon repairs have traditionally been performed using a prone position. Prone positioning gives the surgeon easy visualization of the tendon, but may not offer the safest position for anesthesia and requires more peri-operative positioning time. We propose that the use of a supine position for primary Achilles tendon repairs offers similar surgical times, while saving non-surgical operating room time during positioning and anesthesia set-up. Methods: A retrospective review of primary Achilles tendon repairs done at our institution’s surgical sites between March of 2010 and July of 2015 was performed. Using the institutional database, 145 procedures were identified. Chart review demonstrated that 82 were performed open-supine (OS), 31 were performed open-prone(OP), and 32 were performed percutaneous-prone(PP). Surgical, non-surgical, and total operating room times were compared between the three groups. Results: Average surgical times were 32.8, 49, and 32.3 minutes for the OS, OP, and PP procedures, respectively. Total operating rooms times were 59.1, 88.9, and 76.7; while non-surgical times spent in the operating rooms were 26.3, 39.9, and 44.4 minutes for these groups, respectively. Achilles tendons repaired either OP or PP resulted in an additional 13.6 and 18.1 (average 15.9) minutes of operating room time. There was not an increase in complications with the supine procedure compared to the prone procedures. Conclusion: Primary Achilles tendon repairs can be performed effectively using an open technique in a supine position, saving non-surgical operating room time without increasing complications. The supine position may also offer a safer method of providing anesthesia to these patients by allowing the anesthesiologist a more accessible airway and decreasing the risks involved with placing an intubated patient into a prone position.

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

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.

scholarly journals Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
James Rush Jones ◽  
Haley McKissack ◽  
Aaradhana J. Jha ◽  
Leonardo V. M. Moraes ◽  
Jun Kit He ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Prone Position ◽  
Supine Position ◽  
Surgical Repair ◽  
Traditional Approach ◽  
Perioperative Period ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Mini Open

Category: Sports Introduction/Purpose: Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position. Methods: Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant. Results: A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups. Conclusion: The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

scholarly journals Value of Supine Positioning in Repair of Achilles Tendon Ruptures

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.

Complications of Supine Surgical Achilles Tendon Repair

2018 ◽  
Vol 39 (6) ◽  
pp. 720-724 ◽  
Author(s):  
John J. Marcel ◽  
Katherine Sage ◽  
Gregory P. Guyton
Keyword(s):  
Achilles Tendon ◽  
Supine Position ◽  
Primary Repair ◽  
Tendon Repair ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Achilles Tendon Repair ◽  
Concomitant Surgery ◽  
Tendon Surgery

Background: Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. Methods: Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20–66 years). Median length of follow-up was 116 days (range, 25–1,589 days). Average body mass index was 29 kg/m2 (range, 23–36 kg/m2). Results: There were no infections, sural nerve injuries, or reruptures. Conclusions: The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. Level of Evidence: Level IV, case series.

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