Adverse Events Following Minimally Invasive Achilles Tendon Repair

Background The rate of wound complications following traditional open Achilles tendon repair is reported at 7.6%. The purpose of this study is to characterize the rate of wound and other early complications following a specific minimally invasive Achilles tendon repair technique, and to identify any factors associated with increased risk. Methods The postoperative courses of 99 patients who underwent minimally invasive Achilles tendon repair by 2 surgeons at separate academic medical centers were retrospectively reviewed. Mean follow-up was 8.1 months (range 3.0-24.6 months). Repair technique was similar in all cases with the exception that 71 procedures used a longitudinal incision and a tourniquet, while 28 procedures used a transverse incision and no tourniquet (surgeon preference). The rates of complications were compared between patients with differing baseline and procedural characteristics. Results Of the 99 patients included in the study, 2 (2.0%) developed wound complications. There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (2.8% vs 0%; P = 1.000). Four patients (4.0%) developed sural neuropraxia. One patient developed deep venous thrombosis. There were no cases of rerupture. At final follow-up, all 99 patients had intact Thompson tests and well-healed wounds. Conclusions The rate of wound complications following minimally invasive Achilles tendon repair is low at 2.0%. Patients should be counseled that although risk for wound complications may be lower with this minimally invasive technique, there are risks for sural neuropraxia and deep suture reaction. Levels of Evidence: Level III, Retrospective study

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Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00161 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Daniel Bohl ◽

Eric Barnard ◽

Kamran Movassaghi ◽

Kamran Hamid ◽

Adam Schiff

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Suture Material ◽

Tendon Repair ◽

Wound Complications ◽

Transverse Incision ◽

Longitudinal Incision ◽

Achilles Tendon Repair ◽

Deep Suture ◽

No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

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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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Supine Surgical Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000345 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Katherine Sage ◽

Gregory Guyton

Keyword(s):

Achilles Tendon ◽

Supine Position ◽

Complication Rate ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Wound Complications ◽

Achilles Tendon Repair

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Open Achilles tendon repair is typically performed in the prone position for easy visibility of the tendon, but serious complications may be associated with general anesthesia in this position. Open Achilles tendon repair with supine position has been described and potentially avoids these issues, but it is not known whether this position is safe. We reviewed the complication rate of supine open Achilles tendon repair in a retrospective series of patients, looking specifically at wound healing, infection, re-rupture, and sural nerve injury. Methods: CPT codes for Achilles tendon rupture were used to search the records of one surgeon for the years 2010-2014. The charts were then reviewed. Patients were included if they had an Achilles tendon rupture that was surgically treated with primary repair in the supine position within 15 days of injury. Patients were excluded if further reconstruction or tendon transfer was performed. A paramedian incision was utilized 1 cm medial to the Achilles sheath. Results: A total of 37 patients met the inclusion criteria. Of these 37 patients, 31 were men and 6 were women. The average age was 40.0 years (range, 20 to 66 years). Average length of follow-up was 159 days (range 25 to 1589 days). The average BMI was 28 (range 24-36). There were no major complications, including no infections or wound complications. No reruptures and no sural nerve injuries were observed. Conclusion: In 37 patients with early follow-up, supine open Achilles tendon repair had a complication rate equivalent to reported historical data for the prone procedure.

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Minimally Invasive Achilles Tendon Repair Using the Achillon Repair System

Techniques in Foot & Ankle Surgery ◽

10.1097/01.btf.0000235234.20325.f7 ◽

2006 ◽

Vol 5 (3) ◽

pp. 171-174 ◽

Cited By ~ 4

Author(s):

Andrew J. Elliott ◽

John G. Kennedy ◽

Martin O'Malley

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Repair ◽

Repair System ◽

Achilles Tendon Repair

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Mini- open Minimally Invasive Achilles Tendon Repair

Minimally Invasive Surgery in Orthopedics ◽

10.1007/978-3-319-15206-6_98-2 ◽

2016 ◽

pp. 1-9

Author(s):

Serdar Yuksel ◽

Mark E. Easley

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Repair ◽

Achilles Tendon Repair ◽

Mini Open

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There is a high return to sport rate but with reduced career lengths after Achilles tendon repair in Major League Soccer players

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000246 ◽

2019 ◽

Vol 4 (1) ◽

pp. 15-20 ◽

Cited By ~ 1

Author(s):

Kyle R Sochacki ◽

Robert A Jack II ◽

Takashi Hirase ◽

Patrick C McCulloch ◽

David M Lintner ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Return To Sport ◽

Level Of Evidence ◽

Postoperative Performance ◽

Achilles Tendon Repair ◽

Major League Soccer ◽

Major League ◽

And Performance

ObjectivesTo determine (1) return to sport (RTS) rate in Major League Soccer (MLS) players following Achilles tendon repair, (2) postoperative career length and games per season, (3) preoperative and postoperative performance, and (4) postoperative performance compared with control players matched by position, age, body mass index, sex, years of experience and performance.MethodsPublicly available records were used to identify MLS players who underwent Achilles tendon repair with a minimum of 1 year follow-up. Demographic and performance data were collected for each player. Matched controls were identified. RTS was defined as playing in one or more MLS games after surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired sample Student’s t-tests.ResultsTwenty-two players (mean age 28.4±4.0 years; mean 3.0±2.2 years follow-up) and 23 Achilles tendon repairs (one bilateral repair) were analysed. Seventeen players (18 Achilles tendon repairs; 77.3%) were able to RTS in the MLS at mean 306.6±199.2 days. Players who RTS after repair had shorter careers than matched controls (2.5±2.2 vs 4.5±3.0 seasons, respectively; p=0.021). Additionally, players who RTS after repair played in fewer games per season than matched controls (13.4±8.4 vs 23.2±6.5, respectively; p<0.001). There was no significant decrease in performance postsurgery compared with presurgery.ConclusionThere is a 77.3% RTS rate in the MLS following Achilles tendon repair. Following repair, players had shorter careers and played fewer games per season than matched controls. There was no significant decrease in performance postsurgery compared with presurgery nor in postsurgery compared with postindex. A significantly greater number of Achilles tendon tears occurred in the left versus the right lower extremity.Level of evidenceLevel III.

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