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

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.

Percutaneous versus Open Repair of the Ruptured Achilles Tendon

2005 ◽  
Vol 33 (9) ◽  
pp. 1369-1379 ◽  
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.

Correlation Between Recovery of Triceps Surae Muscle Strength and Level of Activity After Open Repair of Acute Achilles Tendon Rupture

2017 ◽  
Vol 38 (12) ◽  
pp. 1324-1330 ◽  
Author(s):  
Seikai Toyooka ◽  
Hideki Takeda ◽  
Kohei Nakajima ◽  
Atsushi Masujima ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Open Repair ◽  
Achilles Tendon Rupture ◽  
Triceps Surae ◽  
Triceps Surae Muscle ◽  
Level Of Activity

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

2021 ◽  
pp. 036354652110444
Author(s):  
Chul Hyun Park ◽  
Hongfei Yan ◽  
Jeongjin Park ◽  
Min Cheol Chang
Keyword(s):  
Postoperative Complications ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Open Repair ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Operation Time ◽  
Maximum Height ◽  
Significant Difference ◽  
Mini Open

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.

Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis

2017 ◽  
Vol 46 (7) ◽  
pp. 1767-1772 ◽  
Author(s):  
Yi-Jun Zhang ◽  
Chi Zhang ◽  
Quan Wang ◽  
Xiang-Jin Lin
Keyword(s):  
Patient Satisfaction ◽  
Achilles Tendon ◽  
Infection Rate ◽  
English Language ◽  
Tendon Rupture ◽  
Meta Analysis ◽  
Achilles Tendon Rupture ◽  
Small Sample ◽  
Significant Difference ◽  
End To End

Background: Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. Purpose: To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. Study Design: Meta-analysis. Methods: A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. Results: Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and nonaugmented (8.1%) repair ( P = .80). Conclusion: Augmented repair, when compared with nonaugmented repair, was not found to improve patient satisfaction or reduce rerupture rate or infection rate. These conclusions are based on 4 trials with small sample sizes, and larger randomized trials are required to confirm these results.

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

Operative Treatment of Acute Achilles Tendon Rupture: Open End-to-End-Reconstruction Versus Reconstruction with Mitek-Anchors

2008 ◽  
Vol 108 (2) ◽  
pp. 236-239 ◽  
Author(s):  
T.J.A. Schönberger ◽  
H.M.J. Janzing ◽  
J.W. Morrenhof ◽  
A.C. de Visser ◽  
P. Muitjens
Keyword(s):  
Achilles Tendon ◽  
Operative Treatment ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
End To End

scholarly journals Deep venous thrombosis after Achilles tendon rupture is associated with poor patient-reported outcome

2020 ◽  
Vol 28 (10) ◽  
pp. 3309-3317
Author(s):  
Simon Svedman ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Surgical Techniques ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Reported

Abstract Purpose The aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization. Methods A cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation). Results The total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71–79 vs 80–87; p < 0.01). Sixty-seven percent (95% CI 57–77%) of the patients devoid of DVT reported a good outcome (ATRS > 80) compared to 51% (95% CI 41–61%) of the patients sustaining a DVT (p < 0.05). Quality of life displayed significantly better outcome in the non-DVT versus DVT patients (mean = 75 (95% CI 71–79) vs. mean = 68 (95% CI 64–72); p < 0.05). A significant difference in total concentric work was observed between non-DVT and DVT patients (median = 1.9 kJ (IQR = 0.9 kJ) vs. median = 1.6 kJ (IQR = 1.0 kJ); p < 0.01). Conclusion Sustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR. Level of evidence III.

scholarly journals Seasonal Variation of Achilles Tendon Injury

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Jon-Michael Caldwell ◽  
Harry Lightsey ◽  
Hasani Swindell ◽  
Justin Greisberg ◽  
J. Turner Vosseller
Keyword(s):  
Seasonal Variation ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Seasonal Pattern ◽  
Achilles Tendon Rupture ◽  
Tendon Injury ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Significant Difference ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.

scholarly journals A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture

2017 ◽  
Vol 2 (4) ◽  
pp. 247301141771543 ◽  
Author(s):  
Robert G. Dekker ◽  
Charles Qin ◽  
Cort Lawton ◽  
Muturi G. Muriuki ◽  
Robert M. Havey ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Lower Limbs ◽  
Gap Formation ◽  
Postoperative Rehabilitation ◽  
Significant Difference ◽  
Load To Failure

Background: Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow and limited open repair for Achilles tendon rupture. We hypothesized that there would be no statistical difference in load to failure, work to failure, and initial linear stiffness. Methods: A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results: The average load to failure (353.8 ± 88.8 N vs 313.3 ± 99.9 N; P = .38) and work to failure (6.4 ± 2.3 J vs 6.3 ± 3.5 J; P = .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than PARS repair (11.8 ± 2.5 N/mm) ( P = .011). Conclusion: No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications.

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