Outcomes of Plantaris Tendon Augmentation in Acute Achilles Tendon Rupture Repair

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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Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors77113 ◽

2021 ◽

Vol 9 (4) ◽

pp. 465-470

Author(s):

Saad Andaloussi

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Skin Wound ◽

Plantaris Tendon ◽

First Case ◽

Tendon Ruptures ◽

Post Traumatic

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

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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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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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Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Foot & Ankle Orthopaedics ◽

10.1177/2473011420965967 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096596

Author(s):

Daniel Carpenter ◽

Katherine Dederer ◽

Paul Weinhold ◽

Joshua N. Tennant

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Return To Sport ◽

Biomechanical Analysis ◽

Absorbable Suture ◽

Operative Repair ◽

Repair Technique ◽

Achilles Tendon Repair

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

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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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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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Management of acute Achilles tendon ruptures

Bone and Joint Research ◽

10.1302/2046-3758.710.bjr-2018-0004.r2 ◽

2018 ◽

Vol 7 (10) ◽

pp. 561-569 ◽

Cited By ~ 19

Author(s):

X. Yang ◽

H. Meng ◽

Q. Quan ◽

J. Peng ◽

S. Lu ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Complication Rates ◽

Functional Rehabilitation ◽

Percutaneous Repair ◽

Tendon Ruptures ◽

Mini Open

ObjectivesThe incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.MethodsA PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.ResultsThe treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous repair, mini-open repair, and augmentative repair. Traditional open repair has lower re-rupture rates with higher risks of complications. Percutaneous repair and mini-open repair show similar re-rupture rates but lower overall complication rates when compared with open repair. Percutaneous repair requires vigilance against nerve damage. Functional rehabilitation combining protected weight-bearing and early controlled motion can effectively reduce re-rupture rates with satisfactory outcomes. Biological adjuncts help accelerating tendon healing by adhering rupture ends or releasing highly complex pools of signalling factors.ConclusionThe optimum treatment for complete rupture remains controversial. Both mini-open repair and functional protocols are attractive alternatives, while biotherapy is a potential future development. Cite this article: X. Yang, H. Meng, Q. Quan, J. Peng, S. Lu, A. Wang. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018;7:561–569. DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2.

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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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Biomechanical Comparison of Panda Rope Bridge Technique and Other Minimally Invasive Achilles Tendon Repair Techniques In Vitro

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211008436 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110084

Author(s):

Ting Wang ◽

Yuan Mu ◽

Yulei Diao ◽

Wenke Liu ◽

Yahong Wu ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Biomechanical Properties ◽

Repair System ◽

Postoperative Rehabilitation ◽

Achilles Tendon Repair ◽

Repair Techniques

Background: Although nonoperative management of acute Achilles tendon rupture (ATR) is a reasonable option, surgical repair has attracted attention for young and active patients. More reliable Achilles tendon repair techniques are needed to enhance recovery after ATR in this population. Purpose/Hypothesis: To biomechanically analyze the panda rope bridge technique (PRBT) and compare it with other minimally invasive repair techniques over a simulated, progressive rehabilitation program. It was hypothesized that PRBT would result in better biomechanical properties and enhanced recovery after ATR. Study Design: Controlled laboratory study. Methods: An Achilles tendon rupture was created 4 cm from the distal tendon insertion site in 40 bovine lower extremities, and specimens were then randomly allocated to 5 Achilles tendon repair techniques: (1) Achillon, (2) modified Achillon, (3) Percutaneous Achilles Repair System (PARS), (4) modified PARS, and (5) PRBT. Each group was subjected to a cyclic loading protocol that was representative of progressive postoperative rehabilitation for ATR (250 cycles at 1 Hz for each loading stage: 20-100 N, 20-200 N, 20-300 N, and 20-400 N). Results: The PRBT technique demonstrated significantly less elongation (1.62 ± 0.25 mm) than the 4 other repair techniques after the first loading stage of 20 to 100 N ( P < .05). All specimens in the 4 other groups developed a large gap (elongation ≥5 mm) at the 20- to 200-N loading stage. When overall biomechanical performance was examined, the PRBT group exhibited higher strength (20-400 N) and more mean loading cycles (984 ± 10) compared with the 4 other groups ( P < .05). Conclusion: In this bovine model, PRBT biomechanically outperformed the other minimally invasive Achilles tendon repair techniques that were tested and could therefore meet the requirements of accelerated rehabilitation. Clinical Relevance: The reduced tendency for premature rerupture and the overall improved biomechanical properties of PRBT suggest that ATR patients treated with PRBT may more readily complete early and aggressive postoperative rehabilitation protocols. In addition, they may have a lower risk of early irreversible suture failure.

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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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