scholarly journals Achilles Tendon Rupture Repairs: A Case Series Reporting Clinical Outcomes of a Novel Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Caroline Williams ◽  
Christopher P. Miller ◽  
John Y. Kwon
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Patient Positioning ◽  
Measurement Information ◽  
Repair Technique ◽  
Patient Reported ◽  
Mini Open

Category: Trauma; Ankle; Sports Introduction/Purpose: Achilles tendon rupture repair has undergone several changes in the last ten years, aiming to minimize complications while maximizing clinical and functional outcomes. Selecting a less invasive approach instead of traditional open incision has shown through various studies to generate excellent results and significantly reduce post-operative infections. Choice of patient positioning during operative repair has also shown to be of great impact, with prone positioning being associated with elevated surgical times and anesthetic requirements, thus secondary affecting clinical outcomes. Other complications associated with prone positioning include neuropraxia and increased risk of iatrogenic ophthalmologic insults as compared to the supine position. This case report evaluates clinical outcomes of patients following treatment of Achilles rupture with a novel Medial Mini- Open Supine Achilles Repair Technique. Methods: Patients were selected for case series inclusion after undergoing novel Medial Mini-Open Supine Achilles Repair Technique for acute achilles rupture. Retrospective medical record review for demographic, perioperative and functional data was completed for each patient, with means, range and standard deviations calculated when appropriate. Patients were then followed postoperatively to monitor recovery. At a final follow up visit scheduled no sooner than six months post operatively, outcomes were assessed with three separate Patient-Reported Outcomes Measurement Information System (PROMIS) surveys; Physical Function, Pain Interference and Depression. Two separate Foot and Ankle Ability Measure (FAAM) assessments, ADLs and Sport, were also completed. Patients were also assessed for physical pain/discomfort using the Visual Analog Scale (VAS). Results: Eighteen patients were included in this study; fifteen male, three female. Mean age was 37.5 years (+-12, range= 20-68). Mean duration of surgery was 31.0 minutes (+- 7.0). Follow up duration averaged 11.8 months (range 6.0-13.5). All patients completed three Patient-Reported Outcomes Measurement Information System (PROMIS) studies and two Foot and Ankle Ability Measure (FAAM) surveys. Mean score for the PROMIS Physical Function survey was 52.3 (+-11.5), for Pain Interference, mean= 50.0 (+-7.30), and for Depression, mean=39.5 (+- 6.96). FAAM Sport survey showed a mean=71.3 (+-29.4), with ADLs form responses showing a mean of 90.7 (+-12.7). All patients reported 0/10 pain on Visual Analog Scale (VAS), and overall satisfaction with their outcomes. Conclusion: In reviewing data collected thus far, the Medial Mini-Open Supine Achilles Repair technique shows promise to serve as a viable option for achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. No complications have been reported at this time; patients have demonstrated excellent outcomes in physical exam in postoperative clinic visits. All patients have expressed satisfaction with their results at final visit.

High Plantar Force Loading After Achilles Tendon Rupture Repair With Early Functional Mobilization

2019 ◽  
Vol 47 (4) ◽  
pp. 894-900 ◽  
Author(s):  
Susanna Aufwerber ◽  
Annette Heijne ◽  
Karin Grävare Silbernagel ◽  
Paul W. Ackermann
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Force Measurement ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Level Of Evidence ◽  
Force Loading ◽  
Fear Of Movement ◽  
Patient Reported ◽  
Plantar Force

Background: Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown. Purpose: The primary aim of this study was to assess the number of steps and the amount of loading in a weightbearing orthosis during the first 6 weeks after surgical ATR repair. A secondary purpose was to investigate if the amount of loading was correlated to fear of movement and/or experience of pain. Study Design: Case series; Level of evidence, 4. Methods: Thirty-four patients (mean ± SD age, 38.8 ± 8.7 years) with ATR repair were included. Early functional mobilization was allowed postoperatively in an orthosis with adjustable ankle range of motion. During the first postoperative 2 weeks, patient-reported loading and pain were assessed with a visual analog scale and step counts with a pedometer. At the 2- and 6-week follow-up, a mobile force sensor was used for measuring plantar force loading, and the Tampa Scale for Kinesiophobia was used to examine fear of movement. Results: Between the first and second weeks, there was a significant increase in the mean number of daily steps taken (from 2025 to 2753, P < .001) as well as an increase in self-reported loading (from 20% to 53%, P < .001). Patient self-reported loading was significantly associated with the plantar force measurement (rho = 0.719, P < .001). At 6 weeks, loading was 88.2% on the injured limb versus the uninjured limb. Fear of movement was not correlated with pedometer data, subjective loading, pain, or force data. Patients with less pain during activity, however, reported significantly higher subjective load and took more steps ( P < .05). Conclusion: This is the first study to demonstrate the actual loading patterns during postoperative functional mobilization among patients with surgically repaired ATR. The quick improvements in loading magnitude and frequency observed may reflect improved tendon loading essential for healing. Pain, rather than fear of movement, was associated with the high variability in loading parameters. The data of this study may be used to improve ATR rehabilitation protocols for future studies. Registration: NCT02318472 (ClinicalTrials.gov).

scholarly journals Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Daniel Carpenter ◽  
Katherine Dederer ◽  
Paul Weinhold ◽  
Joshua N Tennant
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Biomechanical Testing ◽  
Return To Sport ◽  
Smoking History ◽  
Diagnostic Modality ◽  
Lateral Incision ◽  
Patient Reported

Category: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of a cohort of non-operatively treated Achilles tendon ruptures. The PEAT repair technique described is a novel method which avoids a proximal lateral incision. We sought to determine clinical outcomes from a cohort undergoing this procedure as well as its basic biomechanical properties. Methods: Clinical: With IRB approval a cohort of operatively treated patients was assessed with the following PROs: Return to sport, VAS pain score, Satisfaction Likert, patient reported complications, single heel lift, patient reported medical & smoking history, ATRS (Achilles Tendon Rupture Score). Chart review of diagnostic modality, injury mechanism, time to surgery, tourniquet times, and surgeon reported complications were also collected. Biomechanical: 6 pairs (12) of age and sex matched fresh frozen lower extremity specimens (mid tibia to toes) with average age 71.5 (48-89) (8 F specimens, 4 M specimens) underwent either open (Kessler) repair or percutaneous repair. Specimens were cycled 10N-43 N for 100 cycles, and 20N-86 N for 200 cycles, measuring displacement and ultimate load to failure. Results: Clinical: 30 patients operatively treated with the PEAT procedure, 22 contacted by phone. Avg. follow up 2.5 years (1.2- 3.8); Avg ATRS 94.1 (81-100, SD 4.8); “very satisfied” 19/20; Avg VAS 0.3. We had a re-rupture rate of 3.33% (1/30). Biomechanical data: At 10-43 N for 100 cycles, all 12 specimens survived for duration of testing with biomechanical equivalence. At 20-86 N for 200 cycles, percutaneous repairs with greater cyclical displacement (1.7 cm vs 1.0 cm); 1/6 percutaneous with early failure; 11/12 specimens survived. Conclusion: The PEAT repair of Achilles tendon rupture showed excellent clinical outcomes with low complications and with biomechanical testing suggesting equivalent strength at low loads.

Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study

2016 ◽  
Vol 55 (5) ◽  
pp. 971-975 ◽  
Author(s):  
Ersin Taşatan ◽  
Tuluhan Yunus Emre ◽  
Demet Tekdöş Demircioğlu ◽  
Bahtiyar Demiralp ◽  
Vecihi Kırdemir
Keyword(s):  
Prospective Study ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Open Repair ◽  
Achilles Tendon Rupture ◽  
Long Term Results ◽  
Repair Technique ◽  
A Prospective Study ◽  
Mini Open

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

scholarly journals Achilles tendon repair by a minimally invasive technique using Tenolig®

2020 ◽  
Vol 14 (3) ◽  
pp. 269-273
Author(s):  
Vinicius Oliveira ◽  
Sérgio Prata
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Postoperative Infection ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Aofas Score ◽  
Functional Scores

Objective: To assess the degree of postoperative satisfaction of patients with acute Achilles tendon rupture who underwent surgical reconstruction by a minimally invasive technique using Tenolig®. Methods: A retrospective observational study was conducted with 18 patients with acute Achilles tendon rupture diagnosed by a positive Thompson test who underwent surgery. Outcomes were assessed using the American  arthopaedic Foot and Ankle Society (AOFAS) score and the Foot Function Index (FFI). Furthermore, quantitative variables were descriptively treated, and patients’ age was correlated with FII and AOFAS score using Spearman’s correlation coefficient at a significance level of 5%. Results: Patients underwent surgery from one to six days after injury and were discharged one day later. Only one patient had a superficial postoperative infection. Patients’ AOFAS scores ranged from 75 to 100 points, and FFI ranged from 0 to 20%. The patient withsuperficial postoperative infection had an AOFAS score and a FFI of 75 points and 20%, respectively. Conclusion: Percutaneous repair of complete Achilles tendon rupture with Tenolig® resulted in high functional scores and a low rate of complications. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Pediatric Achilles Tendon Rupture: A 10 Year Retrospective Case Series

2021 ◽  
Vol 53 (8S) ◽  
pp. 200-200
Author(s):  
Daniel Chen ◽  
Matthew Beran ◽  
Molly Duncan ◽  
Julie Young ◽  
James MacDonald
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture

2018 ◽  
Vol 46 (12) ◽  
pp. 2929-2934 ◽  
Author(s):  
Simon Svedman ◽  
Robin Juthberg ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Patient Outcome ◽  
Adverse Events ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
Treatment Protocols ◽  
Good Outcome ◽  
Patient Reported

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

2020 ◽  
pp. 107110072096249
Author(s):  
Craig C. Akoh ◽  
Amanda Fletcher ◽  
Akhil Sharma ◽  
Selene G. Parekh
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Repair ◽  
Case Series ◽  
Postoperative Outcome ◽  
Foot And Ankle ◽  
Achilles Tendon Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

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