scholarly journals Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110600
Author(s):  
Kristin C. Caolo ◽  
Stephanie K. Eble ◽  
Carson Rider ◽  
Andrew J. Elliott ◽  
Constantine A. Demetracopoulos ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Repair ◽  
Suture Repair ◽  
Complication Rates ◽  
Achilles Tendon Repair ◽  
Patient Reported ◽  
Acute Rupture

Background: There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. Methods: A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded. Results: PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). Conclusion: Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. Level of Evidence: Level III, retrospective cohort study.

The use of ultrasonography during minimally invasive Achilles tendon repair to avoid sural nerve injury

2019 ◽  
Vol 46 (4) ◽  
pp. 513-514 ◽  
Author(s):  
Joverienne Chavez ◽  
Soichi Hattori ◽  
Yuki Kato ◽  
Shuzo Takazawa ◽  
Shin Yamada ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Repair ◽  
Achilles Tendon Repair

scholarly journals A Comparison of Clinical Outcomes and Complication Rates in Open Versus Minimally Invasive Achilles Tendon Repair Using PROMIS Scores

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Kristin C. Caolo ◽  
Stephanie K. Eble ◽  
Andrew J. Elliott ◽  
Constantine A. Demetracopoulos ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Open Repair ◽  
Tendon Repair ◽  
Complication Rates ◽  
Population Means ◽  
Achilles Tendon Repair ◽  
Acute Rupture ◽  
Repair Group

Category: Sports Introduction/Purpose: While there is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture, there is a recent trend towards decreasing complication rates for both procedures as well as favorable clinical outcomes. While many studies have compared complication rates between these procedures, no study has examined differences in clinical outcomes using PROMIS scores with a large cohort of patients. PROMIS has been validated for use in assessing outcomes following Achilles repair and allows for evaluation of surgical outcomes compared to population means. We hypothesized that patients in both open and MIS groups would have improved PROMIS scores postoperatively, but that there would be minimal differences in PROMIS scores and complication rates between surgical techniques. Methods: 228 patients were identified who underwent surgery for acute unilateral Achilles tendon repair between January 2016 and December 2018. Nine surgeons were represented. The open repair group was defined by a larger incision (>4 cm) and no use of a commercially available minimally invasive device. The minimally invasive group was defined by a smaller incision (<3.5 cm) and use of the device. Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry; all domains have a population mean of 50. 147 patients completed PROMIS at minimum 1 year postoperatively, 50 in the open repair group and 97 in the MIS group. PROMIS scores were compared between procedures using t-tests with a significance level of 0.05. A chi-square test of independence was also performed to analyze the relationship between complications and procedure type. Results: No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. Average postoperative PROMIS scores included: Physical Function (54.92 MIS, 57.25 Open, p=0.123); Pain Interference (45.00 MIS, 45.63 Open, p=0.600); and Pain Intensity (34.97 MIS, 35.21 Open, p=0.812). There were also no significant differences in complication rates between groups. 20.6% of patients in the MIS group had at least one postoperative complication (9.3% DVT, 4.1% rerupture, 2% sural nerve injury, 2% infection), compared to 18.0% in the open group (8% DVT, 2% rerupture, 2% sural nerve injury, 0% infection) (p=0.705). Conclusion: Patients undergoing minimally invasive and open Achilles tendon repair after acute rupture have similar clinical outcomes and complication rates. Though this study did not consider outcomes such as postoperative pain levels and level of sport or return to sport, it demonstrates that patients undergoing Achilles tendon rupture regardless of technique have very favorable PROMIS scores compared to population means. This information is important for surgeons choosing which procedure to use as both are safe and effective techniques for repairing the Achilles tendon.

scholarly journals Ultrasonographic Imaging for Sural Nerve Injury after Achilles Tendon Repair

2018 ◽  
Vol 20 (2) ◽  
pp. 254
Author(s):  
Hsien-Po Chang ◽  
Chueh-Hung Wu ◽  
Levent Özçakar
Keyword(s):  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Repair ◽  
Achilles Tendon Repair

.

An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device

2014 ◽  
Vol 20 (2) ◽  
pp. 90-93 ◽  
Author(s):  
Ken J. Porter ◽  
Shibby Robati ◽  
Priyesh Karia ◽  
Mark Portet ◽  
Matthew Szarko ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Repair ◽  
Cadaveric Study ◽  
Achilles Tendon Repair

scholarly journals Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

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.

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.

scholarly journals Arthroscopically-Asissted Achilles Tendon Repair; Long-Term Results

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0022
Author(s):  
Akın Turgut ◽  
Mert Zeynel Asfuroğlu
Keyword(s):  
Achilles Tendon ◽  
Range Of Motion ◽  
Sural Nerve ◽  
Plantar Flexion ◽  
Tendon Repair ◽  
Long Term Results ◽  
Calf Circumference ◽  
Achilles Tendon Repair ◽  
Arthroscopically Assisted

Objectives: The ruptures of the Achilles tendon (AT) are relatively common. Since there is no consensus on the best method of the repair of the AT; the treatment is determined on the preference of the surgeon and the patient. The study evaluating the cadaveric and short term clinical results done by our clinic in 2002, has shown us that arthroscopically Achilles tendon repair can be good choise in achilles tendon ruptures. Methods: Fortyfour patients who underwent arthroscopically assisted achilles tendon repair during 1997-2011 in Osmangazi University Orthopaedics and Traumatology Department were retrospectively observed. The mean follow-up time was 69,7 months. One of patients had bilateral rupture. The diagnosis was based on loss of plantar flexion strength, palpation of the gap in the tendon, and a positive Thompson test. MRI and USG were used when needed. The ruptures were left-sided in nineteen patients and right-sided in twentysix. The cause of the rupture was recreational sports activity in thirtyeight, fall from height in four, missing a step in a staircase in two. Return the regular activity, ankle range of motion as compared with the opposite side, calf circumference, and ability to walk and stand tiptoe were recorded. All patients were operated on within 2-32 days after the rupture. Thirtysix operations were performed under spinal anesthesia and eight operations were performed under general anesthesia. Tourniquet was always used. Before starting the procedure, the rupture site and location of the gap are marked. Using the common videoarthroscopic instruments, a 70 degrees scope was inserted into the AT through the stab incision made previously, and the torn ends of the tendon were visualized with plantar flexion an extension of the ankle. After the visualization of the torn ends of the tendon and repair by the technique of Ma and Griffith care was focused to contact the ends of the tendon anatomically; then the sutures were knotted. A short leg circular cast with the ankle in slight plantar flexion was applied. American Orthopaedics Foot-Ankle Society (AOFAS) score was used to evaluate the long-term results.. Results: All patients had satisfactory results that no reruptures had occurred. No significant difference in range of motion of the ankle and calf circumference between the opposite sides was observed in any patient. All patients could walk and stand on tiptoe. AOFAS mean score was 94.5 (65-100). The interval from injury to return to regular work and activities was 8-10 weeks. All the patients were able to return back to their activity level before surgery. In three patients temporary sural hypoestesia, in one patient permanent sural hipoestesia and in one patient wound enfection appeared. No sensory deficit was detected in the temporary sural hypoestesia patients after postoperative second year controls. Medical care was supported to the patient with the wound enfection and the enfection was under control in the early stages. Conclusion: In summary; arthroscopically-assisted percutaneous repair of AT appears to overcome some certain problems of open, conservative and percutaneous techniques; but the neurovascular structure damage risk especially the sural nerve remains a potent problem. Accurate knowledge of the anatomy appears to be a solution. Novel percutaneous repairs have been promising to minimize the risk of sural nerve damage.

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