Modified gift box technique for acute compound posttraumatic Achilles tendon repair in young patients

Background: Treatment of Achilles tendon rupture in young active patient remains controversial. Open primary repair remains the mainstay of treatment with prolonged rehabilitation and high wound complication rate (20%). In compound injuries it becomes the default treatment. Newer techniques are being tried to decrease re-rupture rate, decrease local complications and facilitate early rehabilitation. Modified gift box technique of open repair, which has shown higher strength of repair in in-vitro studies and good clinical results in the hands of its inventor. The aim of our study was to evaluate the clinical results of this technique in young active patients with compound Achilles tendon injury.Methods: This is a retrospective study. The parameters recorded at follow up included general demography, ability to single toe raise (on neutral, incline, decline), toe walking for 40 feet, and pain on VAS scale. Achilles tendon total rupture score and modified Rupp score were administered.Results: Out of the 8 patients included in the study, 7 patients had unilateral tear and 1 patient had bilateral tear. The mean age was 27 yrs (20-35) and mean duration of follow up was 17.4 months (08-24 months). Single toe raise and toe walking for 40 ft. was possible in all patients. Two patients complained of grade 2 pain on VAS Scale. The ATRS score was 97.1 (94-99) and modified Rupp score was 28.3 (26-29). Conclusions: Modified gift box technique gives excellent results in young active patients with compound Achilles tendon injury with no re-rupture and return of pre-injury activity.

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Prognostic model of clinical scores in evaluation of treatment outcome in patients with acute Achilles tendon rupture - surgery vs. immobilization

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200517047i ◽

2020 ◽

Vol 148 (7-8) ◽

pp. 455-461

Author(s):

Mihailo Ille ◽

Ivan Milosevic ◽

Marko Ilic ◽

Sladjana Matic ◽

Dejan Tabakovic ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Clinical Results ◽

Tendon Injury ◽

Duration Of Treatment ◽

Early Recovery ◽

Aofas Score ◽

First Choice ◽

The Difference

Introduction/Objective. When choosing the appropriate treatment for Achilles tendon rupture, there may be a dilemma when choosing the optimal treatment. The objective of this study was analyzing groups of patients with acute closed Achilles tendon injury, comparing early recovery and functional parameters in relation to treatment and first choice treatment suggestion. Methods. The prospective study included 80 patients with acute Achilles tendon rupture. The treatment was surgery or immobilization. Results. There is a difference in the mechanism of injury between surgically and non-surgically treated (p = 0.026). In total, 50 (62.5%) patients were operated and 30 (37.5%) patients were treated with circular plaster. The difference (p = 0.000) between the groups in the duration of treatment, The American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale of pain (VAS) was shown. Patients undergoing surgery in the first two days had better clinical results in terms of The Achilles tendon Total Rupture score (ATRS), AOFAS and VAS. Higher satisfaction was achieved in younger people (p = 0.036). Patients whose treatment lasted shorter were more satisfied with their status (p = 0.001). ATRS and AOFAS score are higher in patients who are more satisfied with their own status (ATRS p = 0.301; AOFAS score p = 0.001). Six months after the treatment, 78.75% (63/80) of patients were fully functional. Conclusion. The therapy of choice in the treatment of acute Achilles tendon rupture is surgical, as surgical treatment is shorter; rehabilitation is faster and shorter, and the total costs associated with treatment and absence from work are lower.

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Degenerative tendoachilles tear repaired and augumented by peroneous brevis tendon by dynamic loop technique one year follow up

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202686 ◽

2020 ◽

Vol 6 (4) ◽

pp. 788

Author(s):

K. Vijaya Bhaskar Reddy ◽

Narsimha Lavudi

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Age Groups ◽

Clinical Results ◽

Suture Technique ◽

Common Symptom ◽

Peroneus Brevis ◽

One Year

Background: Repair of degenerative rupture of tendoachilles is a challenge for orthopaedician. We used peroneus brevis tendon in our patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop.Methods: In our study, we evaluated 31 patients with Achilles tendon rupture treated by reconstruction using peroneus brevis tendon transfer by dynamic loop suture technique. The patients were from all age groups excluding those lesser than 35 years. The average follow-up being 6 months.Results: In total 31 patient’s majority of patients belong to 41-50 years (15 cases 48.4%). Male patients being 24 (77.4%) constituted the majority, right sided injury was noted in 23 (74.2%) of the patients. Most common symptom of Achilles tendon rupture is pain. The mechanism of injury in most of the patients by stumbling in the fields in 19 (61.3%). Results of testing the patient’s ability to heel raise for 60 seconds 20 patients were able to sustain, while 8 patients were able to stand on toe with heel raised but could not sustain it. 3 patients could not do raise the heel. 5 patients complained of sensory hypoesthesia at 12 months follow-up. By Rupp scoring, 77% patients had excellent or good results and 10% had fair or poor results.Conclusions: Results of reconstruction of Achilles tendon ruptures using peroneus brevis tendon show a strong and stable repair that allows early weightbearing ambulation with favourable clinical results in most patients.

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Management of commode injuries of Achilles tendon: a newly established tertiary care hospital-based study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205571 ◽

2020 ◽

Vol 7 (1) ◽

pp. 116

Author(s):

Wajahat Ahmad Mir ◽

Javaid Ahmad Ganaie ◽

Rasiq Rashid ◽

Imran Khan ◽

Ab Hai Qureshi

Keyword(s):

Achilles Tendon ◽

Primary Repair ◽

Tertiary Care ◽

Tendon Injury ◽

The Body ◽

Care Hospital ◽

Superficial Infection ◽

Body Sensation ◽

Early Primary

Background: The Achilles tendon is the largest and strongest tendon in the body, formed by the union of gastrocnemius and soleus. Despite its strength, the Achilles tendon is vulnerable to injury, due to its subcutaneous position and the high tensions placed on it. Common mode of Achilles tendon injury nowadays in India is slipping of the foot in Indian type of commode and is often fraught with complications due to the potential contamination of wound at the time of injury. The purpose of this study was to assess the clinical outcome and complications of open Achilles tendon injury with an Indian type commode.Methods: 30 patients who presented with open Achilles tendon injury between the ages of 10 to 55 years were included. All the patients were treated with emergency debridement, thorough washing and primary repair within 24 hours using Krackow technique.Results: Out of the 30 patients meeting the inclusion criteria, there was 1 case of superficial infection which resolved with antibiotics and serial dressings. Foreign body sensation was present in 3 patients at final follow-up. Hypertrophic scar formation was seen in one patient. There were no cases of re-rupture in our study. Mean ROM at ankle in saggital plane at final follow-up was 66.13 degrees.Conclusions: Commode injury is the most common cause of open Achilles tendon injury in Indian population. The complications can be minimized by early primary repair and should only be undertaken after thorough washing and debridement under proper antibiotic cover to contain the infection.

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Rehabilitation after surgical repair of acute Achilles tendon rupture: Functional outcome with a Follow-Up of 6 months.

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2020.09.003 ◽

2020 ◽

Author(s):

Anna E. Röell ◽

Tim K. Timmers ◽

Denise J.C. van der Ven ◽

Ger D.J. van Olden

Keyword(s):

Achilles Tendon ◽

Functional Outcome ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture

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

Foot & Ankle Orthopaedics ◽

10.1177/24730114211003541 ◽

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.

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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

Foot & Ankle International ◽

10.1177/1071100716666365 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1333-1342 ◽

Cited By ~ 4

Author(s):

Prashant N. Gedam ◽

Faizaan M. Rushnaiwala

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Wound Complication ◽

Reconstruction Technique ◽

Level Of Evidence ◽

Invasive Approach ◽

Perioperative Morbidity ◽

The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

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Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000112 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Daniel Baumfeld ◽

Fernando Raduan ◽

Caio Nery ◽

Benjamim Macedo ◽

Thiago Silva ◽

...

Keyword(s):

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Case Series ◽

Invasive Technique ◽

Flexor Hallucis Longus ◽

Open Procedure ◽

Wound Healing Problems ◽

Major Increase ◽

Chronic Injuries

Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.

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Achilles Tendon Ruptures: Comparison between the Clinical Results of Classical Versus Mini-Invasive or Percutaneous Surgical Treatment

ARS Medica Tomitana ◽

10.2478/arsm-2014-0024 ◽

2015 ◽

Vol 20 (3) ◽

pp. 135-138

Author(s):

Obada B. ◽

Serban Al. O.

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Functional Results ◽

Clinical Results ◽

Needle Insertion ◽

Invasive Technique ◽

Percutaneous Technique ◽

Degree Of Satisfaction ◽

Invasive Techniques

Abstract The aim of the study is to evaluate the surgical treatment comparing the results obtained with different techniques. We revised 68 cases with acute Achilles tendon rupture who underwent surgical correction between 2004 and 2011, with a 40 month average follow-up. 34 of these were submitted to a classical open repair using the Kessler or Krakow technique, 25 to a mini-invasive technique (Achilon) and 9 to a percutaneous technique (Tenolig). We report a 29% rate of complications when using the classical technique: the major complications were one re-rupture, two surgical wound dehiscences, one infection and one sural nerve injury. In the mini-invasive/percutaneous techniques, two re-ruptures occurred (5.9% total, one in each technique) and one fistula at the needle insertion location. In regards to the percutaneous and mini-invasive techniques, the functional results and degree of satisfaction were higher, with fewer complications, reflecting a trend that has been expressed in the international literature.

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