PO 18150 - Comparison between the open and minimally invasive repair techniques in acute Achilles tendon injuries

Objective: Our study compares the functional outcomes of patients who underwent open repair of the Achilles tendon with those of patients treated with the minimally invasive technique using the percutaneous Achilles repair system (PARS) over a 1-year minimum follow-up period and presents the complication rates for the 2 techniques. Methods: Between 2011 and 2016, 31 patients were reviewed; of these, 20 were included in the study (10 PARS X 10 open repair technique). Patients with chronic Achilles tendon rupture, insertional or bilateral, and patients with a history of surgery or previous ankle pathology that could mask functional outcomes were excluded from the study. The open repair technique was performed via a posteromedial incision to the ankle to repair the tendon and was combined with myotendinous transfer of the flexor hallucis longus tendon, which was fixed with a Biotenodesis screw. The minimally invasive technique was performed using the PARS of the company Arthrex through a small transverse incision at the site of the Achilles tendon rupture. Functional outcomes and complications were collected after at least 1 year of follow-up. Results: Both groups had similar American Orthopedic Foot and Ankle Society (AOFAS) scores (PARS: 95.3±5.1, open: 96.5±5.1; p=0.604), demonstrating similar functional outcomes. The PARS group had a higher number of complications than the open repair group (PARS: 20% x open: 10%), but the difference was not significant (p=0.383). Conclusion: For the treatment of acute Achilles tendon injuries, the PARS and open repair techniques had similar functional outcomes after 1 year of follow-up.

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Clinical Outcomes in Patients With Minimally Invasive Surgical Approach Combined With Plantar Tendon Transfer Repairing Neglected Achilles Tendon Rupture Compared to the Conventional Approach of V-Y Tendon Plasty: A Retrospective Study With Two Years Follow-Up

10.21203/rs.3.rs-228491/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Kai Liu ◽

Yanshi Liu ◽

Biao Luo ◽

Pengfei Li ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Neglected Achilles Tendon Rupture ◽

Group A ◽

Group B

Abstract Background Unlike acute Achilles tendon rupture (AATR), neglected Achilles tendon rupture (NATR) requires usually tendon grafting procedures for repair tendon defects caused by removing scar tissue. The conventional open surgery of V-Y tendon plasty and minimally invasive technique with plantar tendon transfer had been described, but the long-term efficacy between the two techniques still needs further certification. Methods Between February 1, 2008, and July 31, 2018. All of 46 patients with neglected Achilles tendon rupture, 25 patients in group A (21 males and 4 females; age, 34.28 ± 6.97 years) underwent the conventional operation of V-Y tendon plasty, and 21 patients in group B (14 males and 7 females; age, 35.29 ± 7.42 years) were treated by the minimally invasive technique. Two years follow-up was performed for the functional recovery with examinations of the Achilles tendon rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hind-Foot Scale Score, dorsiflexion, calf circumference, and heel raise test. Results Patient characteristics between the two groups were similar. The functional score of ATRS and AOFAS in Group B was higher than patients in group A at postoperative months 3, 6, and 12, while there is no difference at month 24. In group A, there were three patients exposed to soft tissue infections (two superficial infections and one deep infection) and one case with tendon exposure. In group B, a patient with tendon re-rupture was observed. There was no difference in dorsiflexion and calf circumference at follow-up two years and the much better recovery in heel raise test group B than A. Conclusions Two different techniques produced a significant functional improvement, and return to sports. However, this study demonstrated that the minimally invasive technique was recommended for patients with a tendon defect less than 6 cm and who have an urgent demand to return to the sports.

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Reconstruction of Kuwada grade IV chronic achilles tendon rupture by minimally invasive technique

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00347 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0034

Author(s):

Xu-dong Miao ◽

Le Cao

Keyword(s):

Wound Healing ◽

Retrospective Study ◽

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Minimally Invasive Technique ◽

Cystic Degeneration ◽

Invasive Technique

Category: Trauma Introduction/Purpose: Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. Methods: 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. 32 were followed up for a mean 32.2 months (range 18-72 months), whereas 3 were lost to follow-up. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. Results: Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last follow-up. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were statistically significant differences. The result of the total excellent and good rate was 93.8% (30/32). MRI of Achilles tendon showed even signal without evidence of tear or cystic degeneration. Conclusion: Reconstruction of a chronic Achilles tendon rupture with an FHL tendon harvested using a minimally invasive technique showed good outcomes.

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A New Minimally Invasive Technique for Repairing Achilles Tendon Rupture:A Biomechanical Study

10.1101/642520 ◽

2019 ◽

Author(s):

Peng zhao ◽

Dawei Sun ◽

Yaru Xiong ◽

Ribo Zhuo

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Research Group ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Biomechanical Study ◽

New Technique ◽

Invasive Technique ◽

Invasive Treatment ◽

Cyclical Loading

AbstractIntroductionThe incidence of Achilles tendon rupture shows a gradually increasing trend, which is mainly managed by minimally invasive treatment due to its advantages, such as low wound infection rate. At present, the firmness of the commonly applied minimally invasive suture method for Achilles tendon remains controversial. Our research group has developed a novel suture method for Achilles tendon, which has achieved favorable clinical outcomes. Therefore, this experiment aimed to explore the optimal approach to repair Achilles tendon rupture through comparing the biomechanical strength of the commonly used Achilles tendon suture methods currently.Materials and methods6 fresh frozen human cadaveric Achilles tendon specimens were sutured by three kinds of technique, and were tested through the cyclical loading after repair.ResultsResults of cyclical loading showed that, the repair using the new technique was stronger after 10 cycles, 1000 cycles, and rupture. Moreover, the new technique had displayed superior anti-deformation strength to that of the Ma-Griffith technique.ConclusionsOur experimental results demonstrate that, the new technique proposed by our research group can attain comparable biomechanical properties to those of the Krachow technique. However, the sample size in this study is small, and further clinical trials are warranted.

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Achilles tendon repair by a minimally invasive technique using Tenolig®

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1194 ◽

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.

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Functional Outcomes Of Primary Open Repair With Augmentation And Without Augmentation In Achilles Tendon Rupture

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000486342.99784.58 ◽

2016 ◽

Vol 48 ◽

pp. 446

Author(s):

YILMAZ ERGISI ◽

GULCAN HARPUT ◽

BURAK ULUSOY ◽

HAKAN SELEK ◽

HAMZA OZER ◽

...

Keyword(s):

Achilles Tendon ◽

Functional Outcomes ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture

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Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04802-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yong Li ◽

Qiang Jiang ◽

Hua Chen ◽

Hongkui Xin ◽

Qing He ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Control Group ◽

Repair System ◽

Percutaneous Repair ◽

Repair Group ◽

Mini Open

Abstract Background To reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture. Methods From January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated. Results The mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000). Conclusions Acute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy. Study design Case-control studies, Level of evidence, 3.

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Outcomes of Limited Open Achilles Repair Using Modified Ring Foreceps

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000389 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Jessica Telleria ◽

Jeremy Smith ◽

Lauren Ready ◽

Eric Bluman

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Functional Outcomes ◽

Achilles Tendon Rupture ◽

Attractive Alternative ◽

Functional Level ◽

Superficial Infection ◽

Absorbable Sutures ◽

Clinical Records

Category: Sports Introduction/Purpose: Acute Achilles tendon ruptures have a 2.4-4.7% rate of infection and wound healing complications when treated operatively. The incidence doubles in those with risk factors such as diabetes, smoking or steroid use. To diminish complications minimally invasive approaches have received increasing interest. Meta-analyses have demonstrated equivalent rerupture rates, significantly lower risk of superficial infection, and higher patient satisfaction rates with minimally invasive repairs compared with traditional open Achilles repair techniques. We have previously published a novel technique for limited open Achilles repair using modified ring forceps. The objective of the present study is to review the clinical outcomes of this technique, and to analyze functional results using validated outcomes measures. Methods: Between 2009 and 2016, the clinical records of 29 consecutive patients (average age 45 years [range, 21-76 years], 24 males [83%]) who underwent limited-open repair of an acute Achilles tendon rupture with modified ring forceps were retrospectively reviewed. Through a 2.5-3 cm midline incision a pair of ring forceps bent 30 degrees were used to grasp the tendon stumps deep to paratenon. Three #2 non-absorbable sutures were placed in the proximal and distal segments and delivered out of the wound. The tendon ends were reapproximated and the sutures tied down to secure the tendon. At a minimum of 6 months follow-up the 10-cm Visual Analog Scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sports Assessment – Achilles (VISA-A) were assessed. Results: At final follow-up (average 43.5 months[range, 5.7-90.1]) 28 of 29 patients reported no pain in their Achilles with an average Achilles VAS of 0.8 out of 100(SD±4.5). The average post-operative VISA-A score was 87.9 out of 100(SD±13.2). The average FAAM Activities of Daily Living and Sports subscales were 96.4%(SD±5.5) and 85.1%(SD±21.3), respectively. Post- operatively patients reported their overall functional level was 94.2% of their pre-injury level when performing ADLs, and 80.1% when participating in sports. Seventeen of 29 patients(58.6%) rated their current functional level as “normal,” nine(31.0%) as “nearly normal,” three(10.3%) as “abnormal,” and none as “severely abnormal.” There was one case of superficial wound infection that resolved with oral antibiotics and local wound care; there were no cases of deep infection, sural neuritis or rerupture. Conclusion: These results demonstrate that limited-open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief and good functional outcomes at mid-term follow-up. Additionally, this is one of the first studies to report validated Achilles specific outcomes(VISA-A) in the setting of acute repair. The wide age range, and subsequent variability in elective sport involvement, may have differentially lowered the sports-related functional outcomes in this study. The complication rate was extremely low making it an attractive alternative to traditional open techniques. Furthermore, this technique is easy to learn and cost-effective without the requirement of commercially available single-use kits.

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Minimally Invasive Knotless-Bridge Suture Technique for Acute Achilles Tendon Rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00385 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Zhongmin Shi ◽

Xiaokang Wang

Keyword(s):

Minimally Invasive ◽

Return To Work ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Suture Technique ◽

Calf Circumference ◽

Aofas Score ◽

Superficial Infection

Category: Hindfoot Introduction/Purpose: To investigate the clinical effect of minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture. Methods: Totally 23 cases of acute achilles tendon rupture were treated from August 2016 to December 2016 including 21 cases of males and 2 cases of females with an average age of 42.1 years-old (from 29-51 years). Mini-invasive knotless-bridge suture technique was performed in all cases until the soft tissue condition improved. Ankle range of motion, calf circumference difference between two lower extrenities, number of repetions for single heel-rise in one minute, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Achilles Tendon Total Rupture Score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during follow-up. Results: 23 cases were followed for an average of 28 months . At last follow-up, the average ankle ROM was 60.3±2.2°, calf circumference difference between two lower extrenities was 92.7±1.8%, number of repetions for single heel-rise in one minute was 25±2, AOFAS score was 91.5±2.2, ATRS score was 92.6±2.4, time to return to work ranged from 6 to 9 weeks, averaging 7 weeks.Wound was sutured in one stage and united in one stage.No skin necrosis, superficial infection, sural nerve injury occurred.No achilles tendon re-rupture was seen during follow-up. Conclusion: Minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture is operated easily and lesser-trama, enabling patients to return to work earlier and proved to be an effective treatment.

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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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