Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

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.

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Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

10.21203/rs.3.rs-16380/v2 ◽

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 small saphenous vein (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 American Orthopaedic Foot & Ankle Society (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 Achilles Tendon (AT) rupture.

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A comparative study of innovative percutaneous repair and open repair for acute Achilles tendon rupture: Innovative usage of intraoperative ultrasonography

Journal of Orthopaedic Surgery ◽

10.1177/2309499020910274 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902091027

Author(s):

Jeong-Kil Lee ◽

Chan Kang ◽

Deuk-Soo Hwang ◽

Dong-Hun Kang ◽

Gi-Soo Lee ◽

...

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Nerve Injury ◽

Sural Nerve ◽

Tendon Rupture ◽

Open Repair ◽

Achilles Tendon Rupture ◽

Operative Outcomes ◽

Athletic Ability ◽

Percutaneous Repair

Purpose: There is no definitive consensus on the optimal treatment of Achilles tendon rupture. We comparatively analyzed the clinical outcomes of two types of repair surgeries in treating Achilles tendon rupture. Methods: This retrospective study included 12 patients of Achilles tendon rupture (group A) treated with ultrasound-guided percutaneous repair and 18 patients (group B) treated with open repair. Clinical evaluation was performed using the Arner–Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, Achilles Tendon Total Rupture score (ATRS), visual analog scale, time to single heel raise, bilateral calf circumferences, recovery of athletic ability, and other complications. Results: While the Arner–Lindholm scale, AOFAS ankle–hindfoot score, ATRS, time point when single heel raise was possible, differences in bilateral calf circumference, and recovery of athletic ability compared to pre-rupture level were not significantly different between the two groups (p = 0.999, 0.235, 0.357, 0.645, 0.497, and 0.881, respectively), overall and aesthetic satisfaction levels were higher in the group treated with percutaneous repair under ultrasonography guidance (p = 0.035 and 0.001, respectively). Overall, there were no cases involving sural nerve injury in either group. Conclusion: Innovative percutaneous repair provides not only similar clinical outcomes but also greater overall and aesthetic satisfaction levels of operative outcomes and minimal complications (i.e. sural nerve injury) compared to open repair surgeries. Therefore, percutaneous repair may be a useful technique in the treatment of Achilles tendon rupture.

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Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture—A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10112370 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2370

Author(s):

Łukasz Paczesny ◽

Jan Zabrzyński ◽

Marcin Domżalski ◽

Maciej Gagat ◽

Miron Termanowski ◽

...

Keyword(s):

High Resolution ◽

Achilles Tendon ◽

Nerve Injury ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Long Term Results ◽

Sonographic Guidance

Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.

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A New Modification of Bosworth’s Technique to Repair Infectious Achilles Tendon Rupture

10.21203/rs.2.18598/v1 ◽

2019 ◽

Author(s):

Qipeng Wu ◽

Yuan Xiong ◽

Zhenhua Fang ◽

Junwen Wang ◽

Guohui Liu ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Achilles Tendon ◽

Nerve Injury ◽

Sural Nerve ◽

Skin Necrosis ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background The aim of this study was to assess radiographic and clinical outcomes of a new modified approach on the basis of Bosworth’s technique in the treatment of infectious Achilles tendon rupture (IATR). Materials and methods 15 patients (9 males and 6 females; 15 feet; average age of 38.3 years) were included in the study. After infection, the wounds were transferred to our department for treatment (Figure 1).Radiographic and clinical outcome in terms of the American Orthopaedic Foot&Ankle Society score (AOFAS), the Victorian institute of sports assessment Achilles (VISA-A), and the Achilles tendon total rupture score (ATRS) were investigated at 6 months, 12 months, and 24 months postoperatively. Results Preoperative AOFAS, VISA-A, and ATRS showed statistically significant improvement (p≤0.05) from35.03±6.81 (25-45), 21.04±8.17 (5-45), and 20.08±8.93 (6-55) to 90.04±5.32 (82-97), 95.11±3.09 (79-99), and 96.34±3.61 (89-97) at the last follow-up, respectively. All patients could lift heel on one foot and return to work at 12 to 16 weeks after operation (average 14.2 weeks). Overall, No complications such as infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon occurred at last follow-up. Conclusion The new modified approach of Bosworth’s technique provided powerful curative efficacy of infectious Achilles tendon rupture, without severe complications in terms of infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon. Level of Evidence: Level IV, case series.

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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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Clinical Outcomes and Ultrasonic Evaluation of Percutaneous Achilles Tendon Repair

10.21203/rs.3.rs-590571/v1 ◽

2021 ◽

Author(s):

Ben-Mao Liu ◽

Hung-Chou Chen ◽

Chen-Kun Liaw ◽

Chia-Hsien Chen ◽

Chih-Hwa Chen ◽

...

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Wound Complications ◽

Ultrasonic Evaluation ◽

Achilles Tendon Repair ◽

The Mean

Abstract BackgroundAchilles tendon rupture remains one of the most common tendon injuries in adult population. At present, randomized studies have failed to demonstrate the optimal management of Achilles tendon rupture. Wound complications have been significantly minimized since the emergence of percutaneous repairs when compared to traditional open methods. However, some studies suggested a higher incidence of rerupture rates and iatrogenic sural nerve injuries. The goal of this study was to present the clinical outcomes and ultrasonic evaluation of percutaneous Achilles tendon repair.MethodsBetween August 2015 and May 2018, 36 patients with an acute Achilles tendon rupture, treated in percutaneous repair, were studied retrospectively. American Orthopedic Foot and Ankle Society (AOFAS) score and the 10-point visual analogue scale (VAS) for pain questionnaires were sent to assess the clinical and functional outcomes. Ultrasonic evaluation was recorded using Möller grading system as an objective measurement.ResultsThe 25 male and 11 female (mean age 47.03 years) were clinically followed-up for a minimum of 12 months (average 28.97 months). No wound complications or reruptures occurred. Four(11.1%) patients reported sural nerve hypoesthesia and one of them required additional treatment. The mean AOFAS and VAS score was 92.6 and 1.8 respectively at the 12th postoperative month. Ultrasonic evaluation was performed at the average follow-up of 18.3 months and the mean points were 1.8. All treated tendons were healthily recovered and all patients were able to return to previous work or activities.ConclusionPercutaneous Achilles tendon repair offers good clinical outcome and no apparent increased risk of reruptures. The risk of iatrogenic sural nerve injury, however, remains the most occurred complication. Ultrasound can be used to visualize and examine the repaired tendon, which demonstrated satisfying healing process.

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Augmented Repair of Acute Achilles Tendon Ruptures

Foot & Ankle International ◽

10.1177/107110070002100603 ◽

2000 ◽

Vol 21 (6) ◽

pp. 469-474 ◽

Cited By ~ 22

Author(s):

Richard A. Zell ◽

Vincent M. Santoro

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Functional Recovery ◽

Sural Nerve ◽

Tendon Rupture ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Ankle Motion ◽

Tendon Ruptures ◽

Early Functional Recovery

Twenty-five patients who had an acute Achilles tendon rupture were managed with an augmented repair using the gastrocnemius-soleus fascia. All patients healed their repair and there were no re-ruptures. There was one infection. Augmented repair allowed early functional recovery as evidenced by full ankle motion by four to eight weeks, full unassisted weight bearing by three weeks, cessation of braces by four weeks, and return to work by one to six weeks post-operatively. Augmentation adds a sufficient amount of collagen to allow early range of motion and weight bearing without re-rupture. Disadvantages included a long incision, soft tissue prominence, one infection, and sural nerve injury.

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