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

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.

Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches

“…This evidence discourages the extensive use of such techniques and has led to the search for new methods to reduce the risk. In percutaneous surgery, the risk has been reduced by exposing the SN through small incisions [ 22 , 26 ] or through the identification of the trajectory of the SN using US mapping [ 11 ] or intraoperative US support [ 8 , 32 , 48 ]. In addition, open surgery has a lower risk of SN injury versus MIS [ 13 , 27 ].…”

“…Proximal zones and points may be useful in revision surgery or chronic Achilles tendon rupture surgery [ 16 , 31 , 41 , 44 ] or in some Achilles tendon lengthening techniques [ 7 , 10 , 19 , 41 ]. The central zones may be useful in acute Achilles pathology surgeries [ 12 , 22 , 35 , 47 ] and distal zones in arthroscopic surgeries [ 2 , 23 , 34 ] or ankle fractures [ 18 , 29 , 33 ]. This new reference line can be easily reproduced intraoperatively (using suture or electric scalpel wire) by the surgeon when planning the approach.…”

Results of Percutaneous Sutures Technique in the Treatment of Achilles Tendon Ruptures

“…In the Li et al (26) study, 14.7% of cases had sural nerve injury. The sural nerve injury caused by this method may be mainly attributed to the nerve not being fully exposed during the operation and the suture needle being placed blindly, hence the risk of a direct puncture injury to the nerve.…”

Achilles Tendon Ruptures: Limited Incision Repair

“…However, further research reported less favorable results 15–17 . By now, several attempts have been made to increase the safety of the procedure by modifying and reinforcing the original technique 15,18–20 .…”

“…7 However, further research reported less favorable results. [15][16][17] By now, several attempts have been made to increase the safety of the procedure by modifying and reinforcing the original technique. 15,[18][19][20] Moreover, real-time intraoperative ultrasonography has been introduced to improve suture positioning and confirm stump approximation.…”