Endoscopic-assisted locking block modified Krackow technique combined with a V-Y flap for chronic Achilles tendon rupture

Abstract

PurposeThe purpose of this study was to evaluate the clinical outcomes of the endoscopic‐assisted locking block modified Krackow technique with a V‐Y flap. The hypothesis was that the minimally invasive technique can reduce wound complications and facilitate early recovery. MethodsIn total, 29 men with chronic Achilles tendon rupture who underwent either minimally invasive technique (n = 13) or open repair (n = 16) at our department between 2013 and 2019 were retrospectively analyzed. The rate of complications, time to return to moderate‐intensity exercise, American Orthopedic Foot and Ankle Society ankle hindfoot score, Achilles tendon Total Rupture Score, heel‐rise repetitions in 1 min, heel‐rise height, and bilateral calf circumference at 6 months, 1 year, and 2 years postoperatively were recorded. ResultsAll incisions healed primarily in the minimally invasive technique group; however, three patients in the open repair group experienced wound complications. The time to return to moderate‐intensity exercise, American Orthopedic Foot and Ankle Society score, Achilles tendon Total Rupture Score, heel‐rise repetition ratio, and heel‐rise height ratio at 6 months postoperatively in the minimally invasive technique group were significantly better than those in the open repair group. However, it was not significantly different between both groups at 2 years postoperatively. ConclusionEndoscopy allowed scar tissue and adhesions to be removed, allowing the tendon ends to be mobilized out of the small proximal and distal incisions. Minimally invasive technique may result in a lower wound complication incidence and provide better early functional recovery and return to moderate‐intensity exercise time than the conventional open procedure in treating chronic Achilles tendon ruptures. Clinical trial registrationWuxi Ninth People’s Hospital Medical Ethical Committee, LW2021026. Level of evidenceIII.

Effects of tendon elongation on plantar pressure and clinical outcomes: A comparative analysis between open repair and minimally invasive surgery

“…A recent animal study showed that the absence of the paratenon results in delayed formation of the tendon callus, decreased blood supply and a biomechanically weaker tendon [26]. It has been stated that even long incisions applied in open repair may impair tendon healing by decreasing blood supply [38]. An increase in the length of the tendon following acute ATR can affect various factors, including reduced tendon tension and heel-rise height, increased pennation angle, shorter fascicle length and weakness in plantar flexor power and pushoff mechanism [2,9,16,17,28].…”

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

“…However, studies focusing on the surgical management of CATR were reviewed, specifically those with evidence levels A to D. The researchers carefully analyzed the inclusion criteria of the identified studies to observe and determine the surgical indications for CATR. Following the above search strategy, 16 studies were included [33,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70], of which 1 study was grade A [56], 1 study was grade B [57], 6 studies were grade C [33,[58][59][60][61][62], and 8 studies were grade D [63][64][65][66][67][68][69][70]. The most common conditions for which surgical management is indicated were CATR patients exhibiting signs of functional limitation, such as pain or tenderness, inability to execute a single heel raise, or repetitive single-leg heel raise endurance exercises, as well as difficulty in walking and ascending stairs, along with ankle swelling; these symptoms were accompanied by positive results in the call squeeze and knee flexion [71], and their diagnoses were confirmed through MRI or ultrasound examinations (16 studies).…”