Endoscopic “internal splinting” repair technique for acute Achilles tendon rupture

Wei, Shijun; Chen, Jia; Kong, Changwang; Xu, Feng; Zhi, Xiaosong; Cai, Xianhua

doi:10.1007/s00402-021-03818-y

Cited by 6 publications

(13 citation statements)

References 29 publications

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“…In our opinion, the endoscopic-assisted "suturebridge" repair method could preserve the paratenon space, which is beneficial to the regeneration of the tendon fibers. 14,15 In addition, the average age was slightly older in Group 1. Elongation of the paired tendon was observed in these patients due to the larger resting angle at the final follow-up.…”

Section: The Correlation Between Regeneration and Coaptationmentioning

confidence: 90%

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Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair

Wu,

Dong,

Dong

et al. 2023

Orthopaedic Surgery

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ObjectiveWhen the endoscopic Achilles tendon repair technique is utilized, direct stitching of the ruptured site is challenging due to the frayed tendon stumps. To explore whether undesirable coaptation of the tendon stumps influences the generation of the tendons.MethodsThis study is a retrospective analysis of 46 patients who underwent a modified endoscopic Achilles tendon rupture repair from October 2018 to June 2020. Patients were divided into two groups according to the coaptation of tendon stumps on postoperative ultrasonography. Group 1 included 17 cases with undesirable coaptation (<50%), and Group 2 included 29 cases with appropriate coaptation (≥50%). Magnetic resonance imaging (MRI) was obtained postoperatively at 3, 6, and 12 months to evaluate the tendon morphological construction. Clinical evaluations were performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hind foot score, the Achilles Tendon Total Rupture Score (ATRS), muscle power, and the Achilles tendon resting angle at the final follow‐up. Complications were also encountered. The Student's t‐test and the Mann–Whitney U‐test were used to assess differences among both groups.ResultsThe mean follow‐up time was 37.5 ± 10.6 months in Group 1 and 39.0 ± 11.6 months in Group 2, respectively. The average age in Group 1 is slightly older than in Group 2 (37.3 ± 6.1 vs. 32.7 ± 6.3, p = 0.021). The tendon cross‐section areas and thickness increased initially and decreased later on postoperative MRI evaluation. It also showed a significantly higher signal/noise quotient (SNQ) in Group 1 at postoperative 3 months. At postoperative 6 and 12 months, the SNQ between both groups was similar. The AOFAS score (95.9 ± 5.1 vs. 96.2 ± 4.9, p = 0.832), ATRS score (97.0 ± 3.6 vs. 97.7 ± 3.3, p = 0.527), and muscle power (21.38 vs. 24.74, p = 0.287) were not significantly different between both groups. However, the resting angle of Group 1 was significantly larger than that of Group 2 (4.6 ± 2.4 vs. 2.4 ± 2.3, p = 0.004). There was no difference in the complications (p = 0.628).ConclusionAlthough complete regeneration can be finally achieved, the early stage of tendon stump regeneration can be prolonged due to undesirable coaptation when endoscopic Achilles tendon repair technique is applied. The prolonged high signal duration on MRI indicates the less‐than‐ideal regeneration of the tendon, which might lead to elongation of the tendon.

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Section: The Correlation Between Regeneration and Coaptationmentioning

confidence: 90%

“…However, most minimally invasive repair procedures do not involve direct suturing at the ruptured site. The frayed tendon stumps are difficult to stitch when the endoscopic‐assisted repair technique is applied 14,15 . There is debate about the strength of the repaired site following minimally invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair

Wu,

Dong,

Dong

et al. 2023

Orthopaedic Surgery

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“…To avoid soft tissue complications, a wide variety of minimally invasive repair techniques including percutaneous and endoscopic assisted procedures have been developed [21-23] [24] . In fact, when endoscopic assisted repair technique was used, direct stitch of the ruptured site is very di cult to perform due to the tendon stumps being frayed, horsetail shape [13,14] .…”

Section: Discussionmentioning

confidence: 99%

“…The modi ed endoscopic assisted "Krackow" stitch and "suture-bridge" technique was performed for the acute Achilles tendon rupture repair, which was previously described by Wei, et al [13,14] . The patient was placed in a prone position under epidural anesthesia with a well-padded pneumatic tourniquet applied at the upper thigh.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Is there a Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair?

Dong

Li³

et al. 2023

Preprint

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Background Direct stitch of the ruptured site is very difficult to perform due to the frayed tendon stumps when endoscopic Achilles tendon repair technique is utilized. There is little known about whether undesirable coaptation of the tendon stumps affect the regeneration of tendons. Methods A retrospective analysis of 46 patients who underwent a modified endoscopic Achilles tendon rupture repair from October 2018 to June 2020. Patients were divided into 2 groups according to the coaptation of tendon stumps on postoperative ultrasonography. 17 cases in group 1 with undesirable coaptation(<50%) and 29 cases in group 2 with appropriate coaptation(≥ 50%). Magnetic resonance imaging (MRI) was obtained at postoperative 3, 6 and 12 months to evaluate the tendon morphological construction. Clinical evaluations were performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, Achilles Tendon Total Rupture Score (ATRS), muscle power, and Achilles tendon resting angle at the final follow-up. Complications were also encountered. Results The mean follow-up time was 37.5 ± 10.6 months in group 1 and 39.0 ± 11.6 months in group 2, respectively. The average age in group 1 is slightly older than that of group 2 (37.3 ± 6.1 vs 32.7 ± 6.3, P = 0.021). The tendon cross-section areas and thickness increased initially and decreased later on postoperative MRI evaluation. It also showed a significant higher signal/noise quotient (SNQ) in group 1 at postoperative 3 months. At postoperative 6 and 12 months, the SNQ between both groups was similar. The AOFAS score (95.9 ± 5.1 vs 96.2 ± 4.9, P = 0.832), ATRS score (97.0 ± 3.6 vs 97.7 ± 3.3, P = 0.527), and muscle power (21.38 vs 24.74, P = 0.287) were not significantly different between both groups. However, the resting angle of group 1 was significantly larger than that of group 2 (4.6 ± 2.4 vs 2.4 ± 2.3, P = 0.004). There was no difference in the complications (P = 0.628). Conclusions There is no obvious correlation between coaptation and regeneration of tendon stumps when endoscopic Achilles tendon repair technique is applied. However, older patients could possibly have a separation of tendon stumps, resulting in an elongation of the tendon.

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All‐inside endoscopic semiautomatic running locked stitch technique shows favourable outcomes for acute Achilles tendon ruptures

Wei,

Li,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe safety and reliability of endoscopic Achilles tendon rupture repair are still concerning aspects. This study's aim is to evaluate an all‐inside endoscopic semiautomatic running locked stitch (Endo‐SARLS) technique.MethodsForty cases with acute Achilles tendon rupture were treated with the all‐inside Endo‐SARLS technique between 2020 and 2021. Under endoscopic control, the proximal tendon stumps were stitched with the running locked method using a semiautomatic flexible suture passer. The threads of the high‐strength suture were grasped through the paratenon subspace and then fixed into calcaneal insertion with a knotless anchor. Magnetic resonance imaging (MRI), surgical time and complications were assessed. Achilles Tendon Total Rupture Score (ATRS), Achilles Tendon Resting Angle (ATRA) and Heel Rise Height Scale (HRHS) were utilised to evaluate final outcomes.ResultsThe average follow‐up time was 25.4 ± 0.4 (range: 24–32) months. Appropriate tendon regeneration was observed on MRI after 12 months. At the final follow‐up, the median value of ATRS score was 95 (interquartile range: 94, 98). Furthermore, there is no significant difference between the injured and contralateral side in the average ATRA (18.2 ± 1.8 vs. 18.3 ± 1.9°, ns) and median value of HRHS [14.5 (13.3, 15.5) vs. 14.8 (13.5, 15.6) cm, ns]. No infection and nerve injuries were encountered. Thirty‐nine patients reported that they resumed casual sports activity after 6 months. One patient had a slight anchor cut‐out, due to an addition injury, which was removed after 5 months.ConclusionsAn all‐inside Endo‐SARLS technique showed promising clinical results for acute Achilles tendon ruptures. This procedure reduces the risk of sural nerve injuries while establishing a reliable connection between the tendon stumps.Level of EvidenceLevel IV.

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Endoscopic “internal splinting” repair technique for acute Achilles tendon rupture

Cited by 6 publications

References 29 publications

Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair

Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair

Is there a Correlation between the Coaptation and Regeneration of Tendon Stumps in Endoscopic Assisted Achilles Tendon Rupture Repair?

All‐inside endoscopic semiautomatic running locked stitch technique shows favourable outcomes for acute Achilles tendon ruptures

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