Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery

Abstract

Purpose Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique. Methods Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment. Results All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10-100 N load followed by additional 250 cycles of 10-200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20-400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509-1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006). Conclusions The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases. Level of evidence III

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

“…In group B, there was one case of Achilles tendon re-rupture (Table 2). The same results have also been reported by Bąkowski et al that patients who underwent traditional open techniques might be associated with a higher risk to develop the necrosis of skin and infection 10 . Furthermore, the pressure caused by the shortened Achilles tendon will act on the incision surface of conventional open operation, which may affect the healing of the incision, and increase the incidence of Achilles tendon exposure.…”

“…However, a 10-15cm longitudinal, slightly curved central skin incision would be created to operate the surgery, which will lead to severe trauma and a long postoperative scar on the skin of the posterior leg undoubtedly. On the other hand, various types of minimally invasive surgical approaches have been reported by many researchers for the treatment of NATR with good functional recovery and fewer complications 10,11 . Mafulli N and Piontek T et al also asserted that minimally invasive techniques may be advantageous compared with conventional open techniques since the latter is associated with a higher rate of postoperative infection 12,13 .…”

Clinical Evaluation of a Minimally Invasive Technique Using a Free Semitendinosus Tendon Graft for Reconstruction of a Chronic Achilles Tendon Tear With Wide Gap

“…Bąkowski and colleagues performed biomechanical tests on reconstructed cadaveric Achilles tendons with the minimally invasive endoscopic technique using the hamstring tendon and showed encouraging results. All of the tested Achilles cadaveric specimens survived 2 loading blocks, that is, 250 cycles of 10 to 00 N load, followed by an additional 250 cycles of 10 to 200 N load 24…”

A comprehensive evaluation of minimally invasive Achilles tendon reconstruction with hamstring graft indicates satisfactory long-term outcomes

“…In our recent research we have shown that a minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization allows for good functional recovery [5,6]. As a logical consequence, the primary goal of the present study was to use a holistic approach for a comprehensive evaluation of Achilles tendon reconstruction results on multiple levels: clinical, functional and isokinetic.…”