Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures

Rozis, Meletis; Benetos, Ioannis S.; Karampinas, Panagiotis Κ.; Polyzois, Vasilios D.; Vlamis, John; Pneumaticos, Spiros G.

doi:10.1177/1071100718757971

Cited by 45 publications

(40 citation statements)

References 21 publications

(26 reference statements)

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“…In patients with Achilles tendon rupture, bundle-to-bundle suturing is the most effective surgical method to restore the anatomical structure and physiological characteristics of the tendon [ 4 – 6 ]. Open repair enables direct repair of the rupture site and achievement of maximum mechanical stability [ 4 – 7 , 22 ]; however, the complex sutures used in the modified Bunnell suture technique can form a fiber block of the Achilles tendon that may result in keloid formation and tendon shortening [ 7 , 12 , 23 – 26 ]. Open repair also reportedly causes scar contracture of the Achilles tendon [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years

Liu

luo

et al. 2020

BMC Musculoskelet Disord

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Background This study aimed to compare the operative outcome of percutaneous repair (modified Bunnell suture technique) versus open repair (bundle-to-bundle suture technique) of acute Achilles tendon rupture. Methods Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated in this prospective study. Thirty-six patients were treated using the bundle-to-bundle suture technique (group A), and 36 patients were treated using the modified Bunnell suture technique (group B). All patients underwent functional examination comprising measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides on magnetic resonance imaging. The number of single-leg heel rises (height > 5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome at 12 months postoperatively. Results A total of 61 patients were followed up. The mean follow-up duration did not significantly differ between group A (23.73 ± 2.81 months) and group B (22.61 ± 3.96 months). However, there were significant differences between groups in the heel-rise test (group A, 1.74 ± 0.96; group B, 2.37 ± 1.42) and length of the Achilles tendon (group A, 11.98 ± 1.64 cm; group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in group A than in group B ( p = 0.043). The cross-sectional diameter of the Achilles tendon was significantly smaller in group A than group B. At final follow-up, there were no significant differences between the two groups in the ATRS, AOFAS score, or VAS score. One patient in group A had delayed wound healing, which resolved in 40 days. Conclusions Patients with acute Achilles tendon rupture treated with open repair (bundle-to-bundle suture technique) achieved a better clinical outcome regarding the heel-rise test and calf circumference compared with those treated with percutaneous repair (modified Bunnell suture technique). Trial registration Chinese Clinical Trial Registry, ChiCTR2000035229 , 8/4/2020, Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years

Liu

luo

et al. 2020

BMC Musculoskelet Disord

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“…This technique of endoscopically assisted repair is not novel to our series and has been reported in previous studies with favorable results. 3,10,30,31 Halasi et al 11 reported a large series of percutaneous repairs with and without endoscopic control and had fewer reruptures in the endoscopic group, thus concluding that this technique allows for a more thorough evaluation of tendon apposition after repair. 10 Though reasonable, we do not routinely do this with our technique.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Carpenter¹,

Dederer

Weinhold

et al. 2020

Foot & Ankle Orthopaedics

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Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

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“…32 Although there were favorable results of percutaneous Achilles repairs in the literature with lower wound complications compared with open approaches, there were concerns of tendon rerupture (8%) from not being able to directly visualize the Achilles repair and sural nerve injury (13%). 12,26,48 In 1995, Kakiuchi and colleagues adapted their percutaneous repair by adding a mini-open incision to place their twisted K-wire suture guide. 23 Majewski and colleagues described using a 1.5-cm accessory lateral incision at the level of the Achilles rupture to retract the subcutaneous tissues and sural nerve.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

et al. 2020

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Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

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Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures

Abstract: Level II, prospective case series.

Cited by 45 publications

References 21 publications

Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years

Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years

Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

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