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Huang X, Liu J, Jiang Y, Zhu H, Hu X, Wu K, Wang X, Zhang S. Peritendinous Submembrane Access Technique for Management of Acute Ruptures of the Achilles Tendon: A Retrospective Study of 249 Cases. Orthop Surg 2024; 16:1648-1656. [PMID: 38778391 PMCID: PMC11216843 DOI: 10.1111/os.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Percutaneous repair is an alternative to open surgical repair of the Achilles tendon with comparable, functional results and low re-rupture and infection rates; however, sural nerve injury is a known complication. The purpose of this study is to design a new surgical procedure, the minimally invasive peritendinous submembrane access technique (MIS-PSAT). It offers optimal results, with excellent functional outcomes, and with minimal soft tissue complications and sural nerve injury. METHODS This retrospective study included 249 patients with acute closed Achilles tendon ruptures treated at our institution between 2009 and 2019. All patients underwent MIS-PSAT at our institution and were followed up for 8-48 months. Functional evaluation was based on the Achilles tendon total rupture score (ATRS) and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS), associated with local complications and isokinetic tests. RESULTS None of the patients had infection, necrosis, or sural nerve injury. Re-rupture occurred in two cases. The average times to return to work and sports was 10.4 and 31.6 weeks, respectively. The average ATRS and AOFAS-AHS scores were 90.2 and 95.7, respectively, with an excellent rate of 99.5%. Isokinetic tests showed that ankle function on the affected side was comparable with that on the healthy side (p > 0.05). CONCLUSION The MIS-PSAT for acute Achilles tendon rupture is easy to perform with few complications. Importantly, the surgical technique reduces the risk of sural nerve injuries. Patients have high postoperative satisfaction, low re-rupture rates, and muscle strength, and endurance can be restored to levels similar to those on the healthy side.
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Affiliation(s)
- Xin Huang
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Jia‐Wei Liu
- Department of OrthopaedicsThe 943th Hospital of Joint Logistics Support force of PLAWu weiChina
| | - Yu Jiang
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Hong‐Wei Zhu
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Xing‐Xing Hu
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Ke‐Jian Wu
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Xiao‐Ning Wang
- Department of OrthopaedicsFourth Medical Center of PLA General HospitalBeijingChina
| | - Shuai Zhang
- Department of OrthopaedicsThe 969th Hospital of Joint Logistics Support Force of PLAHohhotChina
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Wang T, Wu W, Gu J, Hou R. Methods of Immobilization after Achilles Tendon Rupture Repair: A Comparative Study in Rat Model. Orthop Surg 2023; 15:2960-2965. [PMID: 37712211 PMCID: PMC10622275 DOI: 10.1111/os.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different immobilization methods' impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and K-wire to determine which is the most stable and has the fewest complications. METHODS Sixty rats aged 5-6 months were selected to establish Achilles tendon injury in two hind legs model. After suturing the ends of the AT together with a modified "Kessler" method (Prolene 5-0). The skin incision was interrupted and sutured with 1-0 thread. Rats were divided into three immobilization methods (plaster cast group, splint group, and K-wire group). In plaster cast group, the hind leg was cast with plaster in the extended position of the hip and knee joints, and the ankle joint was at 150°. Splint and K-wire group used splints and 0.8-mm K-wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chi-square test. RESULTS Within 4 weeks observation, K-wires showed better stability (90%) compared with the other two ways (40% in plaster cast group, 65% in splint group; p < 0.05). Rats immobilized with K-wires (10%) suffered significantly lower complications compared with plaster cast and splint group (15%; p < 0.05). CONCLUSION K-wire has better stability, lower complication rate than other methods. Immobilization with K-wire may be a promising tool in future clinical Achilles tendon rupture applications.
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Affiliation(s)
- Tianliang Wang
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
- Yangzhou UniversityYangzhouChina
| | - Wenjie Wu
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
| | - Jiaxiang Gu
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
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Shoap S, Backer HC, Freibott CE, Ferrer XE, Polzer H, Turner Vosseller J. Rerupture and wound complications following Achilles tendon repair: A systematic review. J Orthop Res 2023; 41:845-851. [PMID: 35864743 DOI: 10.1002/jor.25419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Despite the relatively high frequency of Achilles ruptures, there is no general consensus on the optimal treatment method. A general trend toward more patients being treated nonoperatively has emerged recently with the advent of functional rehabilitation. However, much of the recent data on this subject has been highly variable. This systematic review focused on Achilles tendon rupture (ATR) treatment outcomes, with a focus on rerupture and complication rates. This systematic review specifically focused on articles regarding ATR treatment that also included rerupture and complication rates. Treatments were divided into three categories: open minimally invasive, open standard, and nonoperative. Bivariate analyses were performed to compare complication and rerupture rates among pairs of treatment options, as well as between early weight bearing versus immobilization. There was significantly higher complications for minimally invasive compared to nonoperative treatment (risk ratio [RR] = 4.4154; p < 0.05), lower complication rates for minimally invasive compared to open treatment (RR = 0.3231; p < 0.05), and higher complications for open standard compared to nonoperative treatment (RR = 5.6350; p < 0.001). There were significantly lower rerupture rates in minimally invasive compared to nonoperative treatment (RR = 0.4085; p < 0.001), a significantly lower rerupture rate in nonoperative treatment compared to open treatment (RR = 0.2282; p < 0.001), and no significant difference in rerupture rates when comparing minimally invasive to open standard treatment. We found that operative treatment is associated with fewer reruptures and more complications than a nonoperative approach. Minimally invasive surgery appears to be associated with a lower rate of complications than open operative treatment.
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Affiliation(s)
- Seth Shoap
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida, USA
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Henrik C Backer
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Christina E Freibott
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Xavier E Ferrer
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Hans Polzer
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - James Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
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Attia AK, Mahmoud K, d'Hooghe P, Bariteau J, Labib SA, Myerson MS. Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2023; 51:825-836. [PMID: 34908499 DOI: 10.1177/03635465211053619] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An acute Achilles tendon rupture is one of the most common sports injuries, affecting 18 per 100,000 persons, and its operative repair has been evolving and increasing in frequency since the mid-1900s. Traditionally, open surgical repair has provided improved functional outcomes, reduced rerupture rates, and a quicker recovery and return to activities at the expense of increased wound complications such as infections and skin necrosis compared with nonoperative management. In 1977, Ma and Griffith introduced the percutaneous approach, and over the following decades, multiple improved techniques, and modifications thereof, have been described with comparable outcomes with open repair. PURPOSE The current study aimed to provide updated level 1 evidence comparing open repair with minimally invasive surgery (MIS) through a comprehensive search of the literature published in English, Arabic, Spanish, Portuguese, and German while avoiding limitations of previous studies such as heterogeneous study designs and a small number of included trials. STUDY DESIGN Meta-analysis; Level of evidence, 1. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases to identify randomized controlled trials (RCTs) comparing open repair and MIS of Achilles tendon ruptures. The primary outcomes were (1) functional outcomes, (2) reruptures, (3) sural nerve injuries, and (4) infections (deep/superficial), whereas the secondary outcomes were (1) skin complications, (2) adhesions, (3) other complications, (4) ankle range of motion, and (5) surgical time. RESULTS There were 10 RCTs that qualified for the meta-analysis with a total of 522 patients. Overall, 260 (49.8%) patients underwent open repair, while 262 (50.2%) underwent MIS. The mean postoperative AOFAS score was 94.8 and 95.7 for open repair and MIS, respectively, with a nonsignificant difference (mean difference [MD], -0.73 [95% CI, -1.70 to 0.25]; P = .14; I2 = 0%). The pooled mean total complication rate was 15.5% (0%-36.4%) for open repair and 10.4% (0%-45.5%) for MIS, with a nonsignificant statistical difference (odds ratio [OR], 1.50 [95% CI, 0.87-2.57]; P = .14; I2 = 40%). The mean rerupture rate was 2.5% (0%-6.8%) for open repair versus 1.5% (0%-4.6%) for MIS, with a nonsignificant statistical difference (OR, 1.56 [95% CI, 0.42-5.70]; P = .50; I2 = 0%). No cases of sural nerve injuries were reported in the open repair group. The mean sural nerve injury rate was 3.4% (0%-7.3%) in the MIS group, which was statistically significant (OR, 0.16 [95% CI, 0.03-0.46]; P = .02; I2 = 0%). The mean overall superficial infection rate was 6.0% (0%-18.2%) and 0.4% (0%-4.5%) for open repair and MIS, respectively, with a statistically significant difference (OR, 5.70 [95% CI, 1.80-18.02]; P < .001; I2 = 0%). The mean overall deep infection rate reported in the open repair group was 1.4% (0%-5.0%), while no deep infection was reported in the MIS group, with no statistically significant difference (OR, 3.14 [95% CI, 0.48-20.54]; P = .23; I2 = 0%). There were no significant differences between the open repair and MIS groups in the skin necrosis and dehiscence rate, adhesion rate, or keloid scar rate. The mean surgical time was 51.0 and 29.7 minutes for open repair and MIS, respectively, with a statistically significant difference (MD, 21.13 [95% CI, 15.50-26.75]; P < .001; I2 = 15%). CONCLUSION Open Achilles tendon repair was associated with a longer surgical time, higher risk of superficial infections, and higher risk of ankle stiffness, while MIS was associated with a greater risk of temporary sural nerve palsy. The rerupture rate and functional outcomes were mostly equivalent. We found MIS to be a safe and reliable technique. However, high-quality standardized RCTs are still needed before recommending MIS as the gold standard for managing Achilles tendon ruptures.
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Affiliation(s)
- Ahmed Khalil Attia
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Pieter d'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jason Bariteau
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sameh A Labib
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mark S Myerson
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Civera M, Devietti Goggia E, De Ros M, Burgio V, Bergamin F, Rodriguez Reinoso M, Surace C. Implantable medical devices for tendon and ligament repair: a review of patents and commercial products. Expert Rev Med Devices 2022; 19:825-845. [DOI: 10.1080/17434440.2022.2142557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marco Civera
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Ester Devietti Goggia
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo De Ros
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Vito Burgio
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Federica Bergamin
- Department of Hand, Plastic and Reconstructive Surgery, Ivrea Hospital, Ivrea, Italy
| | - Mariana Rodriguez Reinoso
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
| | - Cecilia Surace
- Laboratory of Bio-Inspired Nanomechanics, Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, Turin, Italy
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Ferracini R, Artiaco S, Daghino W, Falco M, Gallo A, Garibaldi R, Tiraboschi E, Guidotti C, Bistolfi A. Microfragmented Adipose Tissue (M-FATS) for Improved Healing of Surgically Repaired Achilles Tendon Tears: A Preliminary Study. Foot Ankle Spec 2022; 15:472-478. [PMID: 33241717 DOI: 10.1177/1938640020974557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Tendon healing is a complicated process that results in inferior structural and functional properties when compared with healthy tendon; the purpose of this study was to assess the effects of the adjunct of microfragmented adipose tissue (M-FATS) after the suture of a series of Achilles tendons. METHODS After complete Achilles tendon tear, 8 patients underwent open suture repair in conjunction with perilesional application of a preparation of M-FATS rich in mesenchymal stem cells. Results were compared with a similar group of patients treated with conventional open suture. Outcomes were evaluated based on range of motion, functional recovery, and complications according to the American Orthopedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Achilles tendons were examined by ultrasound (US) at 3 months. RESULTS The AOFAS and FADI scores showed no differences between the 2 groups. US evaluation showed quicker tendon remodeling in the M-FATS group. Adverse events were not documented for both procedures. CONCLUSIONS The combined application of derived M-FATS for tendon rupture is safe and presents new possibilities for enhanced healing. LEVELS OF EVIDENCE Level IIIb: Case control study.
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Affiliation(s)
- Riccardo Ferracini
- Orthopaedic Unit, Koelliker Hospital, Turin, Italy.,Orthopaedic Clinic, University of Genova, Italy
| | - Stefano Artiaco
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital Città della Salute e della Scienza, Turin, Italy
| | - Walter Daghino
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital Città della Salute e della Scienza, Turin, Italy
| | - Mara Falco
- Radiodiagnostic Cellini Humanitas, Turin, Italy
| | - Alessandra Gallo
- Diagnostic Imaging and Radiotherapy, Koelliker Hospital, Turin, Italy
| | | | | | - Claudio Guidotti
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital Città della Salute e della Scienza, Turin, Italy
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Tang K, Deng Z, Wang T, Sun X, Yin L, Nie M. Panda rope bridge technique versus open repair of acute Achilles tendon rupture: A comparative clinical study. Injury 2022; 53:2666-2670. [PMID: 35636979 DOI: 10.1016/j.injury.2022.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/27/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment options of acute Achilles tendon rupture (AATR) remain controversial. This article aims to compare the efficacy of a new surgical procedure, the panda rope bridge technique (PRBT) with open surgery of AATR. METHODS Ninety-eight patients with AATR were recruited, 53 underwent the PBRT, and 45 underwent open surgery. The operation time, postoperative American Orthopaedic Foot and Ankle Score, Achilles Tendon Rupture Score, complications and time to return to work and restore exercise were documented. RESULTS The average operation time, intraoperative blood loss and complication rate were 35.1 min, 18.2 ml and 3.8%, respectively, in the PRBT group, which were significantly lower than those of the open surgery group (P<0.001). The post-operative American Orthopaedic Foot and Ankle Score of 99.6 and the Achilles Tendon Rupture Score of 97.5 in the PRBT group were significantly higher than that of the open surgery group (P<0.001). The time to return to work and return to exercise were shorter in the PRBT group (P<0.001). CONCLUSION Compared to open surgery, PRBT is a better approach to the management of AATR. PRBT offers accelerated recovery, lower occurrence of post-operative complications and improved recovery of ankle joint function.
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Affiliation(s)
- Kaiying Tang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Zhibo Deng
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Ting Wang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Xianding Sun
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Liangjun Yin
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Mao Nie
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China.
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Dai G, Zheng Y, Lu X, Liu Y, Weng Q, Hong J. The percutaneous oval forceps suture-guiding method with anchor nails for Achilles tendon repair. Injury 2022; 53:1552-1556. [PMID: 35140028 DOI: 10.1016/j.injury.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute Achilles tendon rupture (AATR) is a common injury of the foot and ankle. So far, the optimal management of AATR remains controversial. The target of the present retrospective study was to describe a new operative technique for percutaneous repair of AATR and evaluate efficacy of the technique. METHODS In the present study, 32 patients were enrolled with AATR treated with the percutaneous oval forceps suture-guiding method with anchor nails from Jan 2014 to Jan 2017. The operation duration and length of incision were collected. The functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon total rupture score (ATRS), range of motion (ROM) of the ankle and plantar flexion strength ratio at the last follow-up. The postoperative sports activity level and complications were also recorded. RESULTS The mean operation duration and length of incision were 24.5 min and 2.0 cm. Whilst patient reported outcome questionnaires like AOFAS and ATRS showed good results, ROM of the ankle was quite low with only 16.5 degrees. Plantar flexion strength ratio was lower post surgery, as well. As for the postoperative sports activity level: 26/32 cases (81.3%) returned to former sports activity level; 4/32 cases (12.5%) showed a decline in sports activity level; 2/32 cases (6.2%) gave up on sports. The overall complication rate was 6.2%, one sural nerve damage and one fusiform thickening were found in the study. CONCLUSION The percutaneous oval forceps suture-guiding method with anchor nails is a new considerable surgery method with adequate healing rates and an alternative to existing surgical procedures.
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Affiliation(s)
- Gaole Dai
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University.
| | - Yijing Zheng
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Xiaolang Lu
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yang Liu
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Qihao Weng
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Jianjun Hong
- Gaole Dai is affiliated to Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University. Other authors are affiliated to The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University.
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9
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Sanada T, Iwaso H, Fukai A, Honda E, Yoshitomi H. Comparison Study of Mini-Incision Versus Original Open Technique of the Half-Mini-Bunnell Achilles Tendon Repair. J Foot Ankle Surg 2022; 61:355-362. [PMID: 34656416 DOI: 10.1053/j.jfas.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 02/03/2023]
Abstract
Mini-incision surgical procedures in our institution have been developed by decreasing the total skin incision length from the original mini half-Bunnell tendon repair technique. We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair technique, would promote the tendon healing process leading to better outcomes and a reduced complication rate compared to the conventional open repair. The study sought to determine the more optimal method by comparing 44 mini-incision sutures to the 99 sutures in the original open Achilles tendon repairs. The mean skin incision length of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was 4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged heel-rise movement and the time to return-to-play was not significantly different between the 2 groups. Achilles Tendon Rupture Score was not significantly different from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture was showed equivalent clinical results to the original open repair, the technique is recommended in terms of curtailment of the surgery time without increase of complication ratio.
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Affiliation(s)
- Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan.
| | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Atsushi Fukai
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Eisaburo Honda
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Hiroki Yoshitomi
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
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10
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Shi F, Wu S, Cai W, Zhao Y. Multiple comparisons of the efficacy and safety for six treatments in Acute Achilles Tendon Rupture patients: A systematic review and network meta-analysis. Foot Ankle Surg 2021; 27:468-479. [PMID: 32732151 DOI: 10.1016/j.fas.2020.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The choice of the best therapeutic regimen for Acute Achilles Tendon Rupture (AATR) remains controversial. Our study aims to evaluate the efficacy and safety of therapeutic regimens in AATR patients using a network meta-analysis of data from clinical randomized controlled trials. MATERIAL/METHODS The studies were abstracted from Medline, Embase, Web of Science, Google Scholar and the Cochrane Central Register of Controlled Trials. RCTs meeting the inclusion and exclusion criteria were selected. Statistical analyses were conducted using Stata software, version 14.0 (Stata Corporation, College Station, Texas, USA). RESULTS 38 randomized controlled trials involving 2480 participants were included. The studies were published between 1981 and 2019. A total of 6 therapeutic regimens -open repair (OR), minimally invasive repair (MIR) and nonoperative treatment (non) combined with traditional standard rehabilitation (TSR) and accelerated functional rehabilitation (AFR) - were included in the literature. The treatments were ranked based on the Surface Under the Cumulative Ranking Curve (SUCRA) probability. In terms of the re-rupture rate, the therapeutic regimens were ranked as follows: OR&AFR, OR&TSR, MIR&AFR, MIR&TSR, nonoperative treatment &AFR and nonoperative treatment &TSR. In terms of the wound-related complication, the therapeutic regimens were ranked as follows: MIR&AFR, nonoperative treatment &AFR, MIR&TSR, nonoperative treatment &TSR, OR&AFR and OR&TSR. In terms of the sural nerve injury, the therapeutic regimens were ranked as follows: non, OR and MIR. In terms of the deep venous thrombosis, the therapeutic regimens were ranked as follows: MIR&AFR, OR&AFR, nonoperative treatment &AFR, OR&TSR, MIR&TSR and nonoperative treatment &TSR. In terms of the returning back to sport, the therapeutic regimens were ranked as follows: MIR&TSR, OR&AFR, OR&TSR, nonoperative treatment &AFR, nonoperative treatment &TSR and MIR&AFR. CONCLUSIONS MIR can repair the ruptured Achilles tendon and narrow the tendon gap with low risk of complications. AFR is superior to TSR without increasing the risk of rerupture. MIR&AFR is the best therapeutic regime for AATR. More RCTs focused on AATR are needed to further indicate this conclusion.
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Affiliation(s)
- Fangling Shi
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shiyuan Wu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Cai
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Youming Zhao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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11
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Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study. Arch Orthop Trauma Surg 2021; 141:383-401. [PMID: 32266518 DOI: 10.1007/s00402-020-03437-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the presence of various different surgical procedures, the preferable technique for repair of acute Achilles tendon ruptures is unknown and, therefore, object of discussions. The purpose of this meta-analysis was to compare clinical outcomes and complication-rates between the minimally invasive and the standard open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS This meta-analysis was performed according to the PRISMA guidelines. In September 2019 the main databases were accessed. All clinical trials of evidence level I to III comparing minimally invasive vs. open surgery of Achilles tendon rupture were included in the present study. Only articles reporting quantitative data under the outcomes of interest were included. Missing data under the outcomes of interest warranted the exclusion from the present work. For the statistical analysis we referred to the Review Manager Software Version 5.3. (The Nordic Cochrane Centre, Copenhagen). Continuous data were analysed through the inverse variance method. For the effect estimate the mean difference was used. Dichotomous data were analysed through the Mante-Haenszel method via odd ratio effect measure. The confidence interval was set at 95% in all the comparisons. Values of P < 0.05 were considered statistically significant. RESULTS A total of 25 articles were included for meta-analysis. The funnel plot revealed poor data dispersion, attesting to this study a low risk of publication bias. The quality of the methodological assessment was moderate. Data from 2223 (1055 open, 1168 minimally invasive) surgical procedures were extracted. The mean follow-up was of 24.29 ± 22.4 months. The open group reported a lower value of post-operative palpable knot at last follow-up and a lower rate of sural nerve palsy. In the minimally-invasive group a shorter surgery duration and a lower rate of post-operative wound necrosis and reduced risk of wound scarring and adhesions has been evidenced. The minimally-invasive cohort detected the lowest values of superficial and deep infections. In both groups no significant difference was shown in re-rupture rate. CONCLUSIONS Compared to the minimally-invasive Achilles tendon reconstruction, the open procedure evidenced a lower rate of sural nerve palsy and postoperative palpable knot, whereas in the minimally-invasive reconstruction group quicker surgery duration, a lower rate of post-operative wound necrosis, superficial and deep infections and less scar tissue adhesions could be observed. No relevant discrepancies were detected among the two techniques in terms of post-operative re-rupture.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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12
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Liu JY, Duan WF, Shen S, Ye Y, Sun YQ, He W. Achillon versus modified minimally invasive repair treatment in acute Achilles tendon rupture. J Orthop Surg (Hong Kong) 2020; 28:2309499020908354. [PMID: 32129145 DOI: 10.1177/2309499020908354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To date, the best treatment of acute Achilles tendon rupture (AATR) is still inconclusive. Achillon seems to be a promising approach with satisfactory function and low complication rate. We hypothesize a modified minimally invasive repair (MMIR), which provides direct visualization of proximal tendon stump without specialized equipment that could provide comparable results. This trial is aimed to evaluate the functional and surgical outcomes of MMIR comparing with Achillon. METHODS From February 2013 to February 2017, 114 patients with AATR were enrolled in this trial, underwent an alternative operation (Achillon or MMIR), and accelerated rehabilitation protocol. Forty-four patients took the Achillon and the other 70 patients took the MMIR at their subjective choice. One hundred eleven full follow-up data were obtained including Achilles tendon total rupture score (ATRS), time back to work, rerupture rate, overall complication rate, and operation time. RESULTS There was no significant difference between groups in demographic characters. There was no statistical difference between both groups regarding to time return to work and ATRS at 3rd, 6th, 12th, and 24th month, respectively. Five reruptures and two Achilles tendons tethering to skins were found in the Achillon group, and two reruptures and one sural nerve injury in the MMIR group. No wound infection and dehiscence occurred. Overall complication rate in the Achillon group is higher (16.3% vs. 4.4%, p = 0.044). The operation time of Achillon is less than MMIR (34.84 vs. 39.71, p < 0.001). CONCLUSION Both techniques combining with accelerated rehabilitation showed to be reliable and effective. MMIR is safer and more economical, and Achillon is faster.
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Affiliation(s)
- Jun-Yi Liu
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Wei-Feng Duan
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Sheng Shen
- Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Ye Ye
- Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Yong-Qiang Sun
- Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Wei He
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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13
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Baumfeld D, Baumfeld T, Spiezia F, Nery C, Zambelli R, Maffulli N. Isokinetic functional outcomes of open versus percutaneous repair following Achilles tendon tears. Foot Ankle Surg 2019; 25:503-506. [PMID: 30321959 DOI: 10.1016/j.fas.2018.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rupture of the Achilles tendon (AT) is frequent in young recreational athletes. Conservative management, open surgery and percutaneous/minimally invasive approaches are all advocated, and conflicting data are available. This study compared functional and anthropometric outcomes of patients who underwent open or percutaneous repair. METHODS A retrospective comparative study, in which 38 patients underwent open and percutaneous techniques to manage AT ruptures. For functional assessment, the calf circumference of both injured and uninjured legs was evaluated. Isokinetic testing included total plantar flexion work, peak plantar flexion torque, total dorsiflexion work peak and dorsiflexion torque. The Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Score (AOFAS) were evaluated at a final minimum follow-up of 12months. RESULTS No major complications were observed. The average time to return to sport was 9months. AOFAS and ATRS values did not differ statistically between groups. Isokinetic variables and circumference were similar in the operated and non-operated limb in both groups, and did not differ either when comparing open and percutaneous repair. CONCLUSIONS Open and percutaneous repair of a torn Achilles tendon produced similar functional outcomes.
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Affiliation(s)
| | | | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo, Presidio Ospedaliero di Villa D'Agri, Viale S. Pio da Pietrelcina, 85050 Villa d'Agri, Marsicovetere, PZ, Italy.
| | - Caio Nery
- Federal University of São Paulo (UNIFESP), Brazil.
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14
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Bisaccia M, Rinonapoli G, Meccariello L, Bisaccia O, Ceccarini P, Rollo G, Ibáñez-Vicente C, Cervera-Irimia J, Sánchez-Sánchez F, Ribes-Iborra A, Gomez-Garrido D, Caraffa A. Validity and Reliability of Mini-Invasive Surgery Assisted by Ultrasound in Achilles Tendon Rupture. Acta Inform Med 2019; 27:40-44. [PMID: 31213742 PMCID: PMC6511267 DOI: 10.5455/aim.2019.27.40-44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: The surgical treatment for Achilles tendon rupture has become very popular in the last years, because of the good outcomes and the low re-rupture rate. Aim: The aim of this study is to compare the results between open surgery and percutaneous ultrasound-assisted surgery. Methods: All patients who underwent an Achilles tendon surgical repair in the last 3 years were included, resulting in a total of 56 patients (40 M and 16 F) with an average age of 53 years. Of these patients, 36 were treated with an open suture, while 20 with a mini invasive ultrasound assisted suture. At a minimum follow-up of one year, patients were evaluated echografically, using both the Achilles Tendon Rupture Total score (ATRS) and the McComis score, and performing the ultrasounds bilaterally to assess both the structure and the diameter of tendons. Results: Both groups of patients showed an average ATRS score >80. The McComis score was 54.18 vs. 56.25 (p>0.05). Plantar flexion and dorsal flexion work were not similar (p>0.05). On average, the calf circumference of the operated side was decreased compared to the healthy side between the groups (p>0.05). The thickness of the operated tendons evaluated with ultrasound measurement compared to the average tendon, (p <0.05). Conclusion: The ultrasound-assisted tenorrhaphy is a reliable treatment with good clinical and functional outcomes; anyway, the percutaneous technique and the open surgery show similar results.
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Affiliation(s)
- Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Giuseppe Rinonapoli
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, Lecce, Italy
| | - Olga Bisaccia
- Section of Diagnostic Imaging, "S. Carlo Hospital", Potenza, Italy
| | - Paolo Ceccarini
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Piazzetta Filippo Muratore, Block: A- Floor:V, Lecce, Italy
| | | | - Javier Cervera-Irimia
- Orthopaedic and Trauma Surgeon "Hospital General de Villalba", ColladoVillalba, Spain
| | - Felix Sánchez-Sánchez
- Division of Orthopedics and Trauma Surgery, "ComplejoHospitalario Universitario de Toledo", Toledo, Spain
| | - Angela Ribes-Iborra
- Department of Intensive Care, "Hospital Corporacion Sanitaria Parc Taulì" Sabadell, Barcellona, Spain
| | - David Gomez-Garrido
- Orthopaedic and Trauma Surgeon "Hospital General de Villalba", ColladoVillalba, Spain
| | - Auro Caraffa
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delleFratte, Perugia, Italy
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15
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Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, Mosca M, Zaffagnini S. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J Bone Joint Surg Am 2018; 100:1969-1981. [PMID: 30480601 DOI: 10.2106/jbjs.17.01364] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the optimal technique for repairing an acute Achilles tendon rupture. The purpose of this meta-analysis was to compare the complications, subjective outcomes, and functional results between minimally invasive surgery and open repair of an Achilles tendon rupture. METHODS A systematic literature search of MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, and ClinicalTrials.gov was performed. Eligible studies were randomized controlled trials (RCTs) comparing minimally invasive surgery and open repair of acute Achilles tendon ruptures. A meta-analysis was performed, while bias and the quality of the evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Eight studies, with 182 patients treated with minimally invasive surgery and 176 treated with open repair, were included. The meta-analysis showed a significantly decreased risk ratio (RR) of 0.21 (95% confidence interval [CI] = 0.10 to 0.40, p = 0.00001) for overall complications and 0.15 (95% CI = 0.05 to 0.46, p = 0.0009) for wound infection after minimally invasive surgery. Patients treated with minimally invasive surgery were more likely to report good or excellent subjective results (RR = 1.18, 95% CI = 1.04 to 1.33, p = 0.009). No differences between groups were found with respect to reruptures, sural nerve injury, return to preinjury activity level, time to return to work, or ankle range of motion. The overall quality of evidence was generally low because of a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSIONS There was a significantly decreased risk of postoperative complications, especially wound infection, when acute Achilles tendon rupture was treated with minimally invasive surgery compared with open surgery. Patients treated with minimally invasive surgery were significantly more likely to report a good or excellent subjective outcome. Current evidence is associated with high heterogeneity and a considerable risk of bias. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alberto Grassi
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy.,II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Annunziato Amendola
- Michael W. Krzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matteo Romagnoli
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alice Bondi
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy.,II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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16
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Alcelik I, Saeed ZM, Haughton BA, Shahid R, Alcelik JC, Brogden C, Budgen A. Achillon versus open surgery in acute Achilles tendon repair. Foot Ankle Surg 2018; 24:427-434. [PMID: 29409202 DOI: 10.1016/j.fas.2017.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open Achilles tendon repairs (OATR) are associated with high complication rates. Minimally invasive surgery (MIS) techniques like the Achillon Achilles tendon repair (AATR) were developed to reduce this. We performed a systematic review and meta-analysis to compare OATR with AATR. METHODS We performed an extensive literature search including all studies that compared the two techniques. Outcomes assessed included overall complication rate, re-rupture rate, sural nerve injury, wound length, The American Orthopaedic Foot and Ankle Scores (AOFAS) scores and return to sports. RESULTS Eight studies were suitable for inclusion totalling 210 patients in the AATR group vs 233 patients in the OATR group. Total complication rates were significantly reduced in the Achillon patients with odd ratio of 0.14 (CI 95%, 0.08-0.27, P<0.00001) in favour. There were no significant differences in re-rupture rate, sural nerve injury, return to sports and AOFAS scores following repair between the two groups. CONCLUSIONS AATR has fewer overall complications compared with OATR. It should be considered as an alternative to open surgical repair.
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Affiliation(s)
- Ilhan Alcelik
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
| | - Zubair M Saeed
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
| | - Ben A Haughton
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
| | - Rizwan Shahid
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
| | - John C Alcelik
- Year 12, All Saints RC School, Mill Mount Lane, York YO24 1BJ, United Kingdom.
| | - Craig Brogden
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
| | - Adam Budgen
- Department of Orthopaedics, York Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
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17
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Deng S, Sun Z, Zhang C, Chen G, Li J. Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg 2018; 56:1236-1243. [PMID: 29079238 DOI: 10.1053/j.jfas.2017.05.036] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Indexed: 02/03/2023]
Abstract
Acute Achilles tendon ruptures can be treated with surgical and nonsurgical treatment. However, the optimal intervention for acute Achilles tendon rupture remains controversial. The aim of the present study was to compare the clinical outcomes of surgical treatment versus conservative management for acute Achilles tendon rupture. Eight randomized controlled studies involving 762 patients were included in the meta-analysis. In general, re-rupture occurred in 14 of 381 surgically treated patients (3.7%) and 37 of 377 nonsurgically treated patients (9.8%). Pooled results showed that the total re-rupture rate was significantly lower in surgical group than that in the nonsurgical group (risk ratio 0.38, 95% confidence interval 0.21 to 0.68; p = .001). No significant differences were found between the 2 treatment groups in the incidence of deep venous thrombosis, the number who returned to sport, ankle range of motion (dorsiflexion, plantarflexion), Achilles tendon total rupture score, or physical activity scale. Surgical treatment can effectively reduce the re-rupture rate and might be a better choice for the treatment of acute Achilles tendon rupture. Multicenter, double-blind randomized controlled trials with stratification and long-term follow-up are needed to obtain a higher level of evidence and to guide clinical practice, especially in the comparison and selection of different treatments.
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Affiliation(s)
- Senlin Deng
- Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Sun
- Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chenghao Zhang
- Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Professor, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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18
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Obut S, Gultekin A, Unal M, Serarslan U, Tuhanioğlu Ü. A simple suture-guiding device for minimally invasive Achilles tendon repair. J Orthop Surg (Hong Kong) 2018; 25:2309499017739484. [PMID: 29141520 DOI: 10.1177/2309499017739484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our hypothesis is to utilize a simple suture-guiding device for minimally invasive repair of Achilles tendon without any extra cost with a minimal risk of rerupture. The purpose of this study is to investigate the results of our minimally invasive technique for Achilles tendon repair using a simple ovarian clamp for suture guiding. MATERIALS AND METHODS Twenty patients with acute Achilles tendon rupture were treated with minimally invasive repair by an expert orthopaedic surgeon. Instead of an Achillon device, an ovarian clamp was directed to the proximal and distal parts of the Achilles tendon. All data relating to daily activities, walking, climbing stairs, sports activity, American Orthopaedic Foot and Ankle Society (AOFAS) and Thermannscores were recorded. Sural nerve was evaluated with physical examination for paraesthesia, hyperaesthesia, lateralis cruris and foot pain in all patient controls. RESULTS The average AOFAS score was 97.06 (76-100). All patients had intact Achilles tendon at last control. No rerupture was observed. Average time taken to return to work was 30.8 days (28-60 days). After 6 months, all patients returned to their previous sports activities. CONCLUSION For Achilles tendon ruptures, minimally invasive repair techniques have shown successful results with low complication rates. Besides their success, some suture-guiding devices bring extra costs for patients or health insurance. Minimally invasive techniques may be performed with devices without any extra cost. Our new suture-guiding device provides knot placement under paratenon like Achillon device to improve outcomes, provides early return to work and minimizes the complications. Finally, our suture-guiding device has no extra cost.
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Affiliation(s)
- Sinan Obut
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Alper Gultekin
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Meric Unal
- 2 Faculty of Medicine, Sports Medicine Department, Suleyman Demirel University, Isparta, Turkey
| | - Ulaş Serarslan
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Ümit Tuhanioğlu
- 3 Orthopaedics and Traumatology Department, Adana Numune Research Hospital, Adana, Turkey
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Investigation of the biomechanical and histopathological effects of autologous conditioned serum on healing of Achilles tendon. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:226-231. [PMID: 29454565 PMCID: PMC6136302 DOI: 10.1016/j.aott.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/07/2017] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Abstract
Objective The aim of this study to evaluate the effects of autologous conditioned serum (ACS) on the healing of transected rat Achilles tendons via the assessment of biomechanical and histological parameters. Methods The study was conducted on 45 male Sprague–Dawley rats. Five rats were used as donors for ACS preparation. Animals were randomly assigned to the experimental or control group. In both groups, the Achilles tendon was cut transversally and then sutured. In the placebo control and ACS-treated groups, saline or ACS, respectively, was injected into the repair zone three times after surgery. Ten rats from each group (ACS group, n = 20; control group, n = 20) were euthanized at days 15 and 30 after surgery for histopathological (n = 5) and biomechanical (n = 5) testing. The histopathological findings were interpreted using the Bonar and Movin scales. Tendon remodelling was evaluated via the immunohistochemical staining of collagen type 3. Biomechanical effects were assessed by tensile testing. Results The Bonar and Movin scale scores were significantly better in the ACS-treated group on both day 15 (p = 0.003 and p = 0.003, respectively) and day 30 (p = 0.005 and p = 0.004, respectively). The immunohistochemical density of collagen type 3 was significantly lower in the ACS-treated group on day 30 (p = 0.018). The type 1/3 collagen ratios of the groups were similar on days 15 and 30, as determined by Sirius Red staining (p = 0.910 and p = 0.133, respectively). In the biomechanical assessment results, the ACS-treated group's maximum load to failure values were significantly higher on day 15 (p = 0.049). Conclusion Injection of ACS had a positive effect on the histopathological healing of rat Achilles tendons on days 15 and 30 and on biomechanical healing on day 15. ACS treatment contributed to lowering the collagen type 3 density by day 30. According to our study, ACS may be favourable for the treatment of human Achilles tendon injuries and tendinopathies.
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Wang KC, Cotter EJ, Cole BJ, Lin JL. Rehabilitation and Return to Play Following Achilles Tendon Repair. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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