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Abdelatif NMN, Batista JP. Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures in Professional Soccer Players. Foot Ankle Int 2022; 43:164-175. [PMID: 34558318 DOI: 10.1177/10711007211036439] [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: 02/01/2023]
Abstract
BACKGROUND Acute Achilles tendon ruptures (AATRs) that occur in athletes can be a career-ending injury. The aim of this study was to describe return to play and clinical outcomes of isolated endoscopic flexor hallucis longus (FHL) transfer in active soccer players with AATR. METHODS Twenty-seven active male soccer players who underwent endoscopically assisted FHL tendon transfer for acute Achilles tendon ruptures were included in this study. Follow up was 46.2 (±10.9) months after surgery. Return to play criteria and clinical outcome measures were evaluated. RESULTS All players returned to playing professional competitive soccer games. Return to active team training was at a mean of 5.8 (±1.1) months postoperatively. However, return to active competitive match play occurred at a mean of 8.3 (±1.4) months. Twenty-two players (82%) were able to return to their preinjury levels and performances and resumed their professional careers at the same soccer club as their preinjury state. One player (3.7%) shifted his career to professional indoor soccer. At 26 months postoperatively, the mean Tegner activity scale score was 9.7 (±0.4), the mean Achilles tendon total rupture score was 99 (±2), and the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 99 (±3). No patients reported any great toe complaints or symptomatic deficits of flexion strength. CONCLUSION The current study demonstrated satisfactory and comparable return to play criteria and clinical results with minimal complications when using an advanced endoscopically assisted technique involving FHL tendon transfer to treat acute Achilles tendon ruptures in this specific subset of patient cohort. LEVEL OF EVIDENCE Level II, prospective cohort case series study.
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Affiliation(s)
| | - Jorge Pablo Batista
- Head Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Ciudad Autónoma de Buenos Aires (CABA), CP, Argentina.,Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
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KEHRİBAR L, COŞKUN S, SURUCU S. Comparison of open repair and modified percutaneous repair techniques for the treatment of acute achilles tendon ruptures. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Caolo KC, Eble SK, Rider C, Elliott AJ, Demetracopoulos CA, Deland JT, Drakos MC, Ellis SJ. Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211060063. [PMID: 35097483 PMCID: PMC8646203 DOI: 10.1177/24730114211060063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. METHODS A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution's registry. Demographics and complications were recorded. RESULTS PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). CONCLUSION Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Kristin C. Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Stephanie K. Eble
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carson Rider
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew J. Elliott
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Jonathan T. Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mark C. Drakos
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Bala MM, Şahin AA, Boz M, Durukan Y, Fırat T, Pakdil M, Özturan KE. Effects of Cyanoacrylate in Rabbits with Induced Achilles Tendon Rupture. Med Sci Monit 2021; 27:e929709. [PMID: 34483334 PMCID: PMC8434771 DOI: 10.12659/msm.929709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate the effects of N-butyl-2-cyanoacrylate (cyanoacrylate) on the biomechanical and histopathological aspects of tendon healing in a rabbit model of Achilles tendon injury. MATERIAL AND METHODS In total, 36 rabbits were randomized to experimental (cyanoacrylate) and control groups (n=36 tendons in each group). A simple suture was used in the control group and a simple suture plus cyanoacrylate was used in the experimental group. Nine rabbits from each group were euthanized at week 4 and week 6 after surgery for histopathological and biomechanical testing. RESULTS Granulation tissue formation was significantly greater in the experimental group in week 4 and week 6 than in the control group. Foreign body giant cell formation was significantly higher in the experimental group in week 4 and week 6. The maximum rupture force was significantly higher in the experimental group in week 4 and week 6 than in the control group. Elasticity and stiffness were comparable between groups in week 4; however, stiffness, but not elasticity, was significantly higher in the experimental group in week 6. CONCLUSIONS In the short term, cyanoacrylate enhanced tendon endurance in both a histopathological and biomechanical manner. We conclude that the early initiation of rehabilitation in patients may be safe in cases of cyanoacrylate use for surgical repair of tendon injury.
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Affiliation(s)
- Mehmet Murat Bala
- Department of Orthopaedics and Traumatology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Abdullah Alper Şahin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Ordu, Ordu, Turkey
| | - Mehmet Boz
- Department of Orthopaedics and Traumatology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Yasin Durukan
- Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, University of Sakarya, Sakarya, Turkey
| | - Tülin Fırat
- Department of Histology and Embryology, Faculty of Medicine, University of Bolu Abant Izzet Baysal, Bolu, Turkey
| | - Murat Pakdil
- Department of Mechanical Engineering, Faculty of Engineering, University of Bolu Abant Izzet Baysal, Bolu, Turkey
| | - Kutay Engin Özturan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Bolu Abant Izzet Baysal, Bolu, Turkey
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O'Donnell SW, Velasco B, Whitehouse B, Kwon JY, Miller CP. Limited Open Achilles Tendon Repair in Supine Position With Modified Ring Forceps: A Technique Tip. Foot Ankle Spec 2019; 12:563-568. [PMID: 31347392 DOI: 10.1177/1938640019863268] [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: 11/15/2022]
Abstract
We present a modification to prior Achilles tendon repair techniques that utilizes readily available noncommercial instrumentation, mini-open incisions, and supine positioning, thus maximizing surgical efficiencies and reducing complications. In our experience, this is a safe and effective technique that minimizes anesthetic requirements and operating room time. Levels of Evidence: Level V, expert opinion.
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Affiliation(s)
- Seth W O'Donnell
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Brian Velasco
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brianna Whitehouse
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christopher P Miller
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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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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Abstract
We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations.
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Affiliation(s)
- Amol Saxena
- Podiatrist, Department of Sports Medicine, Sutter-Palo Alto, Palo Alto, CA.
| | - Deann Hofer
- Fellow, Department of Sports Medicine, Sutter-Palo Alto, Palo Alto, CA
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Zhang H, Liu PZ, Zhang X, Ding C, Cui HC, Ding WB, Wang RK, Wu DJ, Wei Q, Qin S, Wu XL, Tong DK, Wang GC, Tang H, Ji F. A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and "circuit" suture technique. J Orthop Surg Res 2018; 13:198. [PMID: 30097054 PMCID: PMC6086049 DOI: 10.1186/s13018-018-0895-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022] Open
Abstract
Background Traditional incision repair and minimally invasive repair for acute Achilles tendon repair have limitations. This study aimed to present our series of 23 patients with acute Achilles tendon rupture that was repaired using two small incisions to assist the anchor repair of the tear and a new “circuit” suture technique. Methods This was a retrospective study of 23 patients with acute Achilles tendon rupture treated with the new technique at Changhai Hospital between January 2015 and December 2016 and followed up for 14–33 months. Clinical outcome was assessed using the AOFAS, Leppilahti, and Arner-Lindholm scores. Complications, range of motion (ROM), and time to return to work and light sport activity were assessed. Results The AOFAS score was 85–96 at 3 months and 92–100 at 12 months. The 3-month ROM was 27°–37°, and the 12-month ROM was 36°–48°. The Leppilahti score was 85–95 at 3 months and 90–100 at 12 months. The recovery time of the patients was 10–18 weeks. The postoperative recovery time to exercise was 16–24 weeks. There was only one case of deep venous thrombosis. According to the Arner-Lindholm assessment criteria, patient outcomes were rated as excellent in 20 (87.0%) cases, good in three (13.0%) cases, and poor in 0 cases. The excellent-to-good rate was 100%. Conclusion The limited-open procedure combined with a single-anchor and “circuit” suture technique could be used to repair torn Achilles sites, with a low occurrence of complications. This new and minimally invasive technique could be an alternative in the management of acute Achilles tendon rupture.
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Affiliation(s)
- Hao Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Pei-Zhao Liu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xin Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Chen Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao-Chen Cui
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Wen-Bin Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Ren-Kai Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Jiang Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Qiang Wei
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Sheng Qin
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xue-Lin Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Ke Tong
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Guang-Chao Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao Tang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
| | - Fang Ji
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
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9
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The improved oval forceps suture-guiding method for minimally invasive Achilles tendon repair. Injury 2018; 49:1228-1232. [PMID: 29731123 DOI: 10.1016/j.injury.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To discuss the effect and advantage of the improved oval forceps suture-guiding method combined with anchor nail in the treatment of acute Achilles tendon rupture. METHODS A retrospective research was performed on 35 cases of acute Achilles tendon rupture treated with the improved oval forceps suture-guiding method from January 2013 to October 2016. Instead of the Achillon device, we perform the Achillon technique with the use of simple oval forceps, combined with absorbable anchor nail, percutaneously to repair the acute Achilles tendon rupture. RESULTS All patients were followed up for at least 12 months (range, 12-19 months), and all the patients underwent successful repair of their acute Achilles tendon rupture using the improved oval forceps suture-guiding method without any major intra- or postoperative complications. All the patients returned to work with pre-injury levels of activity at a mean of 12.51 ± 0.76 weeks. Mean AOFAS ankle-hindfoot scores improved from 63.95 (range, 51-78) preoperatively to 98.59 (range, 91-100) at last follow-up. This was statistically significant difference (P < 0.001). Mean Achilles Tendon Total Rupture Score (ATRS) at final follow-up was 94.87 (range, 90-100). CONCLUSION The improved oval forceps suture-guiding method could make the advantage of minimally invasive repair with less complications, reduced surgical time and similar functional outcomes compared with the traditional open surgery. In addition, our new technique could save the cost of surgery with the compare of the Achillon device. At the same time for the cases which the remote broken tendon ends were within 2 cm from the calcaneal nodules, because of the less tendon tissue was left in the remote side, traditional percutaneous methods are incapable to ensure the reconstruction strength. By using the anchor nail, the improved technique has better repair capacity and expands the operation indication of oval forceps method.
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Rozis M, Benetos IS, Karampinas P, Polyzois V, Vlamis J, Pneumaticos SG. Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures. Foot Ankle Int 2018. [PMID: 29528724 DOI: 10.1177/1071100718757971] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conservative treatment of an acute Achilles rupture remains a viable and acceptable option as does surgical fixation, with open and percutaneous repair consisting the main operative techniques. The purpose of this study was to compare the outcomes and complication rates of open versus percutaneous surgical procedures. METHODS From 2009 to 2016, 131 patients were admitted to our department with clinically and radiologically confirmed acute Achilles tendon ruptures. Of those, 82 patients met our inclusion criteria and were randomized into 2 groups, group A (open repair) and group B (percutaneous suturing). Suture equipment was the same for both groups. All patients followed the same rehabilitation protocol. Functional evaluation was made using American Orthopaedic Ankle & Foot Society (AOFAS) hindfoot and Achilles tendon Total Rupture Score (ATRS) questionnaires at the 12-month follow-up. Ankle range of motion (ROM), return-to-work time, and complication rates were additionally measured. RESULTS Both techniques had similar results regarding complication rates and return-to-work time. The major complication in group A was superficial infection (7%) and skin necrosis (3%), whereas 3 patients in group B developed paresthesias due to sural nerve entrapment. Patients in group B had better AOFAS hindfoot (96/100) and ATRS (95/100) scores, but the difference was not significant. ROM was similar in both groups at the 12-month follow-up. CONCLUSION Percutaneous suturing seems to be a safe and effective technique that offers good functional outcomes and low complication rates in patients with acute Achilles tendon ruptures who elect to have surgery. LEVEL OF EVIDENCE Level II, prospective case series.
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Affiliation(s)
- Meletis Rozis
- 1 3rd Orthopaedic Department, KAT Hospital, University of Athens, Athens, Greece
| | - Ioannis S Benetos
- 1 3rd Orthopaedic Department, KAT Hospital, University of Athens, Athens, Greece
| | | | - Vasilios Polyzois
- 1 3rd Orthopaedic Department, KAT Hospital, University of Athens, Athens, Greece
| | - John Vlamis
- 1 3rd Orthopaedic Department, KAT Hospital, University of Athens, Athens, Greece
| | - Spyros G Pneumaticos
- 1 3rd Orthopaedic Department, KAT Hospital, University of Athens, Athens, Greece
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Krill MK, Borchers JR, Hoffman JT, Krill ML, Hewett TE. Effect of position, time in the season, and playing surface on Achilles tendon ruptures in NFL games: a 2009-10 to 2016-17 review. PHYSICIAN SPORTSMED 2017; 45:259-264. [PMID: 28617627 DOI: 10.1080/00913847.2017.1343652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Achilles tendon (AT) ruptures are a potentially career-altering and ending injury. Achilles tendon ruptures have a below average return-to-play rate compared to other common orthopaedic procedures for National Football League (NFL) players. The objective of this study was to monitor the incidence and injury rates (IR) of AT ruptures that occurred during the regular season in order to evaluate the influence of player position, time of injury, and playing surface on rupture rates. METHODS A thorough online review was completed to identify published injury reports and public information regarding AT ruptures sustained during regular season and post-season games in the National Football League (NFL) during the 2009-10 to 2016-17 seasons. Team schedules, player position details and stadium information was used to determine period of the season of injury and playing surface. IRs were calculated per 100 team games (TG). Injury rate ratios (IRR) were utilized to compare IRs. RESULTS During eight monitored seasons, there were 44 AT ruptures in NFL games. A majority of AT ruptures were sustained in the first eight games of the regular season (n = 32, 72.7%). There was a significant rate difference for the first and second four-game segments of the regular season compared to the last two four-game segments of the regular season. Defensive players suffered a majority of AT ruptures (n = 32, 72.7%). The IR on grass was 1.00 per 100 TG compared to 1.08 per 100 TG on artificial turf (IRR: 0.93, p = .80). CONCLUSION A significant increase in AT ruptures occurred in the first and second four game segments of the regular season compared to the last two-four game segments of the regular season. Defensive players suffered a majority of AT ruptures compared to offensive or specialist players. There was no difference between AT rupture rates and playing surface in games.
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Affiliation(s)
- Michael K Krill
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,b Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
| | - James R Borchers
- c Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,d Department of Family Medicine , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Joshua T Hoffman
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Matthew L Krill
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Timothy E Hewett
- e Sports Medicine Center , Mayo Clinic , Rochester , MN , USA.,f Department of Orthopedic Surgery , Mayo Clinic , Rochester , MN , USA.,g Department of Biomedical Engineering and Physiology , Mayo Clinic , Rochester , MN , USA.,h Department of Physical Medicine & Rehabilitation , Mayo Clinic , Rochester , MN , USA
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12
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Zayni R, Coursier R, Zakaria M, Desrousseaux JF, Cordonnier D, Polveche G. Activity level recovery after acute Achilles tendon rupture surgically repaired: a series of 29 patients with a mean follow-up of 46 months. Muscles Ligaments Tendons J 2017; 7:69-77. [PMID: 28717614 DOI: 10.11138/mltj/2017.7.1.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Achilles tendon rupture is a common injury but its optimal management is still controversial. When decided, surgical repair can be performed by open or percutaneous techniques. Till now, there is no agreement on the ideal type of surgical management. PURPOSE To compare the outcomes of the percutaneous and open surgical treatment for acute Achilles tendon rupture and to assess the postoperative activity level recovery. METHODS Between 2008 and 2013, 29 patients were surgically treated for acute Achilles tendon rupture in our institution. 16 patients were operated by percutaneous technique and 13 by open repair. All patients received the same postoperative rehabilitation protocol. Patients were evaluated objectively and subjectively after an average of 46 months (23-91). RESULTS 96.6% of patients had excellent and good results according to subjective assessment. No significant difference was observed with respect to the examined clinical variables between the open and percutaneous repair groups. 20.68% of patients had minor complications related to the operation with lesser complications in the percutaneous group. 89.6% of patients resumed sport activity with an average delay of 7,7 months (4-24) and 57,7% of them resumed at a level equal or superior to their level before injury, with higher rate in the percutaneous group. CONCLUSION Percutaneous technique has similar satisfactory outcomes to open surgery in repairing acute ruptured Achilles tendon with lesser complications and higher activity level recovery rate. LEVEL OF EVIDENCE Retrospective comparative study. Level III.
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Affiliation(s)
- Richard Zayni
- Department of Orthopedic Surgery. Groupe Hospitalier de l'Est de la Meurthe-et-Moselle (GHEMM), France
| | - Raphaël Coursier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Moudasser Zakaria
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Jean-François Desrousseaux
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Denis Cordonnier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Gilles Polveche
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
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