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Wilson WT, Kennedy MJ, MacLeod D, Hopper GP, MacKay GM. Outcomes of Anterior Cruciate Ligament Reconstruction With Independently Tensioned Suture Tape Augmentation at 5-Year Follow-up. Am J Sports Med 2023; 51:3658-3664. [PMID: 37975527 PMCID: PMC10691290 DOI: 10.1177/03635465231207623] [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: 04/27/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Reconstruction using autograft remains the gold standard surgical treatment for anterior cruciate ligament (ACL) injuries. However, up to 10% to 15% of patients will suffer a graft failure in the future. Cadaveric studies have demonstrated that the addition of suture tape augmentation to ACL autograft constructs can increase graft strength and reduce elongation under cyclical loading. PURPOSE/HYPOTHESIS This study aimed to investigate the clinical outcomes and rerupture rates after ACL reconstruction (ACLR) with suture tape augmentation. We hypothesized that augmentation with suture tape would lead to lower rerupture rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients undergoing primary ACLR using hamstring or patellar tendon autografts augmented with suture tape between 2015 and 2019 were recruited prospectively. Patients with multiligament injuries or a concomitant lateral extra-articular procedure were excluded. Patients were observed in person for 6 months, and patient-reported outcome measures (PROMs) were collected at 2 and 5 years postoperatively. All patients were contacted, and records were reviewed to determine the incidence of graft failure. PROMs collected were as follows: Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Tegner and Marx activity scores, and visual analog scale for pain (VAS). RESULTS A total of 97 patients, with a mean age of 34.7 (±13.4) years, were included (76% men; 52 hamstring and 45 patellar tendon grafts). The mean graft diameter was 8 (±1) mm. There was 1 rerupture (1.1%) out of the 90 patients who were contactable at a mean of 5 years postoperatively. Median KOOS scores at 2 years were as follows: Pain, 94; Symptoms, 86; Activities of Daily Living, 99; Sport and Recreation, 82; and Quality of Life, 81. The postoperative scores were significantly higher than the preoperative scores (P < .001). The VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remained at 56 at 5 years. The VAS pain, Tegner, and Marx scores were 0, 6, and 9, respectively, at 2 years postoperatively. There was no difference in PROMs between graft types. CONCLUSION This study demonstrates encouraging results of suture tape augmentation of autograft ACLR for both hamstring and patellar tendon grafts. The failure rate of 1.1% at a mean follow-up of 5 years is lower than published rates for reconstruction, and PROMs results are satisfactory. The technique is safe to use and may permit a return to the preinjury sporting level with a lower chance of reinjury.
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Affiliation(s)
- William T. Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
- Department of Orthopaedics, NHS Ayrshire & Arran, Glasgow, UK
| | | | - Douglas MacLeod
- Department of Orthopaedics, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Graeme P. Hopper
- Department of Orthopaedics, NHS Lanarkshire, Glasgow, UK
- Rosshall Hospital, Glasgow, UK
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Vaidya SR, Sharma SC, Al-Jabri T, Kayani B. Return to sport after surgical repair of the Achilles tendon. Br J Hosp Med (Lond) 2023; 84:1-14. [PMID: 37235667 DOI: 10.12968/hmed.2022.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Achilles tendon rupture is among the most common sports injuries. In patients with high functional demands, surgical repair is preferred to facilitate early return to sporting function. This article reviews the literature and provides evidence-based guidance for return to sport after operative management of Achilles tendon rupture. A search was performed using PubMed, Embase and Cochrane Library for all studies reporting on return to sport after operative management of Achilles tendon rupture. The review included 24 studies reporting on 947 patients, and found that 65-100% of patients were able to return to sport between 3 and 13.4 months post-injury, with incidence of rupture recurrence 0-5.74%. These findings will help patients and healthcare professionals plan a recovery timeline, discuss athletic functionality post-recovery, and understand complications of repair and risk of tendon re-rupture.
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Affiliation(s)
| | | | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
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Zhao X, Yang X, Hao Y, Yang F, Zhang Z, Qian Q, Fu P, Zhou Q. Treatment of Calcific Insertional Achilles Tendinopathy: Knotless Internal Brace versus Knot-Tying Suture Bridge. J Pers Med 2023; 13:jpm13030404. [PMID: 36983586 PMCID: PMC10059861 DOI: 10.3390/jpm13030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023] Open
Abstract
Background: This study aimed to compare the knotless internal brace technique and the knot-tying suture bridge technique via the medial approach in the treatment of calcific Achilles tendinopathy. Methods: The clinical data of 25 cases of calcific Achilles tendinopathy in which nonoperative treatments had failed were retrospectively collected. All the patients received Achilles tendon debridement and Haglund deformity excision through a medial approach, followed by repair using the knotless internal brace technique or the knot-tying suture bridge technique. Pain was evaluated by using the visual analog scale (VAS). The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire was administered preoperatively and postoperatively. Results: The mean follow-up time was 2.6 (range 2–3.5) years. There were no wound complications and no Achilles tendon ruptures. At 1 year postoperatively, the internal brace group was superior to the suture bridge group in terms of the VAS scores (p = 0.003). However, no differences were noticed between the two groups in either the VAS or the AOFAS scores at 2 years postoperatively. Conclusions: The medial approach in combination with the suture bridge technique was effective in treating calcific Achilles tendinopathy. The knotless internal brace technique involved less pain compared to the knot-tying suture bridge technique only at the early postoperative stage.
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Affiliation(s)
- Xiaodong Zhao
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Xiaolei Yang
- Department of Anesthesia, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Yifan Hao
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Fujun Yang
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Zhenping Zhang
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Qirong Qian
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Peiliang Fu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Qi Zhou
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
- Correspondence:
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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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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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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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Paterson-Byrne PA, Wilson WT, Hopper GP, MacKay GM. Primary repair of multiligament knee injury with InternalBrace ligament augmentation. BMJ Case Rep 2022; 15:e247173. [PMID: 34983813 PMCID: PMC8728444 DOI: 10.1136/bcr-2021-247173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/04/2022] Open
Abstract
Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.
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Clanton T, Stake IK, Bartush K, Jamieson MD. Minimally Invasive Achilles Repair Techniques. Orthop Clin North Am 2020; 51:391-402. [PMID: 32498958 DOI: 10.1016/j.ocl.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Achilles tendon rupture is an increasingly common problem with an aging population participating in high-level physical activities. Appropriate treatment has been debated for decades, but good outcomes have been reported after conservative and surgical management. The development of minimally invasive surgical techniques for Achilles repair has reduced the incidence of complications and maintained the high level of function reported after open surgery. The Achilles Midsubstance SpeedBridge repair is a newer minimally invasive technique that has demonstrated promising results and is the authors' preferred treatment of Achilles tendon rupture in athletes and active patients.
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Affiliation(s)
- Thomas Clanton
- Foot and Ankle Sports Medicine, The Steadman Clinic and Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Ingrid K Stake
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, Norway and Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
| | - Katherine Bartush
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Marissa D Jamieson
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
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Abstract
Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be defined to guide the rehabilitation of injured athletes.
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Affiliation(s)
- Jon-Michael E Caldwell
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH11-Center Wing, New York, NY 10032, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 622 West 168th Street, PH11-Center Wing, New York, NY 10032, USA.
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