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Zhao Y, Wang H, Zhao B, Diao S, Gao Y, Zhou J, Liu Y. The learning curve for minimally invasive Achilles repair using the "lumbar puncture needle and oval forceps" technique. BMC Musculoskelet Disord 2024; 25:373. [PMID: 38730376 PMCID: PMC11088138 DOI: 10.1186/s12891-024-07489-9] [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: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair. METHODS From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes. RESULTS Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly. CONCLUSION Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.
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Affiliation(s)
- Yanrui Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Binzhi Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Yuling Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
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Maffulli N, Sammaria G, Ziello S, Migliorini F, Oliva F. Percutaneous cruciate repair of ruptured Achilles tendon. J Orthop Surg Res 2023; 18:677. [PMID: 37700324 PMCID: PMC10496360 DOI: 10.1186/s13018-023-04167-9] [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: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, ST4 7QB, UK
| | - Giuliano Sammaria
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Salvatore Ziello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Francesco Oliva
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
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Chuckpaiwong B, Glisson RR, Usuelli FG, Madi NS, Easley ME. Biomechanical Comparison of Nonlocked Minimally Invasive and Locked Open Achilles Tendon Simulated Rupture Repairs. Foot Ankle Int 2023; 44:913-921. [PMID: 37329183 DOI: 10.1177/10711007231178819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Open repair of Achilles tendon ruptures is associated with a risk of infection and other wound complications. Although percutaneous repairs reduce these complications, they may increase the risk of nerve injury. This study was designed to determine whether a percutaneous nonlocking repair can approach the gapping resistance offered by a standard open repair under conditions approximating typical postoperative physiotherapy. METHODS Ten pairs of cadavers Achilles tendons were transected in situ 5 cm above the insertion. One tendon from each pair was repaired using an open 4-strand Krackow locking loop, and the contralateral tendon was repaired with the Achillon system using the same suture material. Displacement transducers were attached to the medial, lateral, anterior, and posterior aspects of the tendon, spanning the repair. Each tendon underwent 1000 tensile loading cycles to 86.5 N, simulating passive ankle range-of-motion physiotherapy. Gapping was documented on the 1st, 50th, 100th, 500th, and 1000th cycles. The ultimate tensile strength of each repaired tendon was then measured by distracting until gross failure occurred. RESULTS Gapping of the percutaneous repairs exceeded that of conventional open repairs on the first, 500th, and 1000th load cycles. All 10 conventionally repaired tendons withstood 1000 load cycles without gross failure, but 4 of 10 percutaneous minimally invasive repairs failed, one on the 9th load cycle and the others between the 100th and 500th cycles. On average, tendons repaired with the open technique withstood 66% greater tensile load in failure testing than those repaired with the percutaneous technique. CONCLUSION Open Krackow Achilles tendon repairs may better withstand more aggressive postoperative physiotherapy than nonlocked percutaneous repairs. CLINICAL RELEVANCE The study suggests that surgeons should consider locking suture approaches to avoid loss of repair integrity with early motion.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Naji S Madi
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Xu L, Jin J, Liu Z, Wu M, Peng B, Jiang J, Liu G, He J, White S, Xia Y. A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study. Orthop Surg 2022; 15:517-524. [PMID: 36573277 PMCID: PMC9891928 DOI: 10.1111/os.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Percutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure. METHODS Data of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive-combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner-Lindholm scale (A-L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2-year follow-up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded. RESULTS Twenty consecutive subjects with an average follow-up of 28.3 ± 4.5 months (range, 24-41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20-44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28-71) preoperatively to 97.8 ± 3.34 (range, 87-100) at the last follow-up. The A-L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10). CONCLUSIONS The results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.
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Affiliation(s)
- Lihu Xu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jiaxin Jin
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Zhongcheng Liu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Meng Wu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Bo Peng
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jin Jiang
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Guangyao Liu
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou University Second Hospital, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial IntelligenceLanzhouChina
| | - Jinwen He
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Sylvia White
- Department of PathologyYale University School of MedicineNew HavenCTUSA
| | - Yayi Xia
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
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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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Effect of Platelet-Rich Plasma Augmentation on Endoscopy-Assisted Percutaneous Achilles Tendon Repair. J Clin Med 2022; 11:jcm11185389. [PMID: 36143034 PMCID: PMC9501121 DOI: 10.3390/jcm11185389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Achilles tendon ruptures are one of the most common sports injuries. Recently, platelet-rich plasma (PRP) has been widely used in tendon-related disorders to enhance tendon healing. However, studies regarding PRP treatment in Achilles tendon rupture show inconsistent results. The purpose of this study was to evaluate the effectiveness of PRP in patients with acute Achilles tendon rupture treated with endoscopy-assisted percutaneous repair. Methods: A total of 62 patients with acute Achilles tendon rupture treated with surgical repair from January 2014 to December 2018 were enrolled in this study. Surgical repair in conjunction with PRP augmentation after surgery was classified as the PRP group. Surgical repair without PRP augmentation was classified as the non-PRP group. All patients were followed up at least 2 years post-operation. The outcomes were evaluated on the basis of rate of return to sports, time to return to play, Achilles Tendon Total Rupture Score (ATRS), calf circumference ratio, ankle range of motion (ROM) and complications following surgery. Results: At 2-year follow-up, the ATRS score was not significantly different between groups (p = 0.8), but the ATRS score in both groups improved with time. Rate of return to sports and time to return to play were not different between the two groups (p = 1.00). Moreover, calf circumference ratio and ankle ROM were evaluated at 6-month, 12-month, 18-month and 24-month follow-ups. At 6 months, the PRP group had better ankle ROM (p = 0.003) and a higher calf circumference ratio (p = 0.011); however, at the 24-month evaluation, there were no between-group differences regarding calf circumference ratio, ankle dorsiflexion and plantarflexion (p > 0.05). Conclusion: We show that PRP augmentation in Achilles tendon surgery did not yield superior functional and clinical outcomes. Therefore, clinicians should inform patients of the above information when undergoing Achilles tendon surgery and offer correct expectations to family and patients regrading PRP treatment.
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Abdelatif NMN, Batista JP. Outcomes of Percutaneous Achilles Repair Compared With Endoscopic Flexor Hallucis Longus Tendon Transfer to Treat Achilles Tendon Ruptures. Foot Ankle Int 2022; 43:1174-1184. [PMID: 35686445 DOI: 10.1177/10711007221096674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both percutaneous and endoscopically assisted methods are reported to produce good results in the surgical management of acute Achilles tendon ruptures. The aim of this retrospective study was to compare between a percutaneous method and a recently described isolated endoscopically assisted flexor hallucis longus (FHL) transfer method as surgical means of management in patients with acute Achilles tendon ruptures. METHODS One hundred seventeen patients were included in the current study and divided into 2 groups: 59 patients who underwent percutaneous Achilles repair (PAR Group) and 58 patients who underwent isolated endoscopic FHL transfer (FHL Group) were compared. Patients were clinically evaluated using American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score (ATRS), and Achilles tendon resting angle (ATRA) measures. In addition, ankle plantarflexion power, FHL dynamometry, Tegner activity levels, and return to previous levels of activity were also documented for all patients. RESULTS Nine months after surgery, patients in the FHL transfer group were more likely to be able to return to normal activities (91% vs 73%, P < .01). Thirty months after surgical treatment, we found no difference in ATRS, AOFAS, ATRA, ankle plantarflexion strength, or Tegner activity scores between study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PAR group (13.6%). No major neurovascular or skin complications were encountered. CONCLUSION The current study demonstrated satisfactory and comparable results and complications when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures. LEVEL OF EVIDENCE Level III, retrospective controlled trial.
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Affiliation(s)
| | - Jorge Pablo Batista
- Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista, Ciudad Autónoma de Buenos Aires, Argentina.,Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
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Jun L, Hao Y, Junfeng Z, Jisen Z, Xinzhong X, Yunfeng Y, Dasheng T, Jia X. Comparison of Ma-Griffith combined with a minimally invasive small incision to a modified suture technique for the treatment of acute achilles tendon ruptures. BMC Musculoskelet Disord 2022; 23:822. [PMID: 36042433 PMCID: PMC9425948 DOI: 10.1186/s12891-022-05769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The Achilles tendon is the strongest tendon in the human body, although it is also prone to injury and rupture. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. The aim of this study was to compare the efficacy of the Ma-Griffith method combined with a minimally invasive small incision (M-G/MISI) with the modified suture technique (MST). Methods We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analyzed to compare the treatment efficacy of the two operative methods. Results A total of 67 patients were enrolled in the study, 34 of whom underwent M-G/MISI treatment, and 33 of whom underwent MST treatment. The intraoperative blood loss in the M-G/MISI group (16.47 ± 13.23 ml) was significantly lower than that in the MST group (34.55 ± 13.01 ml), and the difference was statistically significant (P ˂0.001). The incision in the M-G/MISI group (3.79 ± 1.81 cm) was significantly shorter than that in the MST group (5.79 ± 1.00 cm), and the difference was statistically significant (P˂0.001). The Achilles tendon rupture score and the American Orthopedic Foot and Ankle Society (AOFAS) score were higher than those of the MST group at the sixth month after the operation (P˂0.001). Postoperatively, there was 1 case of traumatic Achilles tendon rupture in the M-G/MISI group and 1 case each of infection and deep vein thrombosis in the modified suture group. Conclusions Compared with the MST group, the M-G/MISI group had better Achilles tendon and ankle function scores at 6 months postoperatively, and less bleeding and shorter incisions. M-G/MISI is less invasive than MST.
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Affiliation(s)
- Li Jun
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Yu Hao
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Zhan Junfeng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Zhang Jisen
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Xu Xinzhong
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Yao Yunfeng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Tian Dasheng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Xie Jia
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China.
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Oliva F, Marsilio E, Asparago G, Giai Via A, Biz C, Padulo J, Spoliti M, Foti C, Oliva G, Mannarini S, Rossi AA, Ruggieri P, Maffulli N. Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study. J Clin Med 2022; 11:jcm11133698. [PMID: 35806982 PMCID: PMC9267833 DOI: 10.3390/jcm11133698] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Materials and methods: Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. Results: “Return to work activities/sport” was negatively predicted by the presence of a metabolic disorder (β = −0.451; OR = 0.637) and ‘open’ surgery technique (β = −0.389; OR = 0.678). “Medical complications” were significantly predicted by metabolic disorders (β = 0.600 (0.198); OR = 1.822) and was negatively related to ‘mini-invasive’ surgery (i.e., not ‘open’ nor ‘percutaneous’) (β = −0.621; OR = 0.537). “Immediate weightbearing” and “immediate walking without assistance” were negatively predicted by ‘open’ technique (β = −0.691; OR = 0.501 and β = −0.359 (0.174; OR = 0.698)). Conclusions: Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- Correspondence: ; Tel.: +39-3465115396
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Carlo Biz
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy;
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, 00133 Rome, Italy;
| | - Gabriella Oliva
- Department of Internal Medicine, Ospedale del Mare, ASL1, 80147 Napoli, Italy;
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
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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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11
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Nilsson N, Gunnarsson B, Carmont MR, Brorsson A, Karlsson J, Nilsson Helander K. Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques. Knee Surg Sports Traumatol Arthrosc 2022; 30:2477-2484. [PMID: 35396938 PMCID: PMC9206609 DOI: 10.1007/s00167-022-06943-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/08/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps. METHOD Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34-73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12 months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work. RESULTS The patients reported a median (range) ATRS of 76 (45-99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40-61°), p < 0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2-22) compared with 26 (2-27), (p < 0.001), and a median (range) heel-rise height of 5.5 cm (1.0-11.0 cm) compared with 9.0 cm (5.0-11.5 cm), (p < 0.001). The median calf circumference was 1.5 cm smaller on the injured side, 37.5 cm compared with 39 cm, when medians were compared. The median (range) tendon length of the injured side was 24.8 cm (20-28.2 cm) compared with 22 cm (18.4-24.2 cm), (p < 0.001), on the non-injured side. CONCLUSION The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Baldvin Gunnarsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael R. Carmont
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80 Gothenburg, Sweden ,grid.415251.60000 0004 0400 9694Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Shropshire, UK
| | - Annelie Brorsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80 Gothenburg, Sweden ,IFK Kliniken Rehab, Gothenburg, Sweden
| | - Jón Karlsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Katarina Nilsson Helander
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, Mölndal, 431 80 Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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12
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Maffulli N, Oliva F, Migliorini F. Check-rein technique for Achilles tendon elongation following conservative management for acute Achilles tendon ruptures: a two-year prospective clinical study. J Orthop Surg Res 2021; 16:690. [PMID: 34819119 PMCID: PMC8611836 DOI: 10.1186/s13018-021-02830-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background Following conservative management for acute Achilles tendon (AT) ruptures, the tendon may heal in continuity, and some patients may present with an elongated Achilles tendon–gastrosoleus complex. This study investigated the efficacy and feasibility of a novel minimally invasive technique, which we named “check-rein procedure”, in patients with intact and elongated AT following conservative management for AT ruptures. Methods All patients who underwent the check-rein procedure for elongation of the gastrosoleus–AT complex by one experienced surgeon were prospectively enrolled. The AT resting angle (ATRA) and AT rupture score (ATRS) were assessed at baseline and repeated at 2-year follow-up, as were calf circumference and isometric plantarflexion strength of both ankles. Results Forty-three patients (43 procedures) were analysed. The mean time elapsed from injury to surgery was 28.7 ± 7.9 weeks. The mean age at surgery was 38.5 ± 5.7 years. At the last follow-up, ATRS, ATRA, isometric strength difference, and calf circumference of the affected side were increased (P < 0.0001). The rate of the return to sport was 98% (42 of 43). No wound complications or rupture were experienced by any patient. Conclusion The check-rein technique for AT elongation after conservative management of AT tears is effective and feasible to restore tendon length and calf function. The surgical outcome was influenced by the preoperative performance status, and longer time elapsed from injury to surgery worsens the outcomes.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
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Jaibaji M, Jaibaji R, Volpin A. Mesenchymal Stem Cells in the Treatment of Cartilage Defects of the Knee: A Systematic Review of the Clinical Outcomes. Am J Sports Med 2021; 49:3716-3727. [PMID: 33555942 DOI: 10.1177/0363546520986812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral lesions are a common clinical problem and their management has been historically challenging. Mesenchymal stem cells have the potential to differentiate into chondrocytes and thus restore hyaline cartilage to the defect, theoretically improving clincal outcomes in these patients. They can also be harvested with minimal donor site morbidity. PURPOSE To assess the clinical and functional outcomes of mesenchymal stem cell implantation to treat isolated osteochondral defects of the knee. A secondary purpose is to assess the quality of the current available evidence as well as the radiological and histological outcomes. We also reviewed the cellular preparation and operative techniques for implantation. STUDY DESIGN Systematic review. METHODS A comprehensive literature search of 4 databases was carried out: CINAHL, Embase, MEDLINE, and PubMed. We searched for clinical studies reporting the outcomes on a minimum of 5 patients with at least 12 months of follow-up. Clinical, radiological, and histological outcomes were recorded. We also recorded demographics, stem cell source, culture technique, and operative technique. Methodological quality of each study was assessed using the modified Coleman methodology score, and risk of bias for the randomized controlled studies was assessed using the Cochrane Collaboration tool. RESULTS Seventeen studies were found, encompassing 367 patients. The mean patient age was 35.1 years. Bone marrow was the most common source of stem cells utilized. Mesenchymal stem cell therapy consistently demonstrated good short- to medium-term outcomes in the studies reviewed with no serious adverse events being recorded. There was significant heterogeneity in cell harvesting and preparation as well as in the reporting of outcomes. CONCLUSION Mesenchymal stem cells demonstrated a clinically relevant improvement in outcomes in patients with osteochondral defects of the knee. More research is needed to establish an optimal treatment protocol, long-term outcomes, and superiority over other therapies. REGISTRATION CRD42020179391 (PROSPERO).
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Affiliation(s)
- Monketh Jaibaji
- Division of Interventional Sciences, University College London, London, UK
| | - Rawan Jaibaji
- Division of Interventional Sciences, University College London, London, UK
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14
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Li Y, Jiang Q, Chen H, Xin H, He Q, Ruan D. Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture. BMC Musculoskelet Disord 2021; 22:914. [PMID: 34717595 PMCID: PMC8556965 DOI: 10.1186/s12891-021-04802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background To reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture. Methods From January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated. Results The mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000). Conclusions Acute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy. Study design Case-control studies, Level of evidence, 3. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04802-8.
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Affiliation(s)
- Yong Li
- Department of Orthopedics Surgery, The 6th Medical Center of Chinese PLA General Hospital, No. 6, Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
| | - Qiang Jiang
- Department of Orthopedics Surgery, The 6th Medical Center of Chinese PLA General Hospital, No. 6, Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100048, People's Republic of China
| | - Hongkui Xin
- Department of Orthopedics Surgery, The 6th Medical Center of Chinese PLA General Hospital, No. 6, Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Qing He
- Department of Orthopedics Surgery, The 6th Medical Center of Chinese PLA General Hospital, No. 6, Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Dike Ruan
- Department of Orthopedics Surgery, The 6th Medical Center of Chinese PLA General Hospital, No. 6, Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
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15
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Biz C, Cerchiaro M, Belluzzi E, Bragazzi NL, De Guttry G, Ruggieri P. Long Term Clinical-Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig. ACTA ACUST UNITED AC 2021; 57:medicina57101073. [PMID: 34684110 PMCID: PMC8537444 DOI: 10.3390/medicina57101073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical-functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical-functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle-Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical-functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Giacomo De Guttry
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
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16
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Saxena A, Maffulli N, Jin A, Isa E, Arthur WP, Asthana S. Acute Achilles Tendon Rupture Repair in Athletically Active Patients: Results on 188 Tendons. J Foot Ankle Surg 2021; 60:935-940. [PMID: 33947591 DOI: 10.1053/j.jfas.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 02/03/2023]
Abstract
We report on the outcome of acute Achilles tendon ruptures by a single surgeon using open and percutaneous techniques was performed. This prospective study included 186 patients with 188 ruptured Achilles tendons. A traditional open technique was primarily performed on patients from January 2001 to December 2011. From January 2012 to January 2018, a percutaneous repair was primarily performed. Outcome measures included the Roles and Maudsley (RM) score, ability to perform a single leg heel raise, calf atrophy and return to activity. There were 149 males (average age 42.5 ± 12.7 years) and 39 females (average age 41.7 ± 11.4 years). Of the 188 ruptured tendons (92 repairs on the right Achilles and 96 on the left), 103 were repaired percutaneously and 85 had open repairs. There were 18 (9.6%) complications. Three re-ruptures occurred, one following open and two following percutaneous repairs, all within 12 weeks of the original repair. Two patients developed a Venousthromboembolism (1.0%). Thirteen patients had suture reactions; three infections (1.6%), 11 wound complications (5.8%), and 3 required surgical excision of the suture material (1.6%). Non-absorbable sutures were associated with more wound complications and were more frequently used in open repairs (p = .003). Patients who underwent open repair experienced more wound complications (p = .0001). Patients who underwent percutaneous repair using absorbable suture experienced a lower rate of overall complications (p = .0007). Basketball (n = 29) was the most common sport during which ruptures occurred. Return to activity (RTA) was 8.2 ± 2.9 months. There was no difference for RTA between males and females (p = .54) and RM scores (p= .69), nor surgical technique, and no difference for RTA based on the desired activity (p = .47). 123 of the 188 patients returned to their desired activity (65.5%). There was a statistically significant evidence of a positive association between inability to perform heel-raises and decreased activity (p = .01).
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| | - Anqi Jin
- PAMF Research Institute, Researcher, Palo Alto, CA
| | | | | | - Saumya Asthana
- Rosalind Franklin University, Scholl College, Chicago IL
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17
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Ma Y, Meng X, Su Y, Yan Z, Shao Q, Chen Y. Evaluation of a Modified Spoon-Shaped Medial Incision in the Surgical Repair of a Chronic Achilles Tendon Rupture. J Foot Ankle Surg 2021; 60:729-732. [PMID: 33773920 DOI: 10.1053/j.jfas.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
This study aims to investigate the clinical significance of preventing incision skin necrosis and the improved function offered in patients with a chronic Achilles tendon rupture treated surgically with a modified spoon-shaped medial incision. From January 2013 to January 2017, 50 patients (N = 50) who were admitted to our department with a clinically and radiologically confirmed chronic Achilles tendon rupture met inclusion criteria and were divided retrospectively into two groups. In group A (n = 26), a modified spoon-shaped medial incision in the surgical repair of Achilles tendon rupture was performed. In group B (n = 24), a traditional posterior medial incision was used. All skin healing was observed. Functional evaluation was performed using American Orthopedic Ankle & Foot Society scale(AOFAS) hindfoot score and Achilles tendon total rupture score(ATRS). Return-to-work time and major complications were also measured. The patients were followed for 12 to 48 months. All incisions exhibited primary healing in group A, while four incisions healed delay for skin necrosis which includes superficial, deeper necrosis, and skin defection caused by the necrosis in group B. Both groups had similar results regarding return-to-work time. There were no infections in either group. There was no rerupture of the Achilles tendon in either group. Patients in group A had better AOFAS hindfoot score (p = .020) and ATRS (p = .010), and the difference was significant (p ≤ .05).Using the modified spoon-shaped medial incision in the surgical repair of a chronic Achilles tendon rupture seems to be a safe and effective method that may reduce risk of incision skin necrosis and offers better function in patients with a chronic Achilles tendon rupture.
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Affiliation(s)
- Yanming Ma
- Surgeon, Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Xiangjun Meng
- Professor, Department of Ophthalmology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Yun Su
- Professor, Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China.
| | - Zuofa Yan
- Surgeon, Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Quansheng Shao
- Surgeon, Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Yiqing Chen
- Surgeon, Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
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18
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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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19
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Naldo J, Agnew P, Brucato M, Dayton P, Shane A. ACFAS Clinical Consensus Statement: Acute Achilles Tendon Pathology. J Foot Ankle Surg 2021; 60:93-101. [PMID: 33199168 DOI: 10.1053/j.jfas.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/29/2020] [Indexed: 02/03/2023]
Abstract
Injuries to the Achilles tendon are a challenge to the foot and ankle surgeon. In recent years, research has led to a relative change in the way that many surgeons view acute Achilles tendon rupture. In an effort to fully evaluate these trends, as well as to evaluate all aspects of care for acute Achilles tendon rupture, the American College of Foot and Ankle Surgeons convened a panel of experts to create a clinical consensus statement to address selected aspects of care of the acute Achilles tendon injury.
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Affiliation(s)
- Jason Naldo
- Chairperson, ACFAS Acute Achilles Tendon Pathology Clinical Consensus Statement, Chicago, IL; Assistant Professor, Department of Orthopaedics, Virginia Tech Carilion School of Medicine, Roanoke, VA; Foot and Ankle Surgeon, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA.
| | - Patrick Agnew
- Director of Podiatric Medical and Surgical Education, Associate Professor, Eastern Virginia Medical School, Norfolk, VA
| | | | - Paul Dayton
- Private Practice, Foot & Ankle Center of Iowa, Ankeny, IA
| | - Amber Shane
- Chair, Department of Podiatric Surgery, Advent Health System, Orlando, FL; Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
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20
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Batista JP, Abdelatif NMN, Del Vecchio JJ, Diniz P, Pereira H. Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months' Follow-Up. J Foot Ankle Surg 2021; 59:927-937. [PMID: 32527698 DOI: 10.1053/j.jfas.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 02/03/2023]
Abstract
Acute Achilles tendon rupture can be treated either surgically or nonsurgically. The flexor hallucis longus (FHL) has been used successfully in patients with large chronic Achilles tendon defects. The aim of this study was to describe the clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a minimum follow-up of 18 months. Fifty-six male patients with an average age of 36.3 years who underwent endoscopic FHL transfer as a treatment for acute Achilles tendon ruptures were included. Follow-up was for a mean (± standard deviation) of 27.5 ± 7.29 months. At 18 months postoperatively, the Achilles tendon total rupture score mean was 95 ± 4.26, and the American Orthopaedic Foot and Ankle Society score was a mean of 96.4 ± 4.31. The median value for FHL tendon dynamometry on the surgical side was 95.72 (range 70.1 to 142), and 100.7 (range 68 to 161) for the nonoperated side. Mean ankle plantarflexion strength at 18 months was 19.19 ± 2.55 kg • m compared with the uninjured side of 19.27 ± 2.16 kg • m. Relative Achilles tendon resting angle showed a mean of -0.25° ± 2.43°. Magnetic resonance imaging performed at a minimum of 18 months postoperatively showed a homogeneous continuous Achilles tendon signal for 43 patients and heterogeneous signal intensity in 13 patients (23.21%). No patients reported any great toe complaints or symptomatic deficits of flexion strength. No neurovascular or skin complications were encountered. The current study demonstrated satisfactory and comparable results with minimal complications when using the endoscopic FHL tendon transfer in surgical management of acute Achilles tendon ruptures, compared with the currently used methods.
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Affiliation(s)
- Jorge Pablo Batista
- Head, Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Buenos Aires, Argentina; Head, Soccer Medical Department, Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
| | | | - Jorge Javier Del Vecchio
- Head, Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro. Hospital Universitario, Buenos Aires, Argentina; Professor, Department of Kinesiology and Physiatry, Universidad Favaloro, Buenos Aires, Argentina
| | - Pedro Diniz
- Orthopaedic Surgeon, Hospital de Sant'Ana, Parede, Portugal; PhD Student, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Helder Pereira
- Orthopedic Surgeon, Orthopedic Department of Póvoa de Varzim, Ripoll y De Prado Sports Clinic, Murcia-Madrid, Spain; Orthopedic Surgeon, FIFA Medical Centre of Excellence; ICVS/3B's, PT Government Associate Laboratory, Porto, Portugal; Orthopedic Surgeon, ICVS/3B's, PT Government Associate Laboratory - Minho University, Braga, Portugal
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21
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Bryant SA, Trang G, Nash HM, Gardner BB, Kim JY, Park HY, Chakrabarti M, McGahan P, Chen JL. Mini-Open Achilles Repair With a Flat Braided Suture in a Low-Profile Configuration. Arthrosc Tech 2021; 10:e451-e455. [PMID: 33680778 PMCID: PMC7917089 DOI: 10.1016/j.eats.2020.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Achilles repair has evolved over the past 30 years, from large open procedures with high complication rates to shorter, less-invasive procedures with better outcomes. Percutaneous repair has comparable failure rates with open repairs, fewer complications, and faster recovery. However, percutaneous Achilles repairs risk sural nerve injury. A mini-open repair fuses the gap between percutaneous and open procedures, and this approach has the potential to mitigate nerve injury while maintaining the increased efficiency in procedure time and patient recovery. The purpose of this Technical Note and accompanying video is to outline the repair of the Achilles tendon using a mini open repair using a low-profile flat braided suture.
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Affiliation(s)
- Stewart A. Bryant
- Address correspondence to Stewart A. Bryant, M.D., Advanced Orthopaedics and Sports Medicine, 450 Sutter St., Ste 400, San Francisco, CA 94108.
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22
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Wang X, Liu H, Li D, Luo Z, Li Y, Zhang F. Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years. BMC Musculoskelet Disord 2020; 21:580. [PMID: 32847567 PMCID: PMC7450602 DOI: 10.1186/s12891-020-03588-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to compare the operative outcome of percutaneous repair (modified Bunnell suture technique) versus open repair (bundle-to-bundle suture technique) of acute Achilles tendon rupture. METHODS Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated in this prospective study. Thirty-six patients were treated using the bundle-to-bundle suture technique (group A), and 36 patients were treated using the modified Bunnell suture technique (group B). All patients underwent functional examination comprising measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides on magnetic resonance imaging. The number of single-leg heel rises (height > 5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome at 12 months postoperatively. RESULTS A total of 61 patients were followed up. The mean follow-up duration did not significantly differ between group A (23.73 ± 2.81 months) and group B (22.61 ± 3.96 months). However, there were significant differences between groups in the heel-rise test (group A, 1.74 ± 0.96; group B, 2.37 ± 1.42) and length of the Achilles tendon (group A, 11.98 ± 1.64 cm; group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in group A than in group B (p = 0.043). The cross-sectional diameter of the Achilles tendon was significantly smaller in group A than group B. At final follow-up, there were no significant differences between the two groups in the ATRS, AOFAS score, or VAS score. One patient in group A had delayed wound healing, which resolved in 40 days. CONCLUSIONS Patients with acute Achilles tendon rupture treated with open repair (bundle-to-bundle suture technique) achieved a better clinical outcome regarding the heel-rise test and calf circumference compared with those treated with percutaneous repair (modified Bunnell suture technique). TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2000035229 , 8/4/2020, Retrospectively registered.
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Affiliation(s)
- Xiaomeng Wang
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Huixin Liu
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Dengke Li
- Hebei Province General Hospital, 384 West Heping Road, Shijiazhuang, 050000, Hebei, China
| | - Zixuan Luo
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yansen Li
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fengqi Zhang
- Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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23
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Locke RC, Lemmon EA, Dudzinski E, Kopa SC, Wayne JM, Soulas JM, De Taboada L, Killian ML. Photobiomodulation does not influence maturation and mildly improves functional healing of mouse achilles tendons. J Orthop Res 2020; 38:1866-1875. [PMID: 31965620 PMCID: PMC8637462 DOI: 10.1002/jor.24592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Tendon rupture can occur at any age and is commonly treated nonoperatively, yet can result in persisting symptoms. Thus, a need exists to improve nonoperative treatments of injured tendons. Photobiomodulation (PBM) therapy has shown promise in the clinic and is hypothesized to stimulate mitochondrial-related metabolism and improve healing. However, the effect of PBM therapy on mitochondrial function during tendon maturation and healing are unknown, and its effect on tendon structure and function remain unclear. In this study, near-infrared light (980:810 nm blend, 2.5 J/cm2 ) was applied at low (30 mW/cm2 ) or high (300 mW/cm2 ) irradiance to unilateral Achilles tendons of CD-1 mice during postnatal growth (maturation) as well as adult mice with bilateral Achilles tenotomy (healing). The chronic effect of PBM therapy on tendon structure and function was determined using histology and mechanics, and the acute effect of PBM therapy on mitochondrial-related gene expression was assessed. During maturation and healing, collagen alignment, cell number, and nuclear shape were unaffected by chronic PBM therapy. We found a sex-dependent effect of PBM therapy during healing on mechanical outcomes (eg, increased stiffness and Young's modulus for PBM-treated females, and increased strain at ultimate stress for PBM-treated males). Mitochondria-related gene expression was marginally influenced by PBM therapy for both maturation and healing studies. This study was the first to implement PBM therapy during both growth and healing of the murine tendon. PBM therapy resulted in marginal and sex-dependent effects on the murine tendon. Clinical significance: PBM may be beneficial for tendon healing because functional remodeling improves without adverse effects.
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Affiliation(s)
- Ryan C. Locke
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Elisabeth A. Lemmon
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Ellen Dudzinski
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Sarah C. Kopa
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Julianna M. Wayne
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Jaclyn M. Soulas
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | | | - Megan L. Killian
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
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Veronesi F, Giavaresi G, Bellini D, Casagranda V, Pressato D, Fini M. Evaluation of a new collagen-based medical device (ElastiCo®) for the treatment of acute Achilles tendon injury and prevention of peritendinous adhesions: An in vitro biocompatibility and in vivo investigation. J Tissue Eng Regen Med 2020; 14:1113-1125. [PMID: 32592610 DOI: 10.1002/term.3085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 01/05/2023]
Abstract
Tendon healing still represents a challenge for clinicians because it is slow and incomplete. The most injured is the Achilles tendon, and surgery is the therapeutic strategy often adopted because it provides a quicker functional recovery. Peritendinous adhesions are the main complication of surgery with hyperplasia and chemotaxis of fibroblasts. A biomaterial that blocks fibroblast migration, without interfering with the passage of cytokines and growth factors, might be useful. The present study evaluated the biocompatibility of a new Type I collagen-based scaffold (ElastiCo®) and its ability to promote Achilles tendon healing, inhibiting adhesion formation. After verifying in vitro biocompatibility, physical, and mechanical properties of the scaffold, an in vivo study was performed in 28 rats, operated to induce an acute lesion in both Achilles tendons. One tendon was treated with the suture only and the contralateral one with suture wrapped with ElastiCo® film. After 8 and 16 weeks, it was observed that ElastiCo® reduced internal and external peritendinous adhesions and Collagen III content and increased Collagen I. Elastic modulus increased with both treatments over time. Current results highlighted the clinical translationality of ElastiCo® that could improve the quality of life in patients affected by Achilles tendon lesions surgically treated.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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25
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Makulavičius A, Mazarevičius G, Klinga M, Urmanavičius M, Masionis P, Oliva XM, Uvarovas V, Porvaneckas N. Outcomes of open "crown" type v. percutaneous Bunnell type repair of acute Achilles tendon ruptures. Randomized control study. Foot Ankle Surg 2020; 26:580-584. [PMID: 31548150 DOI: 10.1016/j.fas.2019.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal treatment of acute Achilles tendon ruptures (AATR) is still under debate. The purpose of this study was to evaluate outcomes of open repair comparing with percutaneous procedure for AATR. METHODS 100 patients with AATR were randomized in two groups: open "crown" type (group A) and percutaneous Bunnell type repair (group B). 87 patients were available for the mean follow up of 27months RESULTS: No statistically significant difference was observed between groups in ATRS score, leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. CONCLUSIONS Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.
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Affiliation(s)
- Aleksas Makulavičius
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania.
| | - Giedrius Mazarevičius
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
| | - Mindaugas Klinga
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
| | - Matas Urmanavičius
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
| | - Povilas Masionis
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
| | - Xavier Martin Oliva
- Barcelona University, Faculty of Medicine, Department of Embriology and Human Anatomy, Barcelona, Spain
| | - Valentinas Uvarovas
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
| | - Narūnas Porvaneckas
- Vilnius University, Faculty of Medicine, Clinic of Rheumatology, Traumatology Orthopaedic and Reconstructive Surgery, Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Šiltnamių g. 29, LT-04130 Vilnius, Lithuania
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26
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Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study. Eur J Trauma Emerg Surg 2020; 47:2049-2054. [DOI: 10.1007/s00068-020-01376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
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27
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Maffulli N, D'Addona A, Maffulli GD, Gougoulias N, Oliva F. Delayed (14-30 Days) Percutaneous Repair of Achilles Tendon Ruptures Offers Equally Good Results As Compared With Acute Repair. Am J Sports Med 2020; 48:1181-1188. [PMID: 32176527 DOI: 10.1177/0363546520908592] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Minimally invasive repair of acute Achilles tendon ruptures has been performed for several years, resulting in reduced morbidity as compared with open repair. HYPOTHESIS A minimally invasive technique can be used to manage Achilles tendon ruptures in patients presenting between 14 and 30 days from injury. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We prospectively recruited 21 consecutive patients who presented between 14 and 30 days after the index injury, and we compared them with 21 patients who were matched according to sex, age (±2 years), and level of activity, who presented within 14 days of the index injury. All patients underwent the same minimally invasive procedure under local anesthesia: a core suture repair consisting of a modified Bunnell suture in the proximal stump and a modified Kessler suture in the distal stump. RESULTS At 12 months after minimally invasive repair, patients with delayed treatment had a median Achilles tendon rupture score of 91 (SD, 2.4; range, 87-96) as compared with 91 (SD, 2.2; range, 86-96) in patients treated acutely, who presented at a median 2.4 days (range 1-6 days) from the injury. There were no significant differences between groups in terms of mean (SD) Achilles tendon resting angle: delayed repair group, -3.9° (2.0); acute repair group, -3.7° (1.9) (P = .69). No patient in either group developed a wound infection. One patient in the acute group experienced an iatrogenic sural nerve injury. CONCLUSION Patients with Achilles tendon rupture treated by percutaneous repair 14 to 30 days after injury achieved similar results at 1 year as patient treated <14 after injury.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, UK.,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Alessio D'Addona
- Department of Public Health, Section of Orthopaedics and Trauma Surgery, School of Medicine and Surgery "Federico II," Naples, Italy
| | | | - Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK.,Foot Surgery Private Practice, Thessaloniki and Athens, Greece
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy
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28
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Maffulli N, Peretti GM. Treatment decisions for acute Achilles tendon ruptures. Lancet 2020; 395:397-398. [PMID: 32035536 DOI: 10.1016/s0140-6736(19)33133-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke-on-Trent, UK.
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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29
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Koltsov JCB, Gribbin C, Ellis SJ, Nwachukwu BU. Cost-effectiveness of Operative Versus Non-operative Management of Acute Achilles Tendon Ruptures. HSS J 2020; 16:39-45. [PMID: 32015739 PMCID: PMC6974171 DOI: 10.1007/s11420-019-09684-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The management of acute Achilles tendon ruptures is controversial, and most injuries are treated with surgery in the USA. The cost utility of operative versus non-operative treatment of acute Achilles tendon injury is unclear. QUESTIONS/PURPOSES The purpose of this study was to compare the cost-effectiveness of operative versus functional non-operative treatment of acute Achilles tendon ruptures. METHODS A Markov cost-utility analysis was conducted from the societal perspective using a 2-year time horizon. Hospital costs were derived from New York State billing data, and physician and rehabilitation costs were derived from the Medicare physician fee schedule. Indirect costs of missed work were calculated using estimates from the US Bureau of Labor Statistics. Rates of re-rupture, major and minor complications, and the associated costs were obtained from the literature. Effectiveness was expressed in quality-adjusted life years (QALYs). For the base-case analysis, operative and non-operative patients were assumed to have the same utilities (quality of life) following surgery. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of model assumptions. RESULTS In the base-case model, non-operative management of acute Achilles tendon ruptures dominated operative management, resulting in both lower costs and greater QALY gains. The differences in costs and effectiveness were relatively small. The benefit of non-operative treatment was 1.69 QALYs, and the benefit of operative treatment was 1.67 QALYs. Similarly, the total cost of operative and non-operative management was $13,936 versus $13,413, respectively. In sensitivity analyses, surgical costs and days of missed work were important drivers of cost-effectiveness. If hospitalization costs dropped below $2621 (compared with $3145) or the hourly wage rose above $29 (compared with $24), then operative treatment became a cost-effective strategy at the willingness-to-pay threshold of $50,000/QALY. The model results were also highly sensitive to the relative utilities for operative versus non-operative treatment. If non-operative utilities decreased relative to operative utilities by just 2%, then operative management became the dominant treatment strategy. CONCLUSION For acute Achilles tendon ruptures, non-operative treatment provided greater benefits and lower costs than operative management in the base case; however, surgical costs and the economic impact associated with return to work are important determinants of the preferred cost-effective strategy.
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Affiliation(s)
- Jayme C. B. Koltsov
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063 USA
| | - Caitlin Gribbin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Scott J. Ellis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benedict U. Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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30
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Zellers JA, Cortes DH, Pohlig RT, Silbernagel KG. Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:2831-2839. [PMID: 30415387 PMCID: PMC6510650 DOI: 10.1007/s00167-018-5277-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimizing tendon structural recovery during the first 12 weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound-based, tendon-specific measures and to identify relationships between tendon structural characteristics and clinical measures of gait and strength. METHODS Twenty-seven participants (21 males, mean (SD) age 39 (11) years) were assessed at 4, 8, 12, and 24 weeks after injury or surgery using ultrasound imaging techniques. Gait analysis and strength testing were added at the later time points. RESULTS Ruptured tendons had significantly lower dynamic shear modulus (p < 0.001), greater tendon cross-sectional area (p < 0.001), and greater length (p < 0.001) than the uninjured side. Dynamic shear modulus, cross-sectional area, and length were found to increase over time (p < 0.01). Tendon structure at 4 weeks post-injury [cross-sectional area symmetry (r = 0.737, p = 0.002) and dynamic shear modulus (r = 0.518, p = 0.040)] related to stance phase walking symmetry at 24 weeks. CONCLUSIONS Tendon structure assessed by ultrasound imaging changes over the first 24 weeks of healing after Achilles tendon rupture, suggesting it could be used as a biomarker to track tendon healing early in recovery. Additionally, tendon structure within the first 12 weeks relates to later walking gait and heel-rise symmetry, which may indicate that tendon structure could have prognostic value in the care of these patients. This study's clinical relevance is in its support for using ultrasound imaging to assess early patient healing and prognosticate later patient outcomes after Achilles tendon rupture. LEVEL OF EVIDENCE Level 2, prospective cohort prognostic study.
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Affiliation(s)
- Jennifer A Zellers
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA, USA
| | - Ryan T Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA.
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Manegold S, Tsitsilonis S, Gehlen T, Kopf S, Duda GN, Agres AN. Alterations in structure of the muscle-tendon unit and gait pattern after percutaneous repair of Achilles tendon rupture with the Dresden instrument. Foot Ankle Surg 2019; 25:529-533. [PMID: 30321951 DOI: 10.1016/j.fas.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Functional deficits after Achilles tendon (AT) ruptures are observed. The relationship between musculotendinous structural alterations and functional outcome is not clear. METHODS Kinematic analyses (level walking, stair climbing), patient-reported outcome measures (PROMs), calf atrophy (maximum calf circumference (MCC)), and AT length were evaluated in patients after percutaneous AT repair with the Dresden instrument (n=20min. FOLLOW-UP 24 months). RESULTS Patients achieved good results in PROMs. However, MCC decreased significantly and AT length increased significantly postoperatively. Side-to-side MCC differences over 2cm resulted in significantly lower PROMs. AT lengthening correlated with increased dorsiflexion and decreased plantarflexion. CONCLUSION Calf atrophy and AT lengthening after minimally invasive AT repair resulted in inferior ankle kinematics and PROMs.
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Affiliation(s)
- Sebastian Manegold
- Charité - University Medicine Berlin, Center for Musculoskeletal Surgery, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Serafim Tsitsilonis
- Charité - University Medicine Berlin, Center for Musculoskeletal Surgery, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies/BSRT, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Gehlen
- Charité - University Medicine Berlin, Center for Musculoskeletal Surgery, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sebastian Kopf
- Charité - University Medicine Berlin, Center for Musculoskeletal Surgery, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georg N Duda
- Berlin-Brandenburg Center for Regenerative Therapies/BSRT, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alison N Agres
- Berlin-Brandenburg Center for Regenerative Therapies/BSRT, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Stavenuiter XJR, Lubberts B, Prince RM, Johnson AH, DiGiovanni CW, Guss D. Postoperative Complications Following Repair of Acute Achilles Tendon Rupture. Foot Ankle Int 2019; 40:679-686. [PMID: 30808187 DOI: 10.1177/1071100719831371] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of-and specific risk factors associated with-postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. METHODS Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. RESULTS Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. CONCLUSION Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- X J Ruben Stavenuiter
- 1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Boston MA, USA
| | - Bart Lubberts
- 1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Boston MA, USA
| | - Robert M Prince
- 1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Boston MA, USA
| | - A Holly Johnson
- 2 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Newton-Wellesley Hospital, MA, USA
| | - Christopher W DiGiovanni
- 2 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Newton-Wellesley Hospital, MA, USA
| | - Daniel Guss
- 2 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital - Harvard Medical School, Newton-Wellesley Hospital, MA, USA
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Qi H, Ji X, Cui Y, Wang L, Chen H, Tang P. Comparison of channel-assisted minimally invasive repair and 3 common Achilles tendon restoration techniques. Exp Ther Med 2019; 17:1426-1434. [PMID: 30680024 DOI: 10.3892/etm.2018.7075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/23/2018] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to investigate the biomechanical comparison of channel-assisted minimally invasive restoration and three common Achilles tendon restoration techniques in an in vitro model via a progressive rehabilitation program. The 42 porcine tendons were randomly assigned to the following six groups of tendons (n=7/group): Achillon, percutaneous Achilles repair system (PARS), Krackow, channel-assisted minimally invasive repair (CAMIR), CAMIR augmentation (CAMIR+), CAMIR-5 (repair with No. 5 Ethibond suture). There was no significant difference in elongation among groups following the first 10 loading cycles, which consisted of 20-100 N at 1 Hz. The elongation of the CAMIR group (7.51±1.77 mm) was significantly longer than the Achillon group (3.19±0.57 mm) and PARS group (3.73±0.66 mm; P<0.05) following 1,000 cycles. However, the CAMIR group exhibited no significant difference vs. the Krackow (7.32±1.09 mm) and CAMIR+ groups (7.11±1.50 mm) following 1,000 cycles. Following 2,000 cycles, there was no significant difference between the CAMIR-5 (7.99±1.68 mm) group, and the Achillon (3.19±0.57 mm) and PARS groups (3.73±0.66 mm). At the point of restoration construct failure, the total cycles of the CAMIR group (median, 1,000; range, 1,000-1,000) were significantly less than the Achillon group (median, 2,000; range, 2,000-2,013) and PARS group (median, 2,000; range, 2,000-2,010; P<0.05), but had no significant difference compared with the Krackow group (median, 1,000; range, 1,000-1,000) and CAMIR+ group 1,000 (median, 1,000; range, 1,000-1,004). There was also no significant difference between the CAMIR-5 group (median, 2,000; range, 2,000-2,000), and the Achillon group (median, 2,000; range, 2,000-2,013) and PARS group (median, 2,000; range, 2,000-2,010). Restricted by the strength of suture, the one-suture CAMIR restoration technique was weaker than the three-suture Achillon and PARS restoration techniques, but there was no significant difference with the open Krackow restoration technique, which provides a reliable mechanical strength for repairing. CAMIR has an advantage of reducing the risk of suture reactivity.
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Affiliation(s)
- Hongzhe Qi
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China.,Department of Orthopaedic Surgery, Chinese People's Liberation Army 306th Hospital, Beijing 100101, P.R. China
| | - Xinran Ji
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Yalin Cui
- Key Laboratory for Biomechanics and Mechanobiology, Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology, Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P.R. China
| | - Hua Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Peifu Tang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, UK
- Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK
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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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Manegold S, Tsitsilonis S, Schumann J, Gehlen T, Agres AN, Keller J, Gesslein M, Wichlas F. Functional outcome and complication rate after percutaneous suture of fresh Achilles tendon ruptures with the Dresden instrument. J Orthop Traumatol 2018; 19:19. [PMID: 30229505 PMCID: PMC6143488 DOI: 10.1186/s10195-018-0511-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the outcome of patients with a rupture of the Achilles tendon (ATR) treated percutaneously with the Dresden instrument in the hands of surgeons others than its inventors. Materials and methods 118 patients (FU rate: 77.1%) with an acute ATR treated with the Dresden instrument were retrospectively evaluated. The following data were evaluated: pain intensity, functional limitation, Hannover score, Achilles tendon total rupture score (ATRS), AOFAS ankle-hindfoot score, Tegner activity score, complications, maximum calf circumference (MCC) on both sides, and the Matles test for tendon lengthening. The effect of the time point of the surgery after trauma was examined. Results Hannover scores and ATRSs were good; AOFAS scores were excellent. Almost all patients returned to sporting activities postoperatively, and 66.1% were able to return to their previous level. The Tegner activity score revealed a slight posttraumatic decrease (p = 0.009) in the level of physical activity overall (pre-injury: 5.37 ± 0.15; postoperatively: 4.77 ± 0.15). The re-rupture rate was 2%. No sural nerve lesions and no infections were reported. Even after 3 years, there was still a difference in MCC that was correlated with inferior clinical score and AT lengthening. Patients treated within the first 2 days after ATR showed inferior clinical outcomes in terms of AOFAS score, ATRS, and functional limitations. Conclusions Percutaneous ATR suture with the Dresden instrument is a safe and reliable method. Low complication and re-rupture rates, good clinical results, and a high rate of return to play support this fact. The time point of the operation may influence the outcome.
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Affiliation(s)
- Sebastian Manegold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Serafim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Jakob Schumann
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Gehlen
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alison N Agres
- Julius Wolff Institute, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johannes Keller
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Gesslein
- Clinic for Orthopaedics and Traumatology, Klinikum Nürnberg Süd, Paracelsus University, Breslauer Str. 201, 90471, Nuremberg, Germany
| | - Florian Wichlas
- Clinic for Orthopaedics and Traumatology, University of Salzburg, Müllner Hauptstraße 48, Salzburg, Austria
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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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Maffulli N, Oliva F, Maffulli GD, Giai Via A, Gougoulias N. Minimally Invasive Achilles Tendon Stripping for the Management of Tendinopathy of the Main Body of the Achilles Tendon. J Foot Ankle Surg 2018; 56:938-942. [PMID: 28659242 DOI: 10.1053/j.jfas.2017.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively (p < .001). After a mean follow-up period of 40.5 months, 41 patients had resumed sporting activities at an average of 3.5 months postoperatively. A sural nerve injury was recorded in 5 patients (10.6%), and all 5 complications occurred during the first 12 cases. As a result, the technique was slightly modified, and no sural nerve neuropathy was observed subsequently. One superficial infection (2.1%) was recorded. Minimally invasive Achilles tendon stripping seems to be an effective, technically simple, and inexpensive treatment of Achilles tendinopathy. Further randomized controlled trials involving more patients are needed to confirm these outcomes.
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Affiliation(s)
- Nicola Maffulli
- Professor, Department of Musculoskeletal Disorders, Faculty of Medicine, University of Salerno, Salerno, Italy; Professor, Queen Mary University of London, Barts, United Kingdom; Professor, The London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Sports and Exercise Medicine, Mile End Hospital, London, United Kingdom.
| | - Francesco Oliva
- Orthopedist, Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Gayle D Maffulli
- Assistant Professor, Surgical Trials Unit, Curis Consulting, London, United Kingdom
| | - Alessio Giai Via
- Orthopedist, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy
| | - Nikolaos Gougoulias
- Orthopedist, Department of Orthopaedics, Frimley Health National Health Service Foundation Trust, Frimley Park Hospital, Camberley, United Kingdom
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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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Rungprai C, Phisitkul P. Outcomes and Complications Following Endoscopically Assisted Percutaneous Achilles Tendon Repair. Arthroscopy 2018; 34:1262-1269. [PMID: 29273251 DOI: 10.1016/j.arthro.2017.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To review functional and clinical outcomes as well as complications in patients who underwent endoscopically assisted percutaneous Achilles tendon repair using 4-strand core suture configuration via a 6-portal technique. METHODS A retrospective chart review with prospectively collected data was performed in 23 consecutive patients who underwent endoscopically assisted percutaneous Achilles tendon repair between 2008 and 2015. The minimum follow-up to be included in the study was 24 months. The primary outcome was Foot and Ankle Ability Measure (FAAM), Activities of Daily Living (ADL) and Sports subscales; Short Form-36 (SF-36), physical and mental component summaries (PCS and MCS); and visual analog scale (VAS). The secondary outcomes included tourniquet time, recovery time, and complications. RESULTS Twenty-three patients (18 males and 5 females, all unilateral) with the mean age of 36.7 years were included and 6 patients were repaired using an open technique because they did not meet the inclusion criteria owing to presenting late in the clinic (injury more than 2-3 weeks). The average time to final follow-up was 54.1 months. The average tourniquet time was 41.3 minutes. There was significant improvement of VAS (7.9/10 to 0.1/10), SF-36 (PCS, 32.5-44.7, and MCS, 47.9-51.4), and FAAM (ADL, 26.1.0-83.0, and Sports, 0-61.7). The average time to return to activities of daily living, work, and sports were 8.0 weeks, 8.8 weeks, and 5.7 months, respectively. The postoperative morbidity included superficial wound infection at the portal (1 patient with underlying type 2 diabetes, 4.3%) and there was no rerupture, deep vein thrombosis, sural nerve injury, and painful scar in this study. CONCLUSIONS Endoscopically assisted percutaneous Achilles tendon repair has significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS. This technique is safe and feasible with minimal postoperative pain and morbidities, early return to activities, and satisfactory functional outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Chamnanni Rungprai
- Department of Orthopaedic and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Iowa, U.S.A.; Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Phinit Phisitkul
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
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Karatekin YS, Karaismailoglu B, Kaynak G, Ogut T, Dikici AS, Ure Esmerer E, Aydingoz O, Botanlioglu H. Does elasticity of Achilles tendon change after suture applications? Evaluation of repair area by acoustic radiation force impulse elastography. J Orthop Surg Res 2018; 13:45. [PMID: 29499741 PMCID: PMC5834878 DOI: 10.1186/s13018-018-0751-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Achilles tendon injuries are one of the most common tendon injuries. Surgical treatment is preferred in young and active patients. Although there are studies which evaluate the repair area with magnetic resonance imaging and ultrasonography after surgical treatment, there are very few studies which analyzes the elasticity of the tendon by quantitative methods. ARFI (acoustic radiation force impulse) elastography is a simple and non-invasive method that can quantitatively measure the elasticity of the soft tissues. Our study aims to evaluate the elasticity in the repair area of the surgically treated Achilles tendons, compare them to the non-injured side, and evaluate the effect of the suture method to the elasticity of the repaired tendons by using ARFI elastography. Methods In our retrospectively designed study, 19 patients who underwent surgical treatment with Krackow and modified Kessler suture methods after the Achilles tendon rupture between 2006 and 2014 were included. Shear wave velocity (SWV) of the repaired and non-injured Achilles tendons were measured by ARFI elastography in four different positions of the ankle. Results It was determined that SWV in the surgically repaired tendons were significantly higher in each four different position of the ankle, compared to the non-injured side (p < 0.01), indicating less elasticity in the repaired tendons. There was no statistically significant difference between the SWV of Krackow and modified Kessler suture method groups at four different positions of the ankle (p > 0.05). AOFAS Ankle-Hindfoot, VISA-A, VAS, and FAOS scores were not also statistically different between these two suture methods (p > 0.05). Conclusions In the repaired Achilles tendon, there is a decrease in the elasticity compared to the non-injured side. The functional and elastographic results of Krackow and modified Kessler suture methods are similar in long-term follow-ups of the patients.
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Affiliation(s)
- Yavuz Selim Karatekin
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Gokhan Kaynak
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Tahir Ogut
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Atilla Suleyman Dikici
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No: 53, Fatih, Istanbul, Turkey
| | - Emel Ure Esmerer
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No: 53, Fatih, Istanbul, Turkey
| | - Onder Aydingoz
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey
| | - Huseyin Botanlioglu
- Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No:53, Fatih, Istanbul, Turkey.
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Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc 2018; 26:846-853. [PMID: 26410099 DOI: 10.1007/s00167-015-3795-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. METHODS A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included. RESULTS One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. CONCLUSION Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. LEVEL OF EVIDENCE II.
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Ateschrang A, Körner D, Joisten K, Ahrend MD, Schröter S, Stöckle U, Riedmann S. Incidence and risk factors for postoperative Achilles tendon calcifications after percutaneous repair. Arch Orthop Trauma Surg 2018; 138:203-210. [PMID: 29094200 DOI: 10.1007/s00402-017-2829-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Numerous publications are dealing with acute Achilles tendon rupture. To our knowledge, no systematic trial has been published analyzing the incidence, risk factors and the potential clinical impact of postoperative tendon calcifications (PTC) after percutaneous Achilles tendon repair. Therefore, the aim of this study was to analyze these relevant aspects. MATERIALS AND METHODS Between March 2003 and November 2010, a total of 126 patients with an acute, complete Achilles tendon rupture were treated with a percutaneous technique according to Ma and Griffith at a single university-based trauma department. The follow-up included a detailed clinical and sonographic examination. To assess the functional outcome and possible impact of PTC after percutaneous Achilles tendon repair, the Thermann and AOFAS scores were used. 81 patients (65 men and 16 women) with a median age of 46 years (range 24-76) were available for a follow-up examination. The median time of follow-up was 64 months (range 15-110 months). RESULTS PTC occurred in nine out of 81 patients (11.1%). All patients with PTC were male with a median age of 52 years (range 26-76 years). In the group of patients with PTC, the median overall Thermann score was 94 (range 68-100) and the median overall AOFAS score was 97 (range 85-100). In the group of patients without PTC, the median overall Thermann score was 88.5 (range 60-100) and the median overall AOFAS score was 97 (range 85-100). No significant differences were detected between the group of patients with PTC and the group of patients without PTC and the clinical outcome according to the Thermann (p = 0.21) and the AOFAS scores (p = 0.37). None of the patients with PTC sustained a re-rupture. The overall re-rupture rate was 4.9%. PTC was no risk factor for wound and neurological complications. CONCLUSION The incidence of PTC after percutaneous Achilles tendon repair was 11.1%. Male gender and advanced age seem to be risk factors for PTC. In this study, PTC had no negative impact on the postoperative clinical outcome.
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Affiliation(s)
- Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany.
| | - Konrad Joisten
- Department of Oral and Maxillofacial Surgery, Marien Hospital, Stuttgart, Germany
| | - Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Stephan Riedmann
- Orthopedic Clinic Paulinenhilfe, Diakonie Clinic, Stuttgart, Germany
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Ling SKK, Slocum A, Lui TH. 5-year results of the 1.5cm incision Achilles tendon repair. Foot (Edinb) 2017; 33:35-38. [PMID: 29126040 DOI: 10.1016/j.foot.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND To study a hypothesis that the cost-effective 1.5cm medial incision Achilles tendon repair technique will provide good functional outcomes which are maintained for over 5 years. METHOD Prospective study of 12 consecutive cases with a minimal 5-year follow-up were recruited from April 2008 to November 2010. Cases whom were mentally incompetent or those which required concomitant procedures were excluded. Outcomes measures included the numeric pain rating scale, motor power strength, range of motion, functional scoring using the AOFAS hindfoot score and patient's self-assessment using the Foot and Ankle Outcome Score (FAOS). RESULT No re-ruptures or sural nerve injured were identified after a minimal 5-year follow-up. Pain was minimal at 0.5/10, calf power was 5/5 and ankle range was good (plantarflexion: 38°/dorsiflexion: 21°). The AOFAS hindfoot score was 97.4 and all 5 sub-categories of the Foot and Ankle Outcome Score (FAOS) were good. CONCLUSION The 1.5cm medial incision repair of the Achilles tendon is an economically sound surgical technique, with minimal complications, which gives good medium length functional outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Samuel K K Ling
- Dept. of Orthopadics & Traumatology, North District Hospital, Hong Kong Special Administrative Region.
| | - Amanda Slocum
- Dept. of Orthopadics & Traumatology, North District Hospital, Hong Kong Special Administrative Region.
| | - T H Lui
- Dept. of Orthopadics & Traumatology, North District Hospital, Hong Kong Special Administrative Region.
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Usuelli FG, D'Ambrosi R, Manzi L, Indino C, Villafañe JH, Berjano P. Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer. JOINTS 2017; 5:212-216. [PMID: 29270558 PMCID: PMC5738487 DOI: 10.1055/s-0037-1608661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7-7.2) months after the surgery. No patient reported complications or reruptures. Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milan, Italy
| | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Carmont MR, Zellers JA, Brorsson A, Olsson N, Nilsson-Helander K, Karlsson J, Silbernagel KG. Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study. Orthop J Sports Med 2017; 5:2325967117723347. [PMID: 28856168 PMCID: PMC5571770 DOI: 10.1177/2325967117723347] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications. Purpose: To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks. Results: There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively). Conclusion: Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.
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Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, United Kingdom.,Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer A Zellers
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicklas Olsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Kungsbacka Hospital, Kungsbacka, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Carmont MR, Kuiper JH, Grävare Silbernagel K, Karlsson J, Nilsson-Helander K. Tendon end separation with loading in an Achilles tendon repair model: comparison of non-absorbable vs. absorbable sutures. J Exp Orthop 2017; 4:26. [PMID: 28733950 PMCID: PMC5520830 DOI: 10.1186/s40634-017-0101-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/14/2017] [Indexed: 12/28/2022] Open
Abstract
Background Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was performed to determine differences in initial separation, strength and failure characteristics of differing sutures and numbers of core strands in a percutaneous Achilles tendon repair model in response to initial loading. Methods Nineteen bovine Achilles tendons were repaired using a percutaneous/minimally invasive technique with a combination of a modified Bunnell suture proximally and a Kessler suture distally, using non-absorbable 4-strand 6-strand repairs and absorbable 8-strand sutures. Specimens were then cyclically loaded using phases of 10 cycles of 100 N, 100 cycles of 100 N, 100 cycles of 190 N consistent with early range of motion training and weight-bearing, before being loaded to failure. Results Pre-conditioning of 10 cycles of 100 N resulted in separations of 4 mm for 6-strand, 5.9 mm for 4-strand, but 11.5 mm in 8-strand repairs, this comprised 48.5, 68.6 and 72.7% of the separation that occurred after 100 cycles of 100 N. The tendon separation after the third phase of 100 cycles of 190 N was 17.4 mm for 4-strand repairs, 16.6 mm for 6-strand repairs and 26.6 mm for 8-strand repairs. There were significant differences between the groups (p < 0.0001). Four and six strand non-absorbable repairs had significantly less separation than 8-strand absorbable repairs (p = 0.017 and p = 0.04 respectively). The mean (SEM) ultimate tensile strengths were 4-strand 464.8 N (27.4), 6-strand 543.5 N (49.6) and 8-strand 422.1 N (80.5). Regression analysis reveals no significant difference between the overall strength of the 3 repair models (p = 0.32) (4 vs. 6: p = 0.30, 4 vs. 8: p = 0.87; 6 vs. 8: p = 0.39). The most common mode of failure was pull out of the Kessler suture from the distal stump in 41.7% of specimens. Conclusion The use of a non-absorbable suture resulted in less end-to-end separation when compared to absorbable sutures when an Achilles tendon repair model was subject to cyclical loading. Ultimate failure occurred more commonly at the distal Kessler suture end although this occurred with separations in excess of clinical failure. The effect of early movement and loading on the Achilles tendon is not fully understood and requires more research.
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Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital, Telford, UK. .,Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Jan Herman Kuiper
- Department of Biomechanical Engineering, The Robert Jones & Agnes Hunt District General Hospital, University of Keele, Keele, UK
| | | | - Jón Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedic Surgery, Kungsbacka Hospital, Kungsbacka, Sweden
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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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Daghino W, Enrietti E, Sprio AE, di Prun NB, Berta GN, Massè A. Subcutaneous Achilles tendon rupture: A comparison between open technique and mini-invasive tenorrhaphy with Achillon ® suture system. Injury 2016; 47:2591-2595. [PMID: 27622615 DOI: 10.1016/j.injury.2016.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/13/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical management of Achilles tendon rupture is still controversial: open techniques have a higher rate of soft tissue complications but a lower incidence of re-rupture than percutaneous tenorrhaphies. The aim of our retrospective study was to analyze and compare clinical and functional results in patients treated with either the conventional open or minimally invasive suture treatment with the Achillon® system. METHODS A retrospective review of 140 patients was performed; 72 were treated with open tenorrhaphy, 68 with the minimally invasive Achillon® suture system. RESULTS With a comparable re-rupture rate, there was a statistically significant reduction in surgical time, incidence of minor complications, time required to return to sport activities and return to work in the minimally invasive group. CONCLUSIONS Achillon® mini-invasive suture system is a reliable tool for the Achilles tendon ruptures, able to reduce the incidence of soft tissues complications if compared to the classic open tenorrhaphy, while maintaining strength of the suture and leading to superimposed functional outcomes.
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Affiliation(s)
- W Daghino
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy.
| | - E Enrietti
- University of Turin, Medicine and Surgery School, Turin, Italy
| | - A E Sprio
- University of Turin, Department of Clinical and Biological Sciences, Orbassano, Turin, Italy
| | - N Barbasetti di Prun
- University of Turin, Orthopaedic and Traumatology Specialization School, Turin, Italy
| | - G N Berta
- University of Turin, Department of Clinical and Biological Sciences, Orbassano, Turin, Italy
| | - A Massè
- University of Turin, Orthopaedic Clinic, C.T.O. Hospital, Turin, Italy
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