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Wang T, Wu W, Gu J, Hou R. Methods of Immobilization after Achilles Tendon Rupture Repair: A Comparative Study in Rat Model. Orthop Surg 2023; 15:2960-2965. [PMID: 37712211 PMCID: PMC10622275 DOI: 10.1111/os.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different immobilization methods' impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and K-wire to determine which is the most stable and has the fewest complications. METHODS Sixty rats aged 5-6 months were selected to establish Achilles tendon injury in two hind legs model. After suturing the ends of the AT together with a modified "Kessler" method (Prolene 5-0). The skin incision was interrupted and sutured with 1-0 thread. Rats were divided into three immobilization methods (plaster cast group, splint group, and K-wire group). In plaster cast group, the hind leg was cast with plaster in the extended position of the hip and knee joints, and the ankle joint was at 150°. Splint and K-wire group used splints and 0.8-mm K-wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chi-square test. RESULTS Within 4 weeks observation, K-wires showed better stability (90%) compared with the other two ways (40% in plaster cast group, 65% in splint group; p < 0.05). Rats immobilized with K-wires (10%) suffered significantly lower complications compared with plaster cast and splint group (15%; p < 0.05). CONCLUSION K-wire has better stability, lower complication rate than other methods. Immobilization with K-wire may be a promising tool in future clinical Achilles tendon rupture applications.
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Affiliation(s)
- Tianliang Wang
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
- Yangzhou UniversityYangzhouChina
| | - Wenjie Wu
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
| | - Jiaxiang Gu
- Department of Hand and Foot SurgeryClinical Medical CollegeYangzhouChina
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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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Williams CJ, Hodkinson S, Chandrasekaran K, Koc T, Gibb I, Dando C, Bowen C, Oakley J. A retrospective audit of the timescales involved in the diagnosis and management of suspected Achilles tendon ruptures at a single National Health Service trust: A quality service improvement and redesign project. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:117-125. [PMID: 35509302 PMCID: PMC9058383 DOI: 10.1177/1742271x211023800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Introduction The Achilles tendon is the most frequently ruptured tendon. Prompt diagnosis of this injury ensures optimal management decisions are instituted early ensuring the best outcome and patient experience, at minimal cost to the United Kingdom National Health Service. Despite this, regional and national variations to diagnosis and management exist, with anecdotal evidence of inefficiencies in the local patient pathway. To explore this further, a retrospective departmental audit of timescales from presentation to ultrasound diagnosis and definitive treatment decision was undertaken. Methods All suspected Achilles tendon ruptures in 2018 were identified through electronic and written patient records, and information on timescales involved in the diagnosis and management of each compiled. Descriptive statistics were used to map each step of the pathway and timescales involved, with performance assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol. Results In total, 119 patients were identified, of which 113 received an ultrasound examination. Local departmental standards were met in the majority of cases, with 78% (n = 88) diagnosed by ultrasound within one week of the request and 83% (n = 91) given a treatment decision within two weeks of presentation. However, this was suboptimal when compared with timeframes utilised for developing the SMART protocol, with only 7% (n = 8) scanned within 48 hours of presentation. Conclusions Key areas of the patient pathway were identified for quality service improvement and redesign, with multidisciplinary discussion resulting in the development of a revised patient pathway which expedites diagnosis and treatment for these injuries.
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Affiliation(s)
- CJ Williams
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - S Hodkinson
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - T Koc
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - I Gibb
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - C Dando
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - J Oakley
- School of Health and Care Professions, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
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Chegini Kord M, Ebrahimpour A, Sadighi M, Chehrassan M, Nazari L, Najafi A, Minator Sajjadi M. Minimally Invasive Repair of Acute Achilles Tendon Rupture Using Gift Box Technique. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:429-434. [PMID: 31742219 PMCID: PMC6802554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aimed to introduce a modified technique for minimally invasive Achilles tendon (AT) rupture repair using gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients. METHODS In a consecutive case series study, 24 patients with acute AT rupture underwent modified minimally invasive AT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from all patients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calf atrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-rupture. RESULTS After two years, the mean scores of AOFAS and ATRS were obtained at 83±4 and 81.9±6.3, respectively. Approximately 87.5 % of the patients regained their previous level of activity. The mean VAS score was 7.7±0.9 regarding the satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82.7±5.8 and 87.7±4.1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant. In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly, compared to that of the other side; however, the differences were not significant functionally. There was no patient with wound complications, nerve injury, or complaint about problem with footwear. CONCLUSION Minimally invasive repair of acute AT rupture using two mini-incisions and gift box sutures offers good functional and clinical outcomes without wound complications which can be usually observed following open repair of AT ruptures.
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Affiliation(s)
- Mohammadhossein Chegini Kord
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Adel Ebrahimpour
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Mohammadreza Chehrassan
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Leili Nazari
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Arvin Najafi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
| | - Mohammadreza Minator Sajjadi
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Alborz University of Medical Sciences, Tehran, Iran
- Research performed at Taleghani Hospial, Atieh Hospital, Tehran, Iran
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Obut S, Gultekin A, Unal M, Serarslan U, Tuhanioğlu Ü. A simple suture-guiding device for minimally invasive Achilles tendon repair. J Orthop Surg (Hong Kong) 2018; 25:2309499017739484. [PMID: 29141520 DOI: 10.1177/2309499017739484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our hypothesis is to utilize a simple suture-guiding device for minimally invasive repair of Achilles tendon without any extra cost with a minimal risk of rerupture. The purpose of this study is to investigate the results of our minimally invasive technique for Achilles tendon repair using a simple ovarian clamp for suture guiding. MATERIALS AND METHODS Twenty patients with acute Achilles tendon rupture were treated with minimally invasive repair by an expert orthopaedic surgeon. Instead of an Achillon device, an ovarian clamp was directed to the proximal and distal parts of the Achilles tendon. All data relating to daily activities, walking, climbing stairs, sports activity, American Orthopaedic Foot and Ankle Society (AOFAS) and Thermannscores were recorded. Sural nerve was evaluated with physical examination for paraesthesia, hyperaesthesia, lateralis cruris and foot pain in all patient controls. RESULTS The average AOFAS score was 97.06 (76-100). All patients had intact Achilles tendon at last control. No rerupture was observed. Average time taken to return to work was 30.8 days (28-60 days). After 6 months, all patients returned to their previous sports activities. CONCLUSION For Achilles tendon ruptures, minimally invasive repair techniques have shown successful results with low complication rates. Besides their success, some suture-guiding devices bring extra costs for patients or health insurance. Minimally invasive techniques may be performed with devices without any extra cost. Our new suture-guiding device provides knot placement under paratenon like Achillon device to improve outcomes, provides early return to work and minimizes the complications. Finally, our suture-guiding device has no extra cost.
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Affiliation(s)
- Sinan Obut
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Alper Gultekin
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Meric Unal
- 2 Faculty of Medicine, Sports Medicine Department, Suleyman Demirel University, Isparta, Turkey
| | - Ulaş Serarslan
- 1 Orthopaedics and Traumatology Department, Derince Research Hospital, Kocaeli, Turkey
| | - Ümit Tuhanioğlu
- 3 Orthopaedics and Traumatology Department, Adana Numune Research Hospital, Adana, Turkey
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DeVries JG, Scharer BM, Summerhays BJ. Acute Achilles Rupture Percutaneous Repair: Approach, Materials, Techniques. Clin Podiatr Med Surg 2017; 34:251-262. [PMID: 28257678 DOI: 10.1016/j.cpm.2016.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Closed traumatic Achilles tendon rupture is a common injury, especially in the aging athlete. Traditionally open repair has been recognized to offer a lower rerupture rate compared with nonoperative methods but with a higher complication rate. Percutaneous repair has been described to offer the benefits of open repair while avoiding the complications. The sural nerve is potentially susceptible to injury, and specialized instrumentation has been developed to avoid this event. This article discusses several techniques of minimally invasive Achilles tendon repair. Many authors have evaluated these techniques and the results are discussed here.
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Affiliation(s)
- Jason George DeVries
- Orthopedics & Sports Medicine, BayCare Clinic, 2020 Riverside Drive, Green Bay, WI 54301, USA.
| | - Brandon M Scharer
- Orthopedics & Sports Medicine, BayCare Clinic, 2020 Riverside Drive, Green Bay, WI 54301, USA
| | - Benjamin J Summerhays
- Orthoaedic Surgery, University of Missouri Health, 1100 Virginia Avenue, Columbia, MO 65212, USA
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Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture. BIOMED RESEARCH INTERNATIONAL 2017; 2016:6043638. [PMID: 28078295 PMCID: PMC5203875 DOI: 10.1155/2016/6043638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 12/28/2022]
Abstract
The applications of CT examination in the diagnosis of the acute Achilles tendon rupture (AATR) were investigated. A total of 36 patients with suspected acute Achilles tendon rupture were tested using physical examination, ultrasound, and 3DCT scanning, respectively. Then, surgery was performed for the patients who showed positive result in at least two of the three tests for AATR. 3DVR, MPR, and the other CT scan image processing and diagnosis were conducted in PACS (picture archiving and communication system). PACS was also used to measure the length of distal broken ends of the Achilles tendon (AT) to tendon calcaneal insertion. Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture. The length measurement is matched between PACS and those actually measured in operation. CT not only demonstrates more details directly in three dimensions especially with the rupture involved calcaneal insertion flap but also locates the rupture region for percutaneous suture by measuring the length of distal stump in PACS without the effect of the position of ankle. The accuracy of CT diagnosis for Achilles tendon partial rupture is yet to be studied.
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