Minimally invasive Achilles tendon repair: a modification of the Achillon technique

Rerupture and wound complications following Achilles tendon repair: A systematic review

Despite the relatively high frequency of Achilles ruptures, there is no general consensus on the optimal treatment method. A general trend toward more patients being treated nonoperatively has emerged recently with the advent of functional rehabilitation. However, much of the recent data on this subject has been highly variable. This systematic review focused on Achilles tendon rupture (ATR) treatment outcomes, with a focus on rerupture and complication rates. This systematic review specifically focused on articles regarding ATR treatment that also included rerupture and complication rates. Treatments were divided into three categories: open minimally invasive, open standard, and nonoperative. Bivariate analyses were performed to compare complication and rerupture rates among pairs of treatment options, as well as between early weight bearing versus immobilization. There was significantly higher complications for minimally invasive compared to nonoperative treatment (risk ratio [RR] = 4.4154; p < 0.05), lower complication rates for minimally invasive compared to open treatment (RR = 0.3231; p < 0.05), and higher complications for open standard compared to nonoperative treatment (RR = 5.6350; p < 0.001). There were significantly lower rerupture rates in minimally invasive compared to nonoperative treatment (RR = 0.4085; p < 0.001), a significantly lower rerupture rate in nonoperative treatment compared to open treatment (RR = 0.2282; p < 0.001), and no significant difference in rerupture rates when comparing minimally invasive to open standard treatment. We found that operative treatment is associated with fewer reruptures and more complications than a nonoperative approach. Minimally invasive surgery appears to be associated with a lower rate of complications than open operative treatment.

Comparison Study of Mini-Incision Versus Original Open Technique of the Half-Mini-Bunnell Achilles Tendon Repair

Mini-incision surgical procedures in our institution have been developed by decreasing the total skin incision length from the original mini half-Bunnell tendon repair technique. We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair technique, would promote the tendon healing process leading to better outcomes and a reduced complication rate compared to the conventional open repair. The study sought to determine the more optimal method by comparing 44 mini-incision sutures to the 99 sutures in the original open Achilles tendon repairs. The mean skin incision length of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was 4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged heel-rise movement and the time to return-to-play was not significantly different between the 2 groups. Achilles Tendon Rupture Score was not significantly different from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture was showed equivalent clinical results to the original open repair, the technique is recommended in terms of curtailment of the surgery time without increase of complication ratio.

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

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.

Is Achillon repair safe and reliable in delayed presentation Achilles tendon rupture? A five-year follow-up

BACKGROUND

To assess the outcome of delayed repair of ruptured Achilles tendon using the Achillon mini-open technique.

METHODS

A review of all patients who underwent delayed repair (>10 days post injury) of ruptured Achilles tendon with mini invasive technique was compared to acute repairs carried out at the same unit. Leppilahti Score and Achilles Tendon Total Rupture Score (ATRS) were utilised. Complication rates including re-rupture were also reviewed.

RESULTS

14 patients were identified as having delayed repair (11-31 days). The mean follow-up period was 71 months (range: 58-92). There were no statistically significant difference in the Leppilahti Score and ATRS compared to patients treated acutely (<10 days post injury) in the same time period. 79% of patients with delayed repair reported good to excellent, comparable to 80% of patients having undergone acute repair.

CONCLUSIONS

For those patients who would benefit from surgical repair, a mini-open technique using the Achillon suture-passing device remains a safe and reliable option for delayed presentation of 11-31 days.

The improved oval forceps suture-guiding method for minimally invasive Achilles tendon repair

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.

A simple suture-guiding device for minimally invasive Achilles tendon repair

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.

Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play

AIM

This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP.

DESIGN

A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination.

DATA SOURCES

PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included.

RESULTS

108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001).

CONCLUSIONS

80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.

Channel-assisted minimally invasive repair of acute Achilles tendon rupture

BACKGROUND

Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques.

METHOD

Eighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing.

RESULTS

There was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred.

CONCLUSION

CAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.