A new approach for surgical treatment of acute closed Achilles tendon rupture -- a retrospective clinical study
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Abstract
Background To introduce a new surgical approach for Achilles tendon repair and analyze its clinical effect and postoperative complications compared with the traditional long incision approach. Methods A retrospective control study of 43 patients treated with Achilles tendon rupture using two different approaches carried out. The conventional approach: one continuous longitudinal incision, 1cm medial from the central posterior ankle joint. The modified approach: one short S shape incision across the posterior part of the ankle and 2 pairs of tiny incisions at the proximal edges of Achilles tendon. The Arner-Lindholm score was used for ankle function evaluation and complications were summarized. Results In the conventional group (25 patients), there were 4 cases with local skin necrosis. Achilles tendon rupture occurred again in one patient 2 month after surgery. No cutaneous nerve injury occurred. The total incidence rate of complication was 20%. In the modified group (19 patients), one patient had sural nerve injury. No wound dehiscence and re-rupture of Achilles tendon occurred in all the cases. The total incidence rate of complication was 5.3%. There were significant differences between the two groups in the incidence of postoperative complications (P < 0.05). The excellent and good rates of the ankle joint function in the modified group were statistically higher than those in the conventional group (P < 0.05).Conclusion The modified surgical approach for Achilles tendon repair was recommended. With this approach fewer complications and better functional recovery could be achieved.
Keywords
operative approach; Achilles tendon rupture; postoperative complication; curative effect
Cite this paper
Hongtao Xiong, Yuzhou Liu, Yongqing Zhuang, Jie Lao, Chunling Chen,
A new approach for surgical treatment of acute closed Achilles tendon rupture -- a retrospective clinical study
, SCIREA Journal of Clinical Medicine.
Volume 4, Issue 6, December 2019 | PP. 289-303.
References
[ 1 ] | Ahn JH, Choy WS. Tendon adhesion after percutaneous repair of the Achilles tendon: a case report. J Foot Ankle Surg. 2011; 50: 93–95. doi: 10.1053/j.jfas.2010.07.008. |
[ 2 ] | Aibinder WR, Patel A, Arnouk J, et al. The rate of sural nerve violation using the Achillon device: a cadaveric study. Foot Ankle Int. 2013; 34(6): 870–875. doi: 10.1177/1071100712473097. |
[ 3 ] | Aktas S,Kocaoglu B. Open versus minimal invasive repair with Achillon device. Foot Ankle Int. 2009; 30(5): 391–397.doi: 10.3113/FAI.2009.0391. |
[ 4 ] | Bae SH, Lee HS, Seo SG, Kim SW, Gwak HC, Bae SY. Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair. J Bone Joint Surg Am. 2016; 98(14): 1161-1167. doi: 10.2106/JBJS.15.01117. |
[ 5 ] | Bertelli R, Gaiani L, Palmonari M. Neglected rupture of the Achilles tendon treated with a percutaneous technique. Foot Ankle Surg. 2009; 15: 169–173. doi: 10.1016/j.fas.2008.12.003. |
[ 6 ] | Bhattacharyya M,Gerber B. Mini- invasive surgical repair of the Achiles tendon:does it reduce post-operative morbidity? Int orthop. 2009; 33(1): 151-156. doi: 10.1007/s00264-008-0564-5. |
[ 7 ] | Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008; 16: 199–203. doi: 10.1007/s00167-007-0411-z. |
[ 8 ] | Carmont MR, Roberto R, Scheffler S, Dan OM, Beaufils P. Percutaneous & Mini Invasive Achilles tendon repair. Sports Med Arthrosc Rehabil Ther Technol. 2011; 3(1): 1-9. doi: 10.1186/1758-2555-3-28. |
[ 9 ] | Chiodo CP, Glazebrook M, Bluman EM , et al. Diagnosis and treatment of acute Achilles tendon rupture. The Journal of the American Academy of Orthopaedic Surgeons. 2010; 18(8): 503–510. PMID:20675643. |
[ 10 ] | Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med. 2005; 33(9): 1369–1379. doi:10.1177/0363546504271501 |
[ 11 ] | Davies MS, Solan M. Minimal incision techniques for acute Achilles repair. Foot Ankle Clin. 2009; 14: 685–697. doi: 10.1016/j.fcl.2009.07.006. |
[ 12 ] | Eastwood DM, Irgau I, Atkins RM. The distal course of the sural nerve and its significance for incisions around the lateral hindfoot. Foot Ankle. 1992; 13: 199–202. PMID: 1634152. |
[ 13 ] | Elliot RR, Calder JD. Percutaneous and mini open repair of acute Achilles tendon rupture. Foot Ankle Clin. 2007; 12: 573–582. doi:10.1016/j.fcl.2007.07.002. |
[ 14 ] | Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med. 2012; 22: 379–380. doi: 10.1097/JSM.0b013e3182603905. |
[ 15 ] | Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendon Achilles repair. Foot Ankle Int. 2004; 25(4): 215–218. PMID:15132928. |
[ 16 ] | Healy B, Beasley R, Weatherall M. Venous thromboembolism following prolonged cast immobilisation for injury of the tendo Achillis. J Bone Joint Surg. 2010; 92: 646–650. doi: 10.1302/0301-620X.92B5.23241. |
[ 17 ] | Henriquez H, Muñoz R, Carcuro G, Bastias C. Is percutaneous repair better than open repair in acute Achilles tendon rupture[J]. Clin Orthop Relat Res. 2012; 470(4): 998-1003. doi: 10.1007/s11999-011-1830-1. |
[ 18 ] | Kakiuchi M. A combined open and percutaneous technique for repair of tendon Achilles. Comparison with open repair. J Bone Joint Surg Br. 1995; 77(1): 60–63. PMID: 7822398. |
[ 19 ] | Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures: A meta-analysis of randomized, controlled trails [J]. Bone Joint Surg Am. 2005; 87(10): 2202-2210. doi:10.2106/JBJS.D.03049. |
[ 20 ] | Knobe M, Gradl G, Klos K, et al. Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture? Int Orthop. 2015; 39: 535–542. doi: 10.1007/s00264-014-2615-4. |
[ 21 ] | Lansdaal JR, Goslings JC, Reichart M, et al. The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional after treatment. Injury. 2007; 38(7): 839–844. doi: 10.1016/j.injury.2006.12.010. |
[ 22 ] | Longo UG, Ronga M, Maffulli N. Acute ruptures of the achilles tendon. Sports Med Arthrosc. 2009; 17:127–138. doi: 10.1097/JSA.0b013e3181a3d767. |
[ 23 ] | Łukas Kołodziej, Andrzej Bohatyrewicz, Justyna Kromuszczyńska, Jarosław Jezierski, Maciej Biedroń. Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study—preliminary report. Int Orthop. 2013; 37: 625–629. doi: 10.1007/s00264-012-1737-9. |
[ 24 ] | Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res. 1977; 128: 247–255. PMID: 340096. |
[ 25 ] | Maffulli N, Longo UG, Spiezia F, Denaro V. Minimally invasive surgery for Achilles tendon pathologies. OAJSM. 2010; 1: 95–103. PMID: 24198547. |
[ 26 ] | McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg. 2011; 17(4): 211–217. doi: 10.1016/j.fas.2010.11.001. |
[ 27 ] | Metz R, van der Heijden GJ, Verleisdonk EJ, Kolfschoten N, Verhofstad MH, van der Werken C. Effect of complications after minimally invasive surgical repair of acute Achilles tendon ruptures: report on 211 cases. Am J Sports Med. 2011; 39(4): 820–824. doi: 10.1177/0363546510392012. |
[ 28 ] | Molloy A, Wood EV. Complications of the treatment of Achilles tendon ruptures. Foot Ankle Clin. 2009; 14:745–59. doi: 10.1016/j.fcl.2009.07.004. |
[ 29 ] | Nilsson-Helander K, Thurin A, Karlsson J, Eriksson BI. High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1234–1238. doi: 10.1007/s00167-009-0727-y. |
[ 30 ] | Olsson N, Nilsson-Helander K, Karlsson J, et al. Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1385–1393. doi: 10.1007/s00167-011-1511-3. |
[ 31 ] | Saxena A, Maffulli N, Nguyen A, Li A. Wound complications from surgeries pertaining to the Achilles tendon: an analysis of 219 surgeries. J Am Podiatr Med Assoc. 2008; 98: 95–101. PMID:18347116. |
[ 32 ] | Solomon LB, Ferris L, Tedman R, Henneberg M. Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus. J Anat. 2001; 199: 717–723. PMID:11787825. |
[ 33 ] | van der Eng DM, Schepers T, Goslings JC, Schep NW. Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013; 52: 622–628. doi: 10.1053/j.jfas.2013.03.027. |
[ 34 ] | Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int. 2000; 21: 475–477. doi:10.1177/107110070002100604. |
[ 35 ] | Aibinder WR, Patel A, Arnouk J, El-Gendi H, Korshunov Y, Mitgang J, et al. The rate of sural nerve violation using the Achillon device: a cadaveric study. Foot Ankle Int. 2013;34(6):870–875. doi: 10.1177/1071100712473097. |