Abstract
BackgroundFollowing 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.MethodsAll 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.ResultsForty-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.ConclusionThe 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.
Highlights
Acute Achilles tendon (AT) tears are common
The inclusion criteria were: (1) > 3 months conservative management, (2) AT healed in continuity without gap, (3) age 18 to 50 years, (4) unable to stand on tiptoes with the knee extended
The present study demonstrated that the check-rein procedure for elongation of the AT following conservative management of AT rupture is effective and feasible to restore tendon length and calf function
Summary
Acute Achilles tendon (AT) tears are common. Tendon elongation correlates significantly with clinical outcome, being an important cause of morbidity as it may produce permanent functional impairment [19, 21,22,23]. The management of elongated AT is challenging with limited options and unpredictable results, and reconstruction and augmentation surgery are more technically demanding than primary repair procedures [24, 25]. 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
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