Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture

Yang Yongliang,Han Shumei,Wang Bomin,Xu Shihong,Zhang Wupeng,Jia Honglei,Wang Fu,Li Qinghu,Wang Yonghui

doi:10.1186/s13018-020-01776-6

Abstract

BackgroundMinimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.MethodsA retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and the sural nerve was identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV).ResultsAll patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17 ± 5.31 preoperatively to 98.92 ± 1.63 at the time of 12 months follow-up. There was a statistically significant difference (P < 0.001). No patient complained of a negative effect on their life.ConclusionsThe minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time, and less complications, especially sural nerve injury. It is an efficient, reliable, and safe method for acute Achilles tendon (AT) rupture.

Highlights

Invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair
We assessed the outcomes of a minimally invasive repair assisted with intraoperative ultrasonography in patients diagnosed as acute AT rupture, and evaluated the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture
Materials and methods From January 2015 to December 2017, 36 consecutive patients diagnosed as acute AT rupture were treated with minimally invasive repair assisted with intraoperative ultrasonography

Summary

Introduction

Invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. Achilles tendon (AT) rupture is a common injury of the foot and ankle, which mostly occurs in the 30–40-year age group, and the incidence is increasing in recent years [1]. Surgical treatment can be subdivided into open sutures with or without augmentation, minimally invasive, and percutaneous repairs. In comparison with conservative management, surgical repair can decrease the tendon re-rupture rate, and get earlier functional treatment, less calf atrophy, and stronger push off [4]. The possible surgical complications included wound infection and sural nerve (SN) injury

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