Abstract
PurposeChronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique.MethodsMinimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment.ResultsAll of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10–100 N load followed by additional 250 cycles of 10–200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20–400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509–1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006).ConclusionsThe results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases.Level of evidenceIII
Highlights
The treatment of chronic Achilles tendon tears, including chronic ruptures, is a challenge for most orthopedic surgeons [10]
Using semitendinosus and gracilis tendons with Endobutton (Smith & Nephew, USA) stabilization, an Achilles tendon reconstruction in a minimally invasive way with as little as eight small skin incisions and immediate weight-bearing of the injured foot after the surgery has been performed
Assessment of the long-term outcomes of the minimally invasive Achilles tendon reconstruction technique [30] was the primary aim of this study
Summary
The treatment of chronic Achilles tendon tears, including chronic ruptures, is a challenge for most orthopedic surgeons [10]. Several techniques have been described; the superiority of one technique over the others has not been demonstrated and the best surgical management of chronic Achilles tendon ruptures still remains controversial [14, 19, 23, 24, 33, 34, 36]. It has been recently aimed at establishing new technique of Achilles reconstruction to minimize the wound healing problems and to reduce the rate of infection [30]. Presented method has been hypothesized to be potentially beneficial to all patients when it comes to both, restored Achilles tendon function as well as patients satisfaction with the reconstruction outcomes
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