Achillon Device Research Articles

Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS).

Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS).

Mini-open Repair for Acute Achilles Tendon Rupture: Ring Forceps vs the Achillon Device

Background: Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. Purpose: To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results: The AOFAS score (P = .669), Achilles Tendon Total Rupture Score (P = .753), and length of incision (P = .305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P < .001). The maximum height of the SLHR (P = .042) and the number of SLHRs (P = .043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s (P = .185) and 120 deg/s (P = .271). There was no significant difference in the occurrence of postoperative complications between the groups (P = .093). Conclusion: The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

Acute spontaneous bilateral rupture of the Achilles tendon

This is a case report of a 67-year-old active, healthy, male patient who played sports. He presented with pain and bilateral ecchymosis in the calf area. Data from the patient’s history, a physical examination and complementary exams confirmed a diagnosis of atraumatic spontaneous bilateral Achilles tendon rupture. Surgical treatment was performed using the percutaneous technique (the Achillon device) bilaterally. In thepostoperative period, the patient used a walking boot with a 3-cm heel lift in maximum equinus for 45 days and in a neutral position until 60 days after the procedure. The patient began rehabilitation with physical therapy and returned to his sporting activities without restrictions. Level of Evidence V; Prognostic Studies; Expert Opinion.

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

ObjectiveTo 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. MethodsA 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. ResultsAll 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). ConclusionThe 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.

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. 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. 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. 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.

Outcome following use of the Achillon jig for the repair of acutely ruptured Achilles tendons

We report a series of 143 patients who underwent limited open Achilles tendon repair using the Achillon device at a mean follow-up of 25 months.All patients attending our institution with a diagnosis of acute Achilles tendon rupture were considered for operative repair using the Achillon jig unless they declined surgery or met the exclusion criteria.Following surgery patients were contacted and asked to complete an Achilles Tendon Rupture Score (ATRS). The clinical records were reviewed for evidence of complications, demographic information and evidence of re-rupture. Statistical analysis of subgroups including age at presentation, delay to surgery and patients with complications was carried out using the Kruskal Wallis non-parametric test.We report no re-ruptures at a mean of 25 months (minimum 12 months) following surgery. The mean ATRS score was 84/100 (range 15–100). There was no statistical significance between any of the subgroups analyzed.In conclusion, acute Achilles repair using the Achillon jig is safe, with a low re-rupture rate, excellent ATRS scores at a minimum of 12 months post-operatively and low complications. The incidence of sural nerve injury is much lower than published series of percutaneous Achilles tendon repair without the use of a jig.

An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device.

Percutaneous Achilles tendon repairs are gaining in popularity. This study aims to quantify the risk of sural nerve injury when using the Achillon device. The Achillon device was instrumented into 15 cadaveric specimens and through dissection the rate of sural nerve puncture and the position of the sural nerve in relation to the Achilles tendon was documented. The sural nerve was found lateral to the Achilles tendon insertion point over a range of 14.3mm and crossed the lateral border of the Achilles tendon over a range of 57.7mm. The sural nerve was punctured a total of 6 times and in 4 out of 15 cadaveric specimens (27%). Four out of the 6 punctures occurred when the Achillon device was instrumented distally. The sural nerve displays a highly variable anatomical course and there is a risk of puncture during percutaneous Achilles tendon repair using the Achillon device.

The Rate of Sural Nerve Violation Using the Achillon Device

Management of acute Achilles tendon rupture remains controversial. Open repair results in lower rerupture rates but is associated with complications from wound healing. Percutaneous and limited open repairs minimize soft tissue complications; however, there is a theoretical increased risk of sural nerve injury. We evaluated the risk of sural nerve violation with the Achillon limited open repair device in cadavers. This cadaveric study consisted of 2 parts. The first part evaluated the frequency and location of sural nerve violation using the standard Achillon protocol in 18 intact embalmed left lower limbs. The second part involved device manipulation with 30 degrees of either internal or external rotation in 13 paired, intact embalmed lower limbs. In the first part, 5 of 18 specimens had at least 1 suture passing through the sural nerve. Eight of the 54 needle passes (14.8%) directly pierced the substance of the sural nerve. With internal rotation, 8 of 13 specimens had at least 1 violation of the nerve. Ten of the 39 needle passes (25.6%) directly pierced the substance of the sural nerve. With external rotation, no nerves were violated, significantly decreasing the risk of sural nerve violation versus neutral (P = .038) and internal rotation (P = .001). When sural nerve violation was evaluated in regard to instrument outlet, there was a higher risk in the proximal needle passer (outlet no. 3) compared with the distal needle passer (outlet no. 1) with both neutral testing and internal rotation (P = .027). This study demonstrated the potential risk for sural nerve injury using the Achillon device. External rotation of the Achillon decreased the rate of sural nerve violation. This may optimize its use in Achilles tendon repairs.

Achillon Mini-Open Achilles Tendon Repair: Early Outcomes and Return to Duty Results in U.S. Military Service Members

The purpose of this article is to report short-term outcomes and return to duty rates in a cohort of active duty U.S. military personnel who underwent repair of acute Achilles tendon ruptures using the Achillon mini-open technique. Between October 2009 and March 2012, 15 consecutive patients underwent mini-open repair of acute Achilles tendon ruptures using the Achillon device by a single surgeon. Minor and major complications were recorded, and American Orthopaedic Foot and Ankle Society (AOFAS) and pain visual analog scores were recorded at regular follow-up intervals. At mean latest follow-up of 16.7 months postoperatively, all 15 patients had returned to full active duty status without major complications. Specifically, no patient experienced major wound complication, infection, or rerupture. Mean AOFAS score in 9 of 15 patients was 94.1; mean pain visual analog score in 12 of 15 patients was 1.4. The Achillon mini-open technique can be used for treatment of acute Achilles tendon ruptures in appropriately selected high-demand patient populations with the expectation of minimal adverse outcomes.

Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study—preliminary report

PurposeSurgical treatment of an acute Achilles tendon rupture can effectively reduce the risk of re-rupture, but it increases the probability of surgical complications. We postulated that a minimally invasive surgical treatment might reduce the number of complications related to open surgery and improve the functional results.MethodWe enrolled 47 patients with acute Achilles tendon ruptures in a prospective, randomised trial to compare clinical results and complications between a minimally invasive procedure with the Achillon® device and traditional open surgery with Krackow-type sutures. The average patient age was 46 years. The follow up time was 24 months.ResultsNo Achilles tendon re-rupture or nerve injury occurred in treated patients. There were two cases of wound infections in the open surgery group, and one superficial wound infection occurred in the minimally invasive group. The groups were not significantly different in the amount of pain, range of ankle movements, the single heel-rise test, calf circumference, or time to return to work and sports.ConclusionAfter a two year follow-up period, we found no significant differences in clinical outcomes between groups treated with traditional open surgery or minimally invasive surgery.

Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs

The study aim was to describe what kind of operative technique performs best with respect to initial strength after the surgical repair of acute Achilles tendon ruptures. We performed a systematic search of the keywords "Achilles tendon AND (suture strength OR biomechanics) AND (cadaver NOT animal)" in the online databases PubMed, EMBASE, CINAHL, and the Cochrane Library. We included studies that employed open, mini-open, or percutaneous Achilles tendon repair in human cadavers, and assessed some measure of tensile strength as a primary outcome. Our search produced 11 relevant papers reporting results for Kessler, Bunnell, and Krackow sutures in open repair, as well as the Achillon device, the Ma-Griffith repair technique, the triple bundle technique and the "giftbox" technique. The weighted tensile strengths ranged from 81 to 453 N (mean 222.7 N) with the Triple Bundle technique in combination with # 2 Ethibond performing best with a mean of 453 N. Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons.

A biomechanical comparison of the primary stability of two minimally invasive techniques for repair of ruptured Achilles tendon

To compare the primary stability of two minimally invasive procedures of Achilles tendon (AT) repair, namely a modified percutaneous repair of ruptured AT and the Achillon suture configuration. Eighteen (nine matched pairs) frozen ovine ATs were tenotomized 5cm from the calcaneal insertion. In each pair, one tendon was randomly allocated to one of the two techniques: a modified percutaneous repair group and the Achillon device suture configuration. Specimens were tested performing an unidirectional tensile load to failure using a servo-hydraulic testing device (MTS Systems, Eden Prairie, MN, USA), controlled by an electropulse e3000 INSTRON machine (Instron Ltd, Buckinghamshire, UK). The tendons were then loaded to failure at a rate of 10mm/s. Two of the nine pairs of specimens were discarded because one specimen for each of the pair pulled out of the pneumatic clamp during mechanical testing. The remaining seven matched pairs were successfully tested. There were no differences in mean strength, mean maximum load, mean failure elongation, tension, stiffness and mode of failure between the two groups. The Achillon-like configuration and the modified percutaneous repair of ruptured AT provided similar biomechanical performance.

Minimally invasive repair of acute Achilles tendon ruptures with Achillon device

The subcutaneous rupture of the Achilles tendon is a frequently observed lesion. Its treatment, however, remains controversial. The treatment to be applied varies between the conservative method, open surgical procedure and percutaneous or minimally invasive techniques. While conservative treatment results in a high percentage of re-ruptures, the open surgical treatment also has its complications. Surgical wound dehiscence, delayed cutaneous healing due to infection, delayed weight-bearing capacity, and consequent hypertrophic scarring account for 4-19% of all complications. The need for a technique that minimizes these complications has led to the development of percutaneous techniques. From August 2005 to March 2009, 35 consecutive patients underwent reparative surgery of the Achilles tendon using a minimally invasive technique with the Achillon device. All patients were available for follow-up. Dynamometric evaluation was possible on 15 patients. Twenty-five patients reported being very satisfied and 10 as being satisfied. The average AOFAS score was 93.4 (range 88-100 points). No complications occurred as a result of surgery (re-rupture, infection, lesion of the sural nerve, wound complication). All patients returned to work within 2 months, to jogging within 3 months, and to their previous level of sporting activity within 6 months. The authors believe that the minimally invasive technique using the Achillon device is a reliable surgical treatment and provides satisfactory results with a low rate of complication.

Treatment of acute Achilles tendon ruptures with Achillon device: Clinical outcomes and kinetic gait analysis

We reviewed the outcomes of the Achillon minimally invasive suture system and an early semi-functional rehabilitation program for the treatment of acute Achilles tendon ruptures. From December 2006 to April 2008, 18 consecutive patients with acute Achilles tendon ruptures were retrospectively reviewed with an average follow-up of 22 months. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score. Biomechanical gait parameters were obtained using the NedAMH/IBV dynamometric platform. At last follow-up the AOFAS score was 98 (range, 89-100) and correlated well with kinetic gait analysis. All patients regained normal range of motion and were able to resume their previous activities after six months, with a high rate of satisfaction. Three patients had scar adhesions. There were no cases of recurrent rupture or nerve injury. The Achillon device allows semi-functional rehabilitation and provides satisfactory results with a low rate of complication.

Achilles tendon repair: Achillon system vs. Krackow suture: An anatomic in vitro biomechanical study

Background Limited open repairs of acutely ruptured Achilles tendon, using the Achillon device, are becoming a frequently used method of treatment. To date there are no biomechanical studies comparing the strength of the Achillon repair to the Krackow repair. This study provides a direct comparison of the strength of these two repair techniques. Methods Using 10 paired cadaveric Achilles tendon specimens; repairs were performed using a Krackow technique on one specimen and a repair with the Achillon Suture System on the contralateral specimen. All repairs were made with identical suture material. Specimens were tested for ultimate strength using a servo-hydraulic testing device. Findings The mean load to failure of the control group (Krackow suture) was 276 N (standard deviation 87.0), and for the experimental group (Achillon suture) was 342 N (standard deviation 92.8). Using a Wilcoxon test this result was found to be statically significant ( P = 0.03). Interpretation The current study has demonstrated that the Achillon repair is stronger in a cadaveric biomechanical study than the Krackow repair using identical sutures. This provides biomechanical evidence to support the continued use of the limited open repair as opposed to the traditional open repair.