Acute Closed Achilles Tendon Rupture Research Articles

Peritendinous Submembrane Access Technique for Management of Acute Ruptures of the Achilles Tendon: A Retrospective Study of 249 Cases.

Percutaneous repair is an alternative to open surgical repair of the Achilles tendon with comparable, functional results and low re-rupture and infection rates; however, sural nerve injury is a known complication. The purpose of this study is to design a new surgical procedure, the minimally invasive peritendinous submembrane access technique (MIS-PSAT). It offers optimal results, with excellent functional outcomes, and with minimal soft tissue complications and sural nerve injury. This retrospective study included 249 patients with acute closed Achilles tendon ruptures treated at our institution between 2009 and 2019. All patients underwent MIS-PSAT at our institution and were followed up for 8-48 months. Functional evaluation was based on the Achilles tendon total rupture score (ATRS) and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS), associated with local complications and isokinetic tests. None of the patients had infection, necrosis, or sural nerve injury. Re-rupture occurred in two cases. The average times to return to work and sports was 10.4 and 31.6 weeks, respectively. The average ATRS and AOFAS-AHS scores were 90.2 and 95.7, respectively, with an excellent rate of 99.5%. Isokinetic tests showed that ankle function on the affected side was comparable with that on the healthy side (p > 0.05). The MIS-PSAT for acute Achilles tendon rupture is easy to perform with few complications. Importantly, the surgical technique reduces the risk of sural nerve injuries. Patients have high postoperative satisfaction, low re-rupture rates, and muscle strength, and endurance can be restored to levels similar to those on the healthy side.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system

To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture. A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed. No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores. Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Application of Preoperative Ultrasonography in the Percutaneous Minimally Invasive Repair of Acute Closed Achilles Tendon Rupture.

Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.

A Two-year Follow-up Study of Accelerated Functional Rehabilitation Combined with Percutaneous Minimally Invasive Suture in the Treatment of Acute Closed Achilles Tendon Rupture

To explore the effect of fast functional rehabilitation combined with percutaneous minimally invasive suture treatment for acute closed Achilles tendon rupture (ACATR) through 2-year follow-up study.We collected 32 patients with acute closed Achilles tendon rupture operated in our hospital, they were divided into early accelerated functional rehabilitation group(EAFR) and traditional rehabilitation group(TR). AOFAS Ankle Hindfoot Scale (AOFAS), Achilles tendon Total Rupture Score (ATRs) and the Muscle Strength recovery Rate (MSR) were used as follow-up evaluation. No incision-related complications or Achilles tendon rupture re-occurrence in both two groups. ATRS scores and AOFAS scores of the EAFR group were higher than those of the TR group in the 6th and 12th month after surgery, respectively (P<0.05), while no statistical significance in the 24th month when compared the two groups (P>0.05). In the EAFR group, the scores attained in the 12th month were higher when compared with those attained in the 6th month (P<0.05), lower when compared with those assessed in the 24th month (P<0.05). In the TR group, the scores attained in the 24th month were higher than those assessed in the 12th month (P<0.05), no statistical significance between the 6th month and the 12th month after surgery (P>0.05). The rate of muscle strength recovery was higher in the EAFR group in the 12th month after sugery (P<0.05), no statistical significance between the two groups in the 24th month (P>0.05). Percutaneous minimally invasive suture combined with early accelerated functional rehabilitation in treating the ACATR can accelerate the Achilles tendon function recovery without increasing the incidence of complications.

Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture

To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance. From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups. Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05). The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.

Application of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in acute closed Achilles tendon rupture

To explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture. The clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by "V-Y"advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function. The 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases. The treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve.

Treatment of comminuted Neer IV fracture of proximal humerus with lower shoulder replacement assisted by 3D technique

To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique. From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function. Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(P<0.05). Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.

Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures

To explore clinical effects of ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures. From January 2015 to March 2017, 20 patients with acute closed Achilles tendon rupture were treated by minimal traverse-cross technique repair with ultrasound guided. Among them, including 13 males and 7 females, aged from 28 to 49 years old with an average of(31.3 ±4.5) years old. All patients were single side injury. Fifteen patients on the left side and 5 patients were on the right side. The time from injury to operation ranged from 1 to 5 days with an average of (2.5±0.7) days. Operative time, postoperative complications were observed, and AOFAS score before and after operation at 12 months were compared. All patients were followed up for 12 to 27 months with an average of(15.2±4.9) months. Operative time ranged from 33 to 65 min with an average of(43.7±5.6) min. Incision of one patient were continued oozing and improved after changing dressings, other patients were healed at stage I. No sural nerve irritation symptoms and palindromic rapture of heel tendon occurred. AOFAS score was improved from 65.2±7.4 before operation to 97.7±4.7 after operation at 12 months (t=22.5, P<0.01); 18 patients got excellent results and 2 good. Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.

Clinical efficacy of percutaneous minimally invasive anchorage suture in repair of acute closed Achilles tendon rupture

Objective To investigate the clinical efficacy of percutaneous minimally invasive anchorage in the treatment of acute closed rupture of Achilles tendon. Methods A retrospective case-control study was conducted on the clinical data of 32 patients (16 cases on the left side and 16 cases on the right side) with acute closed Achilles tendon rupture treated from January 2015 to January 2017. There were 27 males and five females, aged 24-67 years (mean, 40.8 years). The patients were divided into treatment group which adopted percutaneous minimally invasive combined with anchor suture and control group which used simple minimally invasive suture, with 16 cases in each group. The operation time, hospitalization time, sural nerve injury, single foot heel raise at 3 months and 6 months, difference of calf circumference on the rupture surface between the affected side and healthy side at 6 months, ankle back foot score scale (AOFAS), and infection at 6 months were recorded. Results All patients were followed up for average 8.9 months (range, 6-12 months). In treatment group, the operation time was (35.75±3.10) minutes and hospitalization time was (8.38±1.62)days. The AOFAS score was (92.12±5.86)points. The result of single foot heel raise was positive in one case at 3 months and in 0 case at 6 months. The difference of calf circumference on the rupture surface between the affected side and healthy side at 6 months was (2.23±0.97)cm. In the control group, the operation time was (33.43±3.89)minutes and hospitalization time was (8.50±1.75)days. The AOFAS score was (91.00±7.15)points at 6 months. The result of single foot heel raise was positive in eight cases at 3 months and in 0 case at 6 months. The difference of calf circumference on the rupture surface between the affected side and healthy side at 6 months was (1.64±2.34)cm. There were no significant differences between the two groups in operation time, hospitalization time, the AOFAS score at 6 months, and the results of single foot heel raise at 6 months(P>0.05). Treatment group had better results than control group in terms of the difference of calf circumference on the rupture surface between the affected side and healthy side at 6 months as well as the result of single foot heel raise at 3 months (P<0.05). No infection and sural nerve injury were found in either group. Conclusion The repair of Achilles tendon rupture by percutaneous minimally invasive anchor technique can help patients achieve heel raise early, obtain better muscle capacity, and return to work earlier. Key words: Achilles tendon; Tendon injuries; Surgical procedures, minimally invasive; Anchors

Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture

To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.

Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture

To explore the effectiveness of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture. Between October 2013 and July 2016, 25 cases with acute Achilles tendon rupture were repaired by simple Krackow suture via limited small incision. There were 21 males and 4 females with an average age of 33.6 years (range, 25-39 years). The left side was involved in 15 cases and the right side in 10 cases. The injury caused by sport in 22 cases and by falling in 3 cases. The time from injury to operation was 3-7 days (mean, 4.4 days). Physical examination showed that the Thompson sign and single heel raising test were positive. The operation time was 30-60 minutes with an average of 39.2 minutes. All incisions healed by first intention. There was no complication of wound infection, deep vein thrombosis, tendon re-rupture, and sural nerve injury. All patients were followed up 9-20 months (mean, 14.2 months). The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 92-97 (mean, 94.9) after 9 months. The AOFAS score results were excellent in 13 cases, good in 9 cases, and fair in 3 cases. The range of motion of ankle joint was 49-58° with an average of 53.7°. All single heel raising tests were negative. The method of simple Krackow suture via limited small incision has the advantages of minimal injury, less incidence of re-rupture and sural nerve injury, quicker recovery and so on.

Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture

To investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture. Between December 2013 and December 2016, 29 cases with acute closed Achilles tendon rupture were treated with modified suture technique. There were 23 males and 6 females with an average age of 34 years (range, 22-45 years). All patients were sport injuries. The injury located at left side in 22 cases and right side in 7 cases. American Foot and Ankle Surgery Association (AOFAS) ankle and hind foot function score was 44.6±3.6. According to the Amer-Lindholm criteria, 29 cases were rated as poor. MRI showed the complete rupture of the Achilles tendon. The operation time was 35-62 minutes (mean, 46 minutes). The intraoperative blood loss volume was 7-15 mL (mean, 10 mL). The incisions healed by first intention, and no sural nerve injury occured. All patients were followed up 5-38 months (mean, 18.4 months). AOFAS ankle and hind foot function score was 93.1±4.3 at 3 months after operation, showing significant difference when compared with the preoperative value ( t=-49.581, P=0.000). According to the Amer-Lindholm criteria, the results were excellent in 24 cases and good in 5 cases, and the excellent and good rate was 100%; there was significant difference between pre- and post-operation ( Z=-7.294, P=0.000). MRI showed the continuous and integrity of Achilles tendon. No Achilles tendon rupture recurred during the follow-up period. Modified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery.

The application of contralateral acupuncture for rehabilitation after acute closed achilles tendon rupture

To observe the differences of affected-side ankle plantar flexors function and clinical efficacy between contralateral acupuncture combined with rehabilitation training and rehabilitation training alone for patients with acute closed achilles tendon rupture. Seventy-four patients with acute closed achilles tendon rupture were randomly assigned to an observation group and a control group, 37 cases in each group. Patients in the both groups were treated with routine rehabilitation training after the operation for 12 weeks; besides, patients in the observation group were treated with contralateral acupuncture at Zusanli (ST 36), Yanglingquan (GB 34), Chengshan (BL 57), Taixi (KI 3) before rehabilitation training in the first 6 weeks. The treatment were given once a day, 5 times as 1 course with 2 d at the interval. The Biodex System 4 multi-joint dynamometers system was applied to test and compare affected-side plantar flexion peak torque (PFPT), peak torque/body weight (PT/BW) and total work (TW) after 6 weeks, 8 weeks and 12 weeks. The efficacy evaluation was conducted after 6 weeks and 12 weeks, and the follow-up visit was conducted 12 weeks after end of treatment. The PFPT, PT/BW, TW in the observation group were significantly superior to those in the control group after 8 weeks and 12 weeks of treatment (all P<0.05); compared with those after 6 weeks, the PFPT, PT/BW, TW were significantly increased after 8 weeks of treatment (all P<0.05); compared with those after 6 weeks and 8 weeks, the PFPT, PT/BW, TW were significantly increased after 12 weeks of treatment (all P<0.05). After 12 weeks of treatment and at follow-up visit, the clinical excellent and effective rates in the observation group were higher than those in the control group[89.2% (33/37) vs 70.3% (26/37), 94.6% (35/37) vs 75.7% (28/37), both P<0.05]. During the postoperative rehabilitation of acute closed achilles tendon rupture, the contralateral acupuncture combined with rehabilitation training could improve ankle plantar flexors function and clinical efficacy better than rehabilitation training only.

Limited incision with sponge forceps assisted threading in treatment of acute closed rupture of Achilles tendon

Objective To explore the clinical advantages of limited incision with sponge forceps assisted threading in the treatment of acute closed rupture of achilles tendon.Methods From August 2011 to December 2013,97 cases of acute closed achilles tendon rupture were treated by limited incision with sponge forceps assisted threading.They were 69 men and 28 women,16 to 66 years of age (35.6 years).The left side was injured in 60 cases and the right side in 37 cases.Time from injury to surgery was from 1 to 7 days,averaging 3.2 days.One 2 to 3 cm long incision was made about 1 cm medial to the medial edge of the achilles tendon at the rupture site.With a pair of sponge forceps,suture lines were threaded through the tendon and tied to suture the ruptured tendon.Results The patients were followed up until 6 months postoperatively.The operation time ranged from 37 to 50 minutes,with an average of 43.2 minutes.Local incision exudation occurred in 4 cases which responded to daily dressing change.One patient had superficial wound infection which was cured by debridement and wound suture.The incisions of the other 92 cases healed primarily and their stitches were taken out after 3 weeks.Re-ruptures occurred in 4 cases within 6 months postoperation which were treated by end-to-end anastomosis in re-operation.No sural nerve irritation was observed in this cohort.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores at 6 months postoperation averaged 92.Conclusion Limited incision with sponge forceps assisted threading is a practical technique for treatment of acute closed rupture of achilles tendon,because it is minimally invasive and simple,and leads to fewer complications and quicker recovery. Key words: Achilles tendon; Ankle injuries; Surgical procedures, minimally invasive

Acute Achilles tendon rupture: Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture

Background and purposeAchilles tendon rupture is a common injury of the foot and ankle. However, the optimal treatment strategy for Achilles tendon rupture is still not established. This study was conducted to compare the efficacy and complications of mini-incision repair with double-Tsuge loop sutures and open repair with modified Kessler sutures. MethodsWe evaluated data from 60 patients with acute closed Achilles tendon ruptures who underwent mini-incision repair with double-Tsuge loop sutures (n = 30) or open repair with modified Kessler sutures (n = 30) from 2006 to 2010 in an ongoing prospective study conducted by us and have finished at least 18-month follow-up or finished the study. The AOFAS Ankle–Hindfoot score, ATRS, maximal ankle range of motion and the time to achieve 20 continuous single heel raises after operation were recorded to compare the efficacy. The complications were also evaluated. ResultsDuring a mean follow-up of 25 months after surgery, the time to achieve 20 continuous single heel raises after operation of patients in Group Mini was significantly shorter than patients in Group Open. Moreover, the mini-incision with double-Tsuge repair was associated with a significantly shorter operating time, smaller incision length, and lower rate of complications. ConclusionThe mini-incision with double-Tsuge suture method in our study was shown to provide earlier strength recovery, as well as shorter operation time, less complications and improved cosmetic appearance.

Different Sutures in the Surgical Treatment of Acute Closed Achilles Tendon Rupture.

The aim was to compare the postoperative efficacy of the PDS II and Ethibond W4843 sutures in fresh, closed Achilles tendon rupture. With methods of random grouping (level of evidence II b), a total of 128 patients with fresh Achilles tendon rupture were operated on with PDS II or Ethibond W4843 suture. Postoperative objective examination and the American Orthopaedic Foot & Ankle Society (AOFAS) scoring system were used for the evaluation. Group A underwent 12-39months of follow-up, for an average of 22months. Group B underwent 12-37months of follow-up, for an average of 23months. The postoperative AOFAS score of group A within 3months was 93 ± 9.6 points. One case exhibited re-rupture, five cases exhibited incision infection, one case manifested deep infection, and seven cases exhibited Achilles tendon adhesion. The postoperative AOFAS score of group B within 3months was 97 ± 7.8 points. Eleven cases had incision infection, and 13 cases manifested Achilles tendon adhesion. Minimal differences were observed in the incision infection, re-rupture rate, and Achilles tendon adhesion in the study of the PDS II and Ethibond W4843 sutures. But, based on the AOFAS score and pain score, the Ethibond suture performed better.

Percutaneous Repair of Acute Closed Ruptured Achilles Tendon

The technique of percutaneous suturing repair of acute closed rupture of the Achilles tendon, as described in this article, can be performed under local anesthesia without using an arterioconstrictive tourniquet. Eighteen patients have been successfully treated with this technique, 12 having been closely followed for more than 12 months, and 8 for more than 24 months. Preliminarly, this technique for repairing acute closed Achilles tendon ruptures appears more promising than open surgical repair or short leg equinus casts alone due to tendon continuity restoration, tendon strength restoration,and minimization of postoperative complications.