Augmented Repair of Acute Achilles Tendon Ruptures

Twenty-five patients who had an acute Achilles tendon rupture were managed with an augmented repair using the gastrocnemius-soleus fascia. All patients healed their repair and there were no re-ruptures. There was one infection. Augmented repair allowed early functional recovery as evidenced by full ankle motion by four to eight weeks, full unassisted weight bearing by three weeks, cessation of braces by four weeks, and return to work by one to six weeks post-operatively. Augmentation adds a sufficient amount of collagen to allow early range of motion and weight bearing without re-rupture. Disadvantages included a long incision, soft tissue prominence, one infection, and sural nerve injury.

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Management of acute Achilles tendon ruptures

Bone and Joint Research ◽

10.1302/2046-3758.710.bjr-2018-0004.r2 ◽

2018 ◽

Vol 7 (10) ◽

pp. 561-569 ◽

Cited By ~ 19

Author(s):

X. Yang ◽

H. Meng ◽

Q. Quan ◽

J. Peng ◽

S. Lu ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Complication Rates ◽

Functional Rehabilitation ◽

Percutaneous Repair ◽

Tendon Ruptures ◽

Mini Open

ObjectivesThe incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.MethodsA PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.ResultsThe treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous repair, mini-open repair, and augmentative repair. Traditional open repair has lower re-rupture rates with higher risks of complications. Percutaneous repair and mini-open repair show similar re-rupture rates but lower overall complication rates when compared with open repair. Percutaneous repair requires vigilance against nerve damage. Functional rehabilitation combining protected weight-bearing and early controlled motion can effectively reduce re-rupture rates with satisfactory outcomes. Biological adjuncts help accelerating tendon healing by adhering rupture ends or releasing highly complex pools of signalling factors.ConclusionThe optimum treatment for complete rupture remains controversial. Both mini-open repair and functional protocols are attractive alternatives, while biotherapy is a potential future development. Cite this article: X. Yang, H. Meng, Q. Quan, J. Peng, S. Lu, A. Wang. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018;7:561–569. DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2.

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Conservative Management, Percutaneous or Open Repair of Acute Achilles Tendon Rupture: A Retrospective Study

Scottish Medical Journal ◽

10.1177/003693300505000408 ◽

2005 ◽

Vol 50 (4) ◽

pp. 160-165 ◽

Cited By ~ 15

Author(s):

D Miller ◽

S Waterston ◽

J Reaper ◽

V Barrass ◽

N Maffulli

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Open Repair ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Complication Rates ◽

Systemic Corticosteroids ◽

Patients With Diabetes ◽

Tendon Ruptures ◽

Perceived Outcomes

Background and Aims: To ascertain the differences in patients' perceived outcomes between conservative, percutaneous or open repair of Achilles tendon ruptures. Methods: We studied 111 patients who had been managed for a unilateral closed Achilles tendon rupture. We excluded patients with open Achilles tendon lesions, patients whose tear had occurred more than seven days from operation, patients with diabetes, inflammatory disease, systemic corticosteroids or fluoroquinolones. Patients were contacted by telephone and asked to answer a questionnaire. Results: There was no difference in effects on working life, patient satisfaction, sports performance, muscle strength, swelling and fear of re-rupture. Pain on weight bearing and cramps were significantly more frequent in the patients managed conservatively. Re-rupture and complication rates were comparable to published rates. Conclusion: Treatment should be individualised according to the demands and health of the patient.

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Evaluation of the effectiveness of inveterate Achilles tendon rupture V-Y plasty with immediate subsequent weight-bearing and rehabilitation. Case study

Sports medicine research and practice ◽

10.47529/2223-2524.2020.4.5 ◽

2021 ◽

Vol 10 (4) ◽

pp. 22-29

Author(s):

B. Kacprzak ◽

M. Styk ◽

N. Siuba-Jarosz

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Weight Bearing ◽

Full Range ◽

Achilles Tendon Rupture ◽

Wound Area ◽

Foot Motion ◽

Tendon Ruptures ◽

Pes Equinus

In our paper, we would like to present two cases of treatment of the Achilles tendon ruptures by means of surgical V-Y technique, and implementation of immediate rehabilitation and weight-bearing. V-Y plasty on ruptured tendons was performed. The continuity of the tendon was restored. The sheath of the tendon was stitched together. Dressing was put on; the foot was immobilized in a Walker-type shoe in pes equinus with heel pads and compression underwear. From the first hour after the procedure, the wound area was cooled with a Game Ready device. From the first day after the procedure, both patients were allowed to apply full weight to the limb in the shoe. The crutches were put away as soon as possible. Rehabilitation began right away on the next day; during its course, attempts were made to reduce the use of the shoe to a minimum and to achieve the full range of foot motion as soon as possible. In both patients, the full range of motion was reached approximately 2 weeks after the surgery. The video support for the article is available at: https://youtu.be/bi3xuwOT9vs

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Early Ankle Motion after Triple Bundle Technique Repair vs. Casting for Acute Achilles Tendon Rupture

Foot & Ankle International ◽

10.1177/107110070102201210 ◽

2001 ◽

Vol 22 (12) ◽

pp. 979-984 ◽

Cited By ~ 16

Author(s):

Juha I. Jaakkola ◽

James L. Beskin ◽

Letha H. Griffith ◽

George Cernansky

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Ankle Motion

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The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00282 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0028

Author(s):

Jonathan Kaplan ◽

Jeffery Hillam ◽

Amiethab Aiyer ◽

Niall Smyth

Keyword(s):

Diabetes Mellitus ◽

Postoperative Complications ◽

Achilles Tendon ◽

Power Analysis ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture ◽

The United States ◽

Foot And Ankle ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

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Percutaneous Repair Method and Achilles Tendon Rupture Rehabilitation

10.21203/rs.3.rs-86536/v1 ◽

2020 ◽

Author(s):

Krzysztof Ficek ◽

Paweł Gwiazdoń ◽

Jolanta Rajca ◽

Grzegorz Hajduk

Keyword(s):

Side Effects ◽

Soft Tissue ◽

Minimally Invasive ◽

Achilles Tendon ◽

Range Of Motion ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Well Being ◽

Professional Activity ◽

Rehabilitation Protocol

Abstract Background: Subcutaneous, spontaneous, complete ruptures of the Achilles tendon are usually caused indirectly by trauma associated with rapid movement. When minimally invasive Achilles tendon repair is performed, an active rehabilitation protocol can be implemented that allows for fast, measurable progress, reduced tissue atrophy, and an improved range of motion, thereby reducing pain and increasing patients’ overall physical well-being. However, overestimating the effectiveness of rehabilitative interventions can lead to arbitrary advancements in rehabilitation that significantly exceed the permitted levels of daily or professional activity. This issue can lead to various side effects and slow rehabilitation. The aim of the study was to evaluate the influence of adverse effects on objective outcomes after minimally invasive Achilles tendon repair.Methods: The study included 36 individuals with complete Achilles tendon rupture who underwent the percutaneous Ma-Griffith technique. The same rehabilitation protocol was used.Results: Five side effects were identified during rehabilitation: deformation of the repair construct (DRC), irritation of the sural nerve (SNI), morning ankle stiffness (MAS), edema of the soft tissue around the tendon (OST) and suture knots. DRC and MAS were associated with a longer time being required to achieve full ankle range of motion. SNI and OST were associated with a longer time being required to meet the criteria for dynamic training. None of the side effects were related to the isokinetic strength of the ankle plantar and dorsiflexors.Conclusions: The incidence of the assessed side effects in the postoperative period is not related to the type of activity, whether it is professional or amateur. Among the identified side effects, deformation of the regenerated shape of the heel tendon and MAS cause a delay in the recovery of full ankle range of motion. Calf nerve irritation and soft tissue swelling increase the time it takes to meet the criteria for starting dynamic training.Trial registration:The study was approved by the ethics committee of the Academy of Physical Education in Katowice (no. 13/2007)

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Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

10.21203/rs.3.rs-16380/v1 ◽

2020 ◽

Author(s):

Yongliang Yang ◽

Honglei Jia ◽

Wupeng Zhang ◽

Shihong Xu ◽

Fu Wang ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Nerve Injury ◽

Saphenous Vein ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Intraoperative Ultrasonography ◽

Medial Side ◽

Significant Difference

Abstract Background: Minimally 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.Methods: A 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 sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All 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 AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The 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 AT rupture.

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Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors77113 ◽

2021 ◽

Vol 9 (4) ◽

pp. 465-470

Author(s):

Saad Andaloussi

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Skin Wound ◽

Plantaris Tendon ◽

First Case ◽

Tendon Ruptures ◽

Post Traumatic

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

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Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection

ISRN Orthopedics ◽

10.5402/2011/869703 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Michael H. Amlang ◽

Hans Zwipp ◽

Adina Friedrich ◽

Adam Peaden ◽

Alfred Bunk ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Individual Treatment ◽

Reliable Instrument ◽

Tendon Ruptures ◽

Selection For ◽

Sonographic Classification

Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends. Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%). Of the patients with type 1 and fresh ASR, 96% () were treated nonoperative-functionally, and 4% () were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% () were treated by pDI suture and 6% () by open suture according to Kirchmayr and Kessler. Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.

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