The percutaneous oval forceps suture-guiding method with anchor nails for Achilles tendon repair

BackgroundAcute Achilles tendon rupture (AATR) is a common injury of the foot and ankle. So far, the optimal management of AATR remains controversial. The target of the present retrospective study was to describe a new operative technique for percutaneous repair of AATR and evaluate efficacy of the technique.MethodsIn the present study, 32 patients were enrolled with AATR treated with the percutaneous oval forceps suture-guiding method with anchor nails from Jan 2014 to Jan 2017. The operation duration and length of incision were collected. The functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon total rupture score (ATRS), range of motion (ROM) of the ankle and plantar flexion strength ratio at the last follow-up. The postoperative sports activity level and complications were also recorded.ResultsThe mean operation duration and length of incision were 24.5 min and 2.0 cm. Whilst patient reported outcome questionnaires like AOFAS and ATRS showed good results, ROM of the ankle was quite low with only 16.5 degrees. Plantar flexion strength ratio was lower post surgery, as well. As for the postoperative sports activity level: 26/32 cases (81.3%) returned to former sports activity level; 4/32 cases (12.5%) showed a decline in sports activity level; 2/32 cases (6.2%) gave up on sports. The overall complication rate was 6.2%, one sural nerve damage and one fusiform thickening were found in the study.ConclusionThe percutaneous oval forceps suture-guiding method with anchor nails is a new considerable surgery method with adequate healing rates and an alternative to existing surgical procedures.     

运用Achillon吻合器微创治疗新鲜闭合性跟腱断裂

目的 探讨运用Achillon吻合器治疗新鲜闭合性跟腱断裂的临床疗效.方法 2010年9月至2013年3月,我院运用Achillon吻合器治疗新鲜闭合性跟腱断裂12例.结果 12例获得随访,随访时间8～18个月,平均12个月,按照Amer-Lindholm疗效评定标准,优10例(83.3％),良2例(16.7％);所有病例无伤口感染,未发生跟腱再次断裂.结论 运用Achillon吻合器治疗新鲜闭合性跟腱断裂,具有血运影响小、并发症少、术后功能恢复快等优点.     

Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture

BackgroundTo compare the effectiveness of tenocutaneous suture and conventional Kessler suture techniques in treating acute closed Achilles tendon rupture.MethodsA total of 33 patients with acute closed Achilles tendon rupture who were admitted to our hospital from February 1998 to December 2008 underwent repair with either a tenocutaneous suture or Kessler suture technique. All patients were followed up for 1–5 years (mean, 3 years).ResultsAccording to the American Orthopaedic Foot and Ankle Society ankle–hindfoot scale, the excellence rate was 91% in the Kessler suture group and 98% in the tenocutaneous suture group, with a significant difference between groups.ConclusionOur tenocutaneous suture technique is an effective method for treating Achilles tendon rupture. It has certain advantages compared with the conventional incision method and is worthy of wide clinical application.     

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

BackgroundPercutaneous Achilles tendon repairs are gaining in popularity. This study aims to quantify the risk of sural nerve injury when using the Achillon device.MethodsThe 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.ResultsThe sural nerve was found lateral to the Achilles tendon insertion point over a range of 14.3 mm and crossed the lateral border of the Achilles tendon over a range of 57.7 mm.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.ConclusionsThe sural nerve displays a highly variable anatomical course and there is a risk of puncture during percutaneous Achilles tendon repair using the Achillon device.     

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.     

Achillon微创跟腱吻合器治疗急性跟腱断裂的疗效观察

背景:急性跟腱断裂是一种常见的运动损伤,微创治疗由于其创伤小、并发症少等而日渐被关注。目的:观察应用Achillon微创跟腱吻合器治疗急性跟腱断裂的临床效果。方法:对2010年7月至2011年7月在我院采用Achillon跟腱吻合器治疗的21例急性跟腱断裂患者进行随访。男19例,女2例,年龄19～54岁,平均31.7岁。根据美国骨科协会足踝外科分会(AOFAS)标准评价踝关节功能;观察有无手术并发症,同时调查患者满意度。结果:21例患者均获得随访,时间12～24个月,平均18个月。所有伤口愈合良好,无感染、腓肠肌神经损伤、跟腱再断裂等发生。AOFAS标准评分为88～98分,平均为93.2分,患者满意度高。结论:Achillon微创跟腱吻合器能够有效治疗急性跟腱断裂,具有对合良好、对跟腱局部血供影响小、创伤小、功能恢复快等优点。     

Is Achillon repair safe and reliable in delayed presentation Achilles tendon rupture? A five-year follow-up

Background

To assess the outcome of delayed repair of ruptured Achilles tendon using the Achillon mini-open technique.

Endoscopic-assisted repair of acute Achilles tendon rupture with Krackow suture: An anatomic study

PurposeTo study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered.Type of studyAnatomic study.MethodsTwelve Achilles tendons in six cadavers were cut at 6 cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches.ResultWith endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal.ConclusionsKrackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.     

The Achillon achilles tendon repair: is it strong enough?

BACKGROUND: Open repair of the Achilles tendon is associated with wound breakdown, infection and percutaneous methods risk sural nerve injury. The Achillon mini-incision technique can reduce these risks and may provide the opportunity for early active rehabilitation. The aim of this study was to compare the strength of the Achillon method with the commonly used Kessler method and to assess whether the strength of the repair was related to tendon diameter. MATERIALS AND METHODS: Simulated ruptures in sheep Achilles tendons were repaired using either the Achillon method or a two-strand Kessler technique with a No. 2 Ticron suture (Tyco Healthcare, UK). Each tendon diameter was measured, and matched for both groups. Specimens were loaded to failure using an Instron tensile testing machine (Instron Limited, UK). RESULTS: Mean load to failure for the Achillon repair was 153 N+/-60 (range, 65 to 270), and the mean load to failure for the Kessler Repair was 123 N+/-24 (range, 75 to 150). This difference was not statistically significant (p=0.21). There was a statistically significant higher mean load to failure for wider tendons repaired by the Achillon method (p=0.05), however mean load to failure was not related to tendon width in Kessler repairs (p=0.23). CONCLUSION: This is the first study to compare these two methods of repair. The Achillon repair has comparable tensile strength to the Kessler Repair. CLINICAL RELEVANCE: The Achillon repair appears to be a biomechanically sound method of repair for the acutely ruptured Achilles tendon.     

Clinical Outcomes of Minimally Invasive Repair Using Ring Forceps for Acute Achilles Tendon Rupture

Mini-open techniques using special devices, introduced to preclude the complications of open and percutaneous techniques, have limited usefulness because of the need for the devices and the weak strength of the repair. We developed a mini-open technique using a ring forceps. This technique is easy to use and increases the strength of the repair with crossed sutures. Twenty-six consecutive patients were treated using a mini-open technique using a ring forceps for acute Achilles tendon rupture. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) were evaluated at the last follow-up. The active range of motion of ankle joint and maximum calf circumference (MCC) were measured and compared with the uninjured side at the last follow-up, as well as hopping and single-limb heel-rise (SLHR) tests and isokinetic tests for ankle plantarflexion. AOFAS score and ATRS were 92.2 ± 9.4 and 89.9 ± 10.9, respectively, at the last follow-up. The MCC (p = .035) and maximum height of SLHR (p = .001) were significantly different between uninvolved and involved legs. No significant differences in mean peak torques for plantarflexion at angular speeds of 30°/s (60.9 ± 23.6 vs 50.8 ± 20.4 Nm/kg; p = .299) and 120°/s (31.6 ± 16 vs 29.6 ± 17.7 Nm/kg; p = .776) were observed between uninvolved and involved legs. The mini-open technique using a ring forceps for acute Achilles tendon rupture showed satisfactory clinical outcomes and favorable functional outcomes without complications.     

Management of Acute Achilles Tendon Rupture Using the Krackow and Tendon-Bundle Techniques

Background Acute Achilles tendon rupture is a severe injury of the lower extremities;however,optimal treatment options are not yet available.This study aimed to investigate the surgical method and clinical effect of the Krackow and tendon-bundle techniques for managing acute Achilles tendon rupture.Methods This retrospective case series study analyzed 17 cases of acute Achilles tendon rupture at the Beijing Jishuitan Hospital from December 2012 to January 2020.There were 16 men and one woman,aged 27–45 years,with an average of 39.6 years.Thirteen patients were injured while playing basketball or badminton,and 4 patients were injured while participating in a football match or other sports.All injuries were repaired using the Krackow and tendon-bundle techniques.Postoperative evaluation indicators included active range of motion during ankle plantar flexion and dorsiflexion,height of single foot heel lifting,Amer-Lindholm Achilles tendon function score,and American Orthopedic Foot and Ankle Society(AOFAS)score.Results The patients were followed-up for 6–45 months(average,18.9 months).There was no re-rupture of the Achilles tendon,wound infection,or sural nerve injury.At the final follow-up,the affected and contralateral sides exhibited plantar flexion of 42.1±4.4°and 43.8±2.8°,dorsiflexion of 15.8±2.9°and 16.6±2.9°,respectively,and one foot exhibited a heel lifting height of 7.2±1.0 cm and 7.5±0.9 cm,respectively.There was no significant difference between the affected and contralateral sides(P>0.05).At the final follow-up,the Amer-Lindholm Achilles tendon function score was excellent in 94.1%(16/17)of the patients and good in 5.9%(1/17)of the patients.The AOFAS scores ranged from 90 to 100,with an average of 96.4±3.7.Conclusion Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends,and thus it is an effective repair method for closed Achilles tendon injury.     

Independent evaluation of a recently described Achilles tendon repair technique

BACKGROUND: We investigated a previously reported technique for the repair of acute Achilles tendon ruptures using the percutaneous Achillon suture system (Intega Life Sciences Corporation, Plainsboro, NJ). METHODS: Twenty-five patients with Achilles tendon ruptures were studied prospectively with a minimum of 12 months followup. A single 2- to 3-cm horizontal incision and the Achillon suture system were used. Early rehabilitation and an active range-of-motion brace were instituted. RESULTS: There were no wound problems, sural nerve injuries, or re-ruptures. All patients were able to return to their previous sporting activities by 6 months. CONCLUSIONS: This independent study confirms that the technique offers patients a safe operative procedure for repair of acute Achilles tendon ruptures that allows early active rehabilitation.     

Treatment of acute achilles tendon rupture with the panda rope bridge technique

IntroductionAlthough nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described.MethodsPatient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively.ResultsPBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6.ConclusionThe PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation.     

Percutaneous Achilles tendon repair with the Dresden instrument. Clinical and MRI evaluation of 90 patients

BackgroundThis study aims at evaluating a substantial number of patients treated with a percutaneous, paratenon preserving technique for Achilles tendon repair using three different incisions with clinical follow-up and magnetic resonance imaging (MRI).MethodsNinety patients with percutaneous Achilles tendon repair using the Dresden technique for acute rupture were evaluated. Fifteen patients were treated using a central approach, 15 patients using a posterolateral approach and the original posteromedial approach was used in 60 patients. All patients were followed clinically and with MRI after 1 and 6 months post-operatively.ResultsUsing the standard posteromedial approach no complications were seen. With the central approach 4 (27%) wound healing problems were observed and with the posterolateral approach 2 (13%) sural nerve lesions occurred. One patient (1.1%) had a rerupture. MRI revealed an increased diameter at the rupture site and distal to it as well as an increasingly homogeneous signal over time.ConclusionsPercutaneous Achilles tendon repair with the Dresden technique yields excellent clinical results and a low complication rate. Modification of the original incision is discouraged.     

Value of magnetic resonance imaging in monitoring Achilles tendon healing after percutaneous suture using the Dresden technique

PurposeTendon healing is a complex process taking place in several stages. There is a paucity of data on tendon morphology after percutaneous repair for acute Achilles tendon rupture.Materials and methodsWe used high field MRI (1.5 Tesla to 3 Tesla) with T1 and T2-weighted sequences including fat suppression to assess the healing process after percutaneous Achilles tendon repair using the Dresden technique. MRI was performed at 3, 6, 8 and 12 months postoperatively.ResultsDuring tendon repair a gradual transition from an irregular and hyperintense signal toward a more homogeneous and hypointense signal was observed inside the Achilles tendon after percutaneous repair. These changes took place centripetally. During the early and late remodeling phase at 6 and 12 months, respectively, the tendons look thickened and homogeneous in both sequences.ConclusionsMRI represents an excellent means of monitoring the healing process after percutaneous Achilles tendon repair. The results of the present study confirm that the percutaneous, peritendineum preserving technique with the Dresden instrument results in a near physiologic centripetal tendon healing.     

Neglected rupture of the Achilles tendon treated with a percutaneous technique

IntroductionNeglected rupture of Achilles tendon is an infrequent but debilitating injury. Several surgical methods of treatment have been described to repair neglected Achilles tendon rupture.Material and methodsIn our study we reviewed 20 patients (18 male and 2 female). We describe a new surgical technique using percutaneous repair of the neglected Achilles tendon ruptures. It consists of 10 micro-incisions, five lateral and five medial to the posterior aspect of the Achilles tendon, the suture is performed using an absorbable number 1 Vicryl (Ethicon, Edinburgh UK) inserted percutaneously in a figure of eight fashion.ResultsThe advantages of this procedure are a short time immobilization, an early weight bearing and a return to complete ankle range of motion. The mean AOFAS score was 99.0, no re-ruptures or sural nerve damage were observed. In all the treated patients the results obtained were rated from good to excellent.ConclusionWe would like to encourage this technique as being fast, inexpensive and very satisfactory both to the patient and to the surgeon.     

Rates of complications in Achilles tendon rupture repair using absorbable and nonabsorbable suture material; A systematic review

BackgroundThe impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair.MethodsA systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair.Results12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001).ConclusionNonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair.     

塑型卵圆钳经皮缝合与切开缝合治疗新鲜闭合性跟腱断裂的对照研究

目的 比较塑型卵圆钳经皮微创缝合技术和切开缝合技术治疗新鲜闭合性跟腱断裂的临床疗效。方法 回顾性研究自2014年1月至2016年10月收治的73例新鲜闭合性跟腱断裂病人,最终入组共70例,根据手术方式的不同分为两组：微创组（36例）借助自制的塑型卵圆钳,通过小切口经皮缝合修复跟腱;常规组（34例）采用常规跟腱内侧纵行切口,连续锁边缝合修复跟腱。记录两组手术时间、术中出血量、术后并发症、恢复至伤前运动水平的时间、末次随访时的美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分,术后1年复查MRI评估跟腱修复状况。结果 两组病人获得16~44个月（平均30个月）随访,其中微创组手术时间为（45.34±6.73） min,术中出血量为（15.12±4.11） ml;常规组手术时间为（69.33±13.44） min,术中出血量为（25.47±7.19） ml,两组比较,差异均有统计学意义（P均＜0.05）。微创组2例病人切口延迟愈合,2例出现线结刺激症状,1例腓肠神经损伤,1例于术后半年外伤后再断裂;常规组3例伤口浅表感染,2例出现深部感染,无腓肠神经损伤及跟腱再断裂。末次随访AOFAS评分：微创组为（95.81±2.35）分,常规组为（93.61±4.83）分;微创组有29例病人（21.0±4.7）周（20~24周）恢复至伤前运动水平,常规组有26例（23.0±3.5）周（21~31周）恢复至伤前运动水平;上述指标比较,差异均无统计学意义（P均＞0.05）。术后1年MRI均显示跟腱连续性完整,未观察到跟腱囊性变。结论 自制塑型卵圆钳经皮缝合技术修复新鲜闭合性跟腱断裂手术时间短,术后恢复更快,且并不增加跟腱再断裂发生率。     

不剥离骨膜法肋骨钉内固定治疗多发肋骨骨折的随机对照研究

目的 分别运用Achillon吻合器和改良Kessler缝合法治疗急性闭合性跟腱断裂,随访比较患者的临床效果和功能恢复情况.方法从2009年3月至2012年2月,随机采用 Achillon吻合器微创修复与改良Kessler缝合法治疗49例急性闭合性跟腱断裂.其中Achillon 微创修复28例,改良Kessler法缝合21例.两组均无需行拇长屈肌或腓肠肌延长术.本研究平均随访21个月,分别在术后1周、第6个月、第12个月、随访结束期4个时间段,对两组患者的手术时间、住院时间、切口长度、踝关节运动范围、美国足踝外科协会（AOFAS）踝-后足疗效评分进行评价.结果在术后1周内,Achillon组发生1例神经损伤,改良Kessler组发生2例创口浅表感染,1例延迟愈合.两组并发症发生率差异无统计学意义（P=0.41）.在第6月,Achillon组AOFAS评分要优于改良Kessler组,第12月时两组无明显差异.术后两组踝关节运动范围,差异无统计学意义.截止随访结束时,所有患者均恢复到受伤前运动水平.结论两种缝合方法均能取得良好的疗效,相比改良Kessler缝合法,采用Achillon吻合器具有切口小、住院时间短、功能恢复快、术后美观等优点.     

微创手术与传统手术治疗急性跟腱断裂的比较研究

背景：急性跟腱断裂的临床治疗方案目前尚存争议,微创治疗因为切口相关并发症较少而逐渐被应用于临床,而微创手术与传统手术治疗急性跟腱断裂的比较性研究较少。目的：比较应用跟腱龙（Achillon）跟腱吻合器与Krachow法跟腱端端吻合术治疗急性闭合性跟腱断裂的临床疗效。方法：回顾性研究2009年3月至2011年12月收治的急性闭合性跟腱断裂患者146例,其中37例应用Achillon跟腱吻合器治疗,为微创手术组,男26例,女11例,年龄19~64岁,平均41.6岁;53例应用Krachow法跟腱端端吻合术治疗,为传统手术组,男36例,女17例,年龄21~67岁,平均43.5岁。比较两组患者的切口愈合时间、并发症发生率、踝关节活动度、单足提踵试验结果及整体满意率,并通过美国足踝外科协会（AOFAS）踝与后足评分进行疗效评估。结果：微创手术组37例和传统手术组53例全部获得随访,随访时间为14~57个月,平均32.9个月。微创手术组的再断裂率与传统手术组比较无统计学差异（5.4%vs.1.9%,P=0.38）;传统手术组的伤口延迟愈合率显著高于微创手术组（17.6%vs.0%,P〈0.01）。两组患者的单足提踵试验阳性率（16.2%vs.11.3%）、踝关节活动度减小率（18.9%vs.17.0%）、整体满意率（83.8%vs.71.7%）均无统计学差异。两组患者的AOFAS踝与后足评分的各项指标和总分比较均无统计学差异。结论：Achillon跟腱吻合器治疗跟腱断裂可有效降低切口相关并发症发生率,且未增加跟腱再断裂率,跟腱功能与Krachow法跟腱端端吻合术无统计学差异。