Achilles Tendon Repair, A Modified Technique

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Akhtar Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Department of Orthopedic Surgery, Guilan Road Trauma Research Center Guilan University of Medical Sciences, Rasht, Iran.

3 Department of Orthopedic Surgery Shahid Beheshti University of Medical Sciences Tehran, Iran.

Abstract

 
Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of
significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair.
 
Methods:
In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear.
Results:
Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides.
Conclusion:
The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.

Keywords

References

  1. Paavola M, Kannus P, Paakkala T, Pasanen M, Jarvinen M. Long-term prognosis of patients with Achilles tendinopathy. An observational 8-year follow-up study.Am J Sports Med. 2000; 28:634-42.

  2. Paavola M, Orava S, Leppilahti J, Kannus P, Jarvinen M. Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med .2000;28:77-82.

  3. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, et al .Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010; 92(17):2767-75.

  4. Carmont MR, Heaver C, Pradhan A, Mei-Dan O, Gravare Silbernagel K. Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surg Sports Traumatol Arthrosc. 2013;21(6):1361-8.

  5. Chana JS, Chen HC, Jain V. A new incision for surgery on tendoAchillis using a distally-based fascio cutaneous flap. J Bone Joint Surg Br. 2002; 84(8):1142-4.

  6. Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med. 2005; 33(9):1369-79.

  7. Dalton GP, Wapner KL, Hecht PJ. Complications of Achilles and posterior tibial tendon surgeries. Clin Orthop Relat Res. 2001;391:133-9

  8. Ebinesan AD, Sarai BS, Walley GD, Maffulli N. Conservative, open or percutaneous repair for acute rupture of the Achilles tendon. Disabil Rehabil. 2008; 30(20-22):1721-5.

  9. Jiang N, Wang B, Chen A, Dong F, Yu B .Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence.Int Orthop. 2012; 36(4):765-73.

  10. Aibinder WR, Patel A, Arnouk J, El-Gendi H, Korshunov Y, Mitgang J, et al. The rate of sural nerve violation using the achillon device: a cadaveric study. Foot Ankle Int. 2013;34(6):870-5.

  11. Bradley JP, Tibone JE. Percutaneous and open surgical repairs of Achilles tendon ruptures; a comparative study. Am J Sports Med.1990; 18(2):188-95.

  12. Yepes H, Tang  M, Geddes C, Glazebrook M, Morris SF, Stanish WD. Digital vascular mapping of the integument about the Achilles tendon. J Bone Joint Surg Am. 2010; 92(5):1215-20

  13. Mandelbaum BR, Myerson MS, Forster R. Achilles tendon ruptures. A new method of repair, early range of motion, and functional rehabilitation. Am J Sports Med. 1995;23(4):392-5

  14. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349-53.

  15. Bossley CJ. Rupture of the Achilles tendon. J Bone Joint Surg Am. 2000; 82:1804.

  16. Raisbeck CC. Rupture of the Achilles tendon. J Bone Joint Surg Am. 2000;82:1804-5.

  17. Strauss EJ, Ishak C, Jazrawi L, Sherman O, Rosen J. Operative treatment of acute Achilles tendon ruptures: an institutional review of clinical outcomes. Injury. 2007;38(7):832-8.

  18. Metz R, Kerkhoffs GM, Verleisdonk EJ, van der Heijden GJ. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial BMC Musculoskelet Disord. 2007; 8:108.

  19. Valente M, Crucil M, Alecci V, Frezza G. Minimally invasive repair of acute Achilles tendon ruptures with Achillon device. Musculoskelet Surg. 2012; 96(1):35-9.

  20. Mukundan C, El Husseiny M, Rayan F, Salim J, Budgen A. Mini-open repair of acute tendo Achilles ruptures-the solution? Foot Ankle Surg. 2010; 16(3):122-5.

The Archives of Bone and Joint Surgery
Volume 1, Issue 2 - Serial Number 2
December 2013
Pages 86-89

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History

  • Receive Date: 03 September 2013
  • Revise Date: 19 October 2013
  • Accept Date: 30 November 2013

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