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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2023 | Incision | Research article

Percutaneous cruciate repair of ruptured Achilles tendon

Authors: Nicola Maffulli, Giuliano Sammaria, Salvatore Ziello, Filippo Migliorini, Francesco Oliva

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2023

Abstract

Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.

Carden DG, Noble J, Chalmers J, Lunn P, Ellis J. Rupture of the calcaneal tendon. The early and late management. J Bone Jt Surg Br. 1987;69(3):416–20. https://doi.org/10.1302/0301-620X.69B3.3294839.CrossRef

Lemme NJ, Li NY, DeFroda SF, Kleiner J, Owens BD. Epidemiology of Achilles tendon ruptures in the United States: athletic and nonathletic injuries from 2012 to 2016. Orthop J Sports Med. 2018;6(11):2325967118808238. https://doi.org/10.1177/2325967118808238.CrossRefPubMedPubMedCentral

Bisaccia DR, Aicale R, Tarantino D, Peretti GM, Maffulli N. Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review. Br Med Bull. 2019;130(1):39–49. https://doi.org/10.1093/bmb/ldz006.CrossRefPubMed

Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev. 2018;26(1):16–30. https://doi.org/10.1097/JSA.0000000000000185.CrossRefPubMed

Järvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10(2):255–66. https://doi.org/10.1016/j.fcl.2005.01.013.CrossRefPubMed

I.S.Mu.L.T. Achilles tendon ruptures guidelines. Muscles Ligaments Tendons J. 2018;3(8):310. https://doi.org/10.11138/mltj/2018.8.3.310.

Oliva F, Marsilio E, Asparago G, Giai Via A, Biz C, Padulo J, Spoliti M, Foti C, Oliva G, Mannarini S, Rossi AA, Ruggieri P, Maffulli N. Achilles tendon rupture and dysmetabolic diseases: a multicentric, epidemiologic study. J Clin Med. 2022;11(13):3698. https://doi.org/10.3390/jcm11133698.CrossRefPubMedPubMedCentral

McClelland D, Maffulli N. Percutaneous repair of ruptured Achilles tendon. J R Coll Surg Edinb. 2002;47(4):613–8.PubMed

Maffulli N. Rupture of the Achilles tendon. J Bone Jt Surg Am. 1999;81(7):1019–36. https://doi.org/10.2106/00004623-199907000-00017.CrossRef

10.

Nistor L. Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study. J Bone Jt Surg Am. 1981;63(3):394–9.CrossRef

11.

Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Jt Surg Br. 1999;81(5):877–80. https://doi.org/10.1302/0301-620x.81b5.9784.CrossRef

12.

Häggmark T, Liedberg H, Eriksson E, Wredmark T. Calf muscle atrophy and muscle function after non-operative vs operative treatment of Achilles tendon ruptures. Orthopedics. 1986;9(2):160–4. https://doi.org/10.3928/0147-7447-19860201-06.CrossRefPubMed

13.

Maffulli N, Oliva F, Migliorini F. Check-rein technique for Achilles tendon elongation following conservative management for acute Achilles tendon ruptures: a two-year prospective clinical study. J Orthop Surg Res. 2021;16(1):690. https://doi.org/10.1186/s13018-021-02830-7.CrossRefPubMedPubMedCentral

14.

Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. Br Med Bull. 2014;109:45–54. https://doi.org/10.1093/bmb/ldt029.CrossRefPubMed

15.

Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Jt Surg Am. 2010;92(17):2767–75. https://doi.org/10.2106/JBJS.I.01401.CrossRef

16.

Metz R, van der Heijden GJ, Verleisdonk EJ, Kolfschoten N, Verhofstad MH, van der Werken C. Effect of complications after minimally invasive surgical repair of acute Achilles tendon ruptures: report on 211 cases. Am J Sports Med. 2011;39(4):820–4. https://doi.org/10.1177/0363546510392012.CrossRefPubMed

17.

Maffulli N, D’Addona A, Maffulli GD, Gougoulias N, Oliva F. Delayed (14–30 days) percutaneous repair of Achilles tendon ruptures offers equally good results as compared with acute repair. Am J Sports Med. 2020;48(5):1181–8. https://doi.org/10.1177/0363546520908592.CrossRefPubMed

18.

Kadakia AR, Dekker RG, Ho BS. Acute Achilles tendon ruptures: an update on treatment. J Am Acad Orthop Surg. 2017;25(1):23–31. https://doi.org/10.5435/JAAOS-D-15-00187.CrossRefPubMed

19.

Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res. 1977;128:247–55.

20.

Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):199–203. https://doi.org/10.1007/s00167-007-0411-z.CrossRefPubMed

21.

Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon–a prospective randomized controlled study. Foot Ankle Int. 2001;22(7):559–68. https://doi.org/10.1177/107110070102200705.CrossRefPubMed

22.

Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study. Arch Orthop Trauma Surg. 2021;141(3):383–401. https://doi.org/10.1007/s00402-020-03437-z.CrossRefPubMed

23.

Maffulli N, Gougoulias N, Maffulli GD, Oliva F, Migliorini F. Slowed-down rehabilitation following percutaneous repair of Achilles tendon rupture. Foot Ankle Int. 2022;43(2):244–52. https://doi.org/10.1177/10711007211038594.CrossRefPubMed

24.

Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1852–9. https://doi.org/10.1007/s00167-014-3180-5.CrossRefPubMed

25.

Movin T, Ryberg A, McBride DJ, Maffulli N. Acute rupture of the Achilles tendon. Foot Ankle Clin. 2005;10(2):331–56. https://doi.org/10.1016/j.fcl.2005.01.003.CrossRefPubMed

26.

Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med. 1998;26(2):266–70. https://doi.org/10.1177/03635465980260021801.CrossRefPubMed

27.

Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, Watters WC, Goldberg MJ, Keith M, Haralson RH, Turkelson CM, Wies JL, Raymond L, Anderson S, Boyer K, Sluka P, Surgeons AAI. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18(8):503–10. https://doi.org/10.5435/00124635-201008000-00007.CrossRefPubMed

28.

Simmonds FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179(1069):56–8.PubMed

29.

Thompson TC. A test for rupture of the tendo achillis. Acta Orthop Scand. 1962;32:461–5. https://doi.org/10.3109/17453676208989608.CrossRefPubMed

30.

Matles AL. Rupture of the tendo Achilles: another diagnostic sign. Bull Hosp Jt Dis. 1975;36(1):48–51.

31.

Copeland SA. Rupture of the Achilles tendon: a new clinical test. Ann R Coll Surg Engl. 1990;72(4):270–1.PubMedPubMedCentral

32.

O’Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Jt Surg Am. 1984;66(7):1099–101.CrossRef

33.

Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012;470(8):2268–73. https://doi.org/10.1007/s11999-012-2355-y.CrossRefPubMedPubMedCentral

34.

Park SH, Lee HS, Young KW, Seo SG. Treatment of acute Achilles tendon rupture. Clin Orthop Surg. 2020;12(1):1–8. https://doi.org/10.4055/cios.2020.12.1.1.CrossRefPubMedPubMedCentral

35.

Yongliang Y, Honglei J, Wupeng Z, Shihong X, Fu W, Bomin W, Qinghu L, Yonghui W, Shumei H. Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. J Orthop Surg Res. 2020;15(1):258. https://doi.org/10.1186/s13018-020-01776-6.CrossRefPubMedPubMedCentral

36.

Savage R. The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness. J Hand Surg Eur. 2014;39(1):20–9. https://doi.org/10.1177/1753193413508699.CrossRef

37.

Watanabe K, Ota H, Sasaki H. Eight-strand cross-locked cruciate flexor tendon repair using double-stranded suture: a description of the surgical technique. Plast Reconstr Surg Glob Open. 2016;4(11):e1048. https://doi.org/10.1097/GOX.0000000000001048.CrossRefPubMedPubMedCentral

38.

Yotsumoto T, Mori R, Uchio Y. Optimum locations of the locking loop and knot in tendon sutures based on the locking Kessler method. J Orthop Sci. 2005;10(5):515–20. https://doi.org/10.1007/s00776-005-0929-1.CrossRefPubMed

39.

McLarney E, Hoffman H, Wolfe SW. Biomechanical analysis of the cruciate four-strand flexor tendon repair. J Hand Surg Am. 1999;24(2):295–301. https://doi.org/10.1053/jhsu.1999.0295.CrossRefPubMed

40.

Dogramaci Y, Kalaci A, Sevinç TT, Esen E, Komurcu M, Yanat AN. Does strand configuration and number of purchase points affect the biomechanical behavior of a tendon repair? A biomechanical evaluation using different Kessler methods of flexor tendon repair. Hand (N Y). 2008;3(3):266–70. https://doi.org/10.1007/s11552-008-9095-1.CrossRefPubMed

41.

McCoy BW, Haddad SL. The strength of Achilles tendon repair: a comparison of three suture techniques in human cadaver tendons. Foot Ankle Int. 2010;31(8):701–5. https://doi.org/10.3113/FAI.2010.0701.CrossRefPubMed

42.

Jones MP, Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon rupture: key findings from a recent Cochrane review. J Bone Jt Surg Am. 2012;94(12):e88. https://doi.org/10.2106/JBJS.J.01829.CrossRef

43.

Yang B, Liu Y, Kan S, Zhang D, Xu H, Liu F, Ning G, Feng S. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis. Int J Surg. 2017;40:178–86. https://doi.org/10.1016/j.ijsu.2017.03.021.CrossRefPubMed

44.

Porter KJ, Robati S, Karia P, Portet M, Szarko M, Amin A. An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg. 2014;20(2):90–3. https://doi.org/10.1016/j.fas.2013.11.005.CrossRefPubMed

45.

Zappia M, Berritto D, Oliva F, Maffulli N. High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg. 2018;24(4):342–6. https://doi.org/10.1016/j.fas.2017.03.006.CrossRefPubMed

46.

Lacoste S, Feron JM, Cherrier B. Percutaneous Tenolig((R)) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture. Orthop Traumatol Surg Res. 2014;100(8):925–30. https://doi.org/10.1016/j.otsr.2014.09.018.CrossRefPubMed

Title: Percutaneous cruciate repair of ruptured Achilles tendon
Authors: Nicola Maffulli
Giuliano Sammaria
Salvatore Ziello
Filippo Migliorini
Francesco Oliva
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Incision
Achilles Tendon Rupture
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2023
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-023-04167-9

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Percutaneous cruciate repair of ruptured Achilles tendon

Abstract

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