Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2018

Open Access 01-12-2018 | Research article

A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and “circuit” suture technique

Authors: Hao Zhang, Pei-Zhao Liu, Xin Zhang, Chen Ding, Hao-Chen Cui, Wen-Bin Ding, Ren-Kai Wang, Da-Jiang Wu, Qiang Wei, Sheng Qin, Xue-Lin Wu, Da-Ke Tong, Guang-Chao Wang, Hao Tang, Fang Ji

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Login to get access

Abstract

Background

Traditional incision repair and minimally invasive repair for acute Achilles tendon repair have limitations. This study aimed to present our series of 23 patients with acute Achilles tendon rupture that was repaired using two small incisions to assist the anchor repair of the tear and a new “circuit” suture technique.

Methods

This was a retrospective study of 23 patients with acute Achilles tendon rupture treated with the new technique at Changhai Hospital between January 2015 and December 2016 and followed up for 14–33 months. Clinical outcome was assessed using the AOFAS, Leppilahti, and Arner-Lindholm scores. Complications, range of motion (ROM), and time to return to work and light sport activity were assessed.

Results

The AOFAS score was 85–96 at 3 months and 92–100 at 12 months. The 3-month ROM was 27°–37°, and the 12-month ROM was 36°–48°. The Leppilahti score was 85–95 at 3 months and 90–100 at 12 months. The recovery time of the patients was 10–18 weeks. The postoperative recovery time to exercise was 16–24 weeks. There was only one case of deep venous thrombosis. According to the Arner-Lindholm assessment criteria, patient outcomes were rated as excellent in 20 (87.0%) cases, good in three (13.0%) cases, and poor in 0 cases. The excellent-to-good rate was 100%.

Conclusion

The limited-open procedure combined with a single-anchor and “circuit” suture technique could be used to repair torn Achilles sites, with a low occurrence of complications. This new and minimally invasive technique could be an alternative in the management of acute Achilles tendon rupture.
Literature
1.
go back to reference Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc. 2016;24:3730–7.CrossRefPubMed Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc. 2016;24:3730–7.CrossRefPubMed
2.
go back to reference Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10:255–66.CrossRefPubMed Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10:255–66.CrossRefPubMed
3.
go back to reference Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9:157–60.CrossRefPubMed Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9:157–60.CrossRefPubMed
4.
go back to reference Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–81.CrossRefPubMed Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–81.CrossRefPubMed
5.
go back to reference Lorimer AV, Hume PA. Achilles tendon injury risk factors associated with running. Sports Med. 2014;44:1459–72.CrossRefPubMed Lorimer AV, Hume PA. Achilles tendon injury risk factors associated with running. Sports Med. 2014;44:1459–72.CrossRefPubMed
6.
go back to reference Karousou E, Ronga M, Vigetti D, Passi A, Maffulli N. Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human Achilles tendon rupture. Clin Orthop Relat Res. 2008;466:1577–82.CrossRefPubMedPubMedCentral Karousou E, Ronga M, Vigetti D, Passi A, Maffulli N. Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human Achilles tendon rupture. Clin Orthop Relat Res. 2008;466:1577–82.CrossRefPubMedPubMedCentral
7.
8.
go back to reference Blanco I, Krahenbuhl S, Schlienger RG. Corticosteroid-associated tendinopathies: an analysis of the published literature and spontaneous pharmacovigilance data. Drug Saf. 2005;28:633–43.CrossRefPubMed Blanco I, Krahenbuhl S, Schlienger RG. Corticosteroid-associated tendinopathies: an analysis of the published literature and spontaneous pharmacovigilance data. Drug Saf. 2005;28:633–43.CrossRefPubMed
9.
go back to reference Royer RJ, Pierfitte C, Netter P. Features of tendon disorders with fluoroquinolones. Therapie. 1994;49:75–6.PubMed Royer RJ, Pierfitte C, Netter P. Features of tendon disorders with fluoroquinolones. Therapie. 1994;49:75–6.PubMed
10.
go back to reference Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–9.CrossRefPubMed Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–9.CrossRefPubMed
11.
12.
go back to reference Wallace RG, Traynor IE, Kernohan WG, Eames MH. Combined conservative and orthotic management of acute ruptures of the Achilles tendon. J Bone Joint Surg Am. 2004;86-A:1198–202.CrossRefPubMed Wallace RG, Traynor IE, Kernohan WG, Eames MH. Combined conservative and orthotic management of acute ruptures of the Achilles tendon. J Bone Joint Surg Am. 2004;86-A:1198–202.CrossRefPubMed
13.
go back to reference Karabinas PK, Benetos IS, Lampropoulou-Adamidou K, Romoudis P, Mavrogenis AF, Vlamis J. Percutaneous versus open repair of acute Achilles tendon ruptures. Eur J Orthop Surg Traumatol. 2014;24:607–13.CrossRefPubMed Karabinas PK, Benetos IS, Lampropoulou-Adamidou K, Romoudis P, Mavrogenis AF, Vlamis J. Percutaneous versus open repair of acute Achilles tendon ruptures. Eur J Orthop Surg Traumatol. 2014;24:607–13.CrossRefPubMed
14.
go back to reference Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94:2136–43.CrossRefPubMedPubMedCentral Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94:2136–43.CrossRefPubMedPubMedCentral
15.
go back to reference Jallageas R, Bordes J, Daviet JC, Mabit C, Coste C. Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes. Orthop Traumatol Surg Res. 2013;99:577–84.CrossRefPubMed Jallageas R, Bordes J, Daviet JC, Mabit C, Coste C. Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes. Orthop Traumatol Surg Res. 2013;99:577–84.CrossRefPubMed
16.
go back to reference Sarman H, Muezzinoglu US, Memisoglu K, Aydin A, Atmaca H, Baran T, et al. Comparison of semi-invasive “internal splinting” and open suturing techniques in Achilles tendon rupture surgery. J Foot Ankle Surg. 2016;55:965–70.CrossRefPubMed Sarman H, Muezzinoglu US, Memisoglu K, Aydin A, Atmaca H, Baran T, et al. Comparison of semi-invasive “internal splinting” and open suturing techniques in Achilles tendon rupture surgery. J Foot Ankle Surg. 2016;55:965–70.CrossRefPubMed
17.
go back to reference Lo IK, Kirkley A, Nonweiler B, Kumbhare DA. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a quantitative review. Clin J Sport Med. 1997;7:207–11.CrossRefPubMed Lo IK, Kirkley A, Nonweiler B, Kumbhare DA. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a quantitative review. Clin J Sport Med. 1997;7:207–11.CrossRefPubMed
18.
go back to reference Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010;9:CD003674. Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010;9:CD003674.
19.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
20.
go back to reference Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:199–203.CrossRefPubMed Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:199–203.CrossRefPubMed
21.
go back to reference Ververidis AN, Kalifis KG, Touzopoulos P, Drosos GI, Tilkeridis KE, Kazakos KI. Percutaneous repair of the Achilles tendon rupture in athletic population. J Orthop. 2016;13:57–61.CrossRefPubMed Ververidis AN, Kalifis KG, Touzopoulos P, Drosos GI, Tilkeridis KE, Kazakos KI. Percutaneous repair of the Achilles tendon rupture in athletic population. J Orthop. 2016;13:57–61.CrossRefPubMed
22.
go back to reference Gorschewsky O, Vogel U, Schweizer A, van Laar B. Percutaneous tenodesis of the Achilles tendon. A new surgical method for the treatment of acute Achilles tendon rupture through percutaneous tenodesis. Injury. 1999;30:315–21.CrossRefPubMed Gorschewsky O, Vogel U, Schweizer A, van Laar B. Percutaneous tenodesis of the Achilles tendon. A new surgical method for the treatment of acute Achilles tendon rupture through percutaneous tenodesis. Injury. 1999;30:315–21.CrossRefPubMed
23.
go back to reference Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden instrument. Oper Orthop Traumatol. 2006;18:287–99.CrossRefPubMed Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden instrument. Oper Orthop Traumatol. 2006;18:287–99.CrossRefPubMed
24.
go back to reference 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;15:349–53.CrossRefPubMed 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;15:349–53.CrossRefPubMed
25.
go back to reference Spennacchio P, Vascellari A, Cucchi D, Canata GL, Randelli P. Outcome evaluation after Achilles tendon ruptures. A review of the literature. Joints. 2016;4:52–61.CrossRefPubMedPubMedCentral Spennacchio P, Vascellari A, Cucchi D, Canata GL, Randelli P. Outcome evaluation after Achilles tendon ruptures. A review of the literature. Joints. 2016;4:52–61.CrossRefPubMedPubMedCentral
26.
go back to reference Maffulli G, Buono AD, Richards P, Oliva F, Maffulli N. Conservative, minimally invasive and open surgical repair for management of acute ruptures of the Achilles tendon: a clinical and functional retrospective study. Muscles Ligaments Tendons J. 2017;7:46–52.CrossRefPubMedPubMedCentral Maffulli G, Buono AD, Richards P, Oliva F, Maffulli N. Conservative, minimally invasive and open surgical repair for management of acute ruptures of the Achilles tendon: a clinical and functional retrospective study. Muscles Ligaments Tendons J. 2017;7:46–52.CrossRefPubMedPubMedCentral
27.
go back to reference Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N. Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon. 2013;11:14–9.CrossRefPubMed Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N. Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon. 2013;11:14–9.CrossRefPubMed
28.
go back to reference Ding WG, Li H, Zhu YP, Liu ZW. Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture. Foot Ankle Surg. 2014;20:105–8.CrossRefPubMed Ding WG, Li H, Zhu YP, Liu ZW. Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture. Foot Ankle Surg. 2014;20:105–8.CrossRefPubMed
29.
go back to reference Keller A, Ortiz C, Wagner E, Wagner P, Mococain P. Mini-open tenorrhaphy of acute Achilles tendon ruptures: medium-term follow-up of 100 cases. Am J Sports Med. 2014;42:731–6.CrossRefPubMed Keller A, Ortiz C, Wagner E, Wagner P, Mococain P. Mini-open tenorrhaphy of acute Achilles tendon ruptures: medium-term follow-up of 100 cases. Am J Sports Med. 2014;42:731–6.CrossRefPubMed
30.
go back to reference Ozsoy MH, Cengiz B, Ozsoy A, Aksekili MA, Yucel M, Fakioglu O, et al. Minimally invasive Achilles tendon repair: a modification of the Achillon technique. Foot Ankle Int. 2013;34:1683–8.CrossRefPubMed Ozsoy MH, Cengiz B, Ozsoy A, Aksekili MA, Yucel M, Fakioglu O, et al. Minimally invasive Achilles tendon repair: a modification of the Achillon technique. Foot Ankle Int. 2013;34:1683–8.CrossRefPubMed
31.
go back to reference McCormack R, Bovard J. Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2015;49:1329–35.CrossRefPubMed McCormack R, Bovard J. Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2015;49:1329–35.CrossRefPubMed
32.
go back to reference Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle. 1990;11:67–72.CrossRefPubMed Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle. 1990;11:67–72.CrossRefPubMed
33.
go back to reference Davies MS, Solan M. Minimal incision techniques for acute Achilles repair. Foot Ankle Clin. 2009;14:685–97.CrossRefPubMed Davies MS, Solan M. Minimal incision techniques for acute Achilles repair. Foot Ankle Clin. 2009;14:685–97.CrossRefPubMed
34.
go back to reference Wilkins R, Bisson LJ. Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med. 2012;40:2154–60.CrossRefPubMed Wilkins R, Bisson LJ. Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med. 2012;40:2154–60.CrossRefPubMed
35.
go back to reference Nilsson-Helander K, Silbernagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, et al. Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38:2186–93.CrossRefPubMed Nilsson-Helander K, Silbernagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, et al. Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38:2186–93.CrossRefPubMed
36.
go back to reference Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br. 2001;83:843–8.CrossRefPubMed Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br. 2001;83:843–8.CrossRefPubMed
37.
go back to reference Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Initial Achilles tendon repair strength––synthesized biomechanical data from 196 cadaver repairs. Int Orthop. 2012;36:1947–51.CrossRefPubMedPubMedCentral Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Initial Achilles tendon repair strength––synthesized biomechanical data from 196 cadaver repairs. Int Orthop. 2012;36:1947–51.CrossRefPubMedPubMedCentral
38.
go back to reference Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, et al. Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med. 2013;41:1642–8.CrossRefPubMed Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, et al. Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med. 2013;41:1642–8.CrossRefPubMed
39.
go back to reference Wren TA, Lindsey DP, Beaupre GS, Carter DR. Effects of creep and cyclic loading on the mechanical properties and failure of human Achilles tendons. Ann Biomed Eng. 2003;31:710–7.CrossRefPubMed Wren TA, Lindsey DP, Beaupre GS, Carter DR. Effects of creep and cyclic loading on the mechanical properties and failure of human Achilles tendons. Ann Biomed Eng. 2003;31:710–7.CrossRefPubMed
40.
go back to reference 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;16:122–5.CrossRefPubMed 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;16:122–5.CrossRefPubMed
41.
go back to reference Maquirriain J. Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation. Yale J Biol Med. 2011;84:289–300.PubMedPubMedCentral Maquirriain J. Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation. Yale J Biol Med. 2011;84:289–300.PubMedPubMedCentral
42.
go back to reference Kilicoglu O, Turker M, Yildiz F, Akalan E, Temelli Y. Suture anchor tenodesis in repair of distal Achilles tendon injuries. Eur J Orthop Surg Traumatol. 2014;24:117–22.CrossRefPubMed Kilicoglu O, Turker M, Yildiz F, Akalan E, Temelli Y. Suture anchor tenodesis in repair of distal Achilles tendon injuries. Eur J Orthop Surg Traumatol. 2014;24:117–22.CrossRefPubMed
43.
go back to reference Prokop A, Dolezych R, Chmielnicki M. Percutaneus suture of Achilles tendon rupture––operation for beginners? Z Orthop Unfall. 2016;154:58–62.PubMed Prokop A, Dolezych R, Chmielnicki M. Percutaneus suture of Achilles tendon rupture––operation for beginners? Z Orthop Unfall. 2016;154:58–62.PubMed
44.
Metadata
Title
A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and “circuit” suture technique
Authors
Hao Zhang
Pei-Zhao Liu
Xin Zhang
Chen Ding
Hao-Chen Cui
Wen-Bin Ding
Ren-Kai Wang
Da-Jiang Wu
Qiang Wei
Sheng Qin
Xue-Lin Wu
Da-Ke Tong
Guang-Chao Wang
Hao Tang
Fang Ji
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-018-0895-x

Other articles of this Issue 1/2018

Journal of Orthopaedic Surgery and Research 1/2018 Go to the issue