Clinical Outcomes and Complications With Open vs Minimally Invasive Achilles Tendon Repair

Background: There is no current consensus on whether to use an open or minimally invasive (MIS) approach for Achilles tendon repair after acute rupture. We hypothesized that patients in both open and MIS groups would have improved patient-reported outcome scores using the PROMIS system postoperatively, but that there would be minimal differences in these scores and complication rates between operative techniques. Methods: A total of 185 patients who underwent surgery for an acute, unilateral Achilles tendon rupture between January 2016 and June 2019, with minimum 1-year follow-up were included in the cohort studied. The minimally invasive group was defined by use of a commercially available minimally invasive device through a smaller surgical incision (n=118). The open repair group did not use the device, and suture repair was performed through larger surgical incisions (n=67). Postoperative protocols were similar between groups. Preoperative and postoperative PROMIS scores were collected prospectively through our institution’s registry. Demographics and complications were recorded. Results: PROMIS scores overall improved in both study groups after operative repair. No significant differences in postoperative PROMIS scores were observed between the open and MIS repair groups. There were also no significant differences in complication rates between groups. Overall, 19.5% of patients in the MIS group had at least 1 postoperative complication (8.5% deep vein thrombosis [DVT], 3.3% rerupture, 1.7% sural nerve injury, 2.5% infection), compared to 16.4% in the open group (9.0% DVT, 1.5% rerupture, 1.5% sural nerve injury, 0% infection). Conclusion: Patients undergoing either minimally invasive or open Achilles tendon repair after acute rupture have similar PROMIS outcomes and complication types and incidences. Level of Evidence: Level III, retrospective cohort study.

Clinical Outcomes and Ultrasonic Evaluation of Percutaneous Achilles Tendon Repair

BackgroundAchilles tendon rupture remains one of the most common tendon injuries in adult population. At present, randomized studies have failed to demonstrate the optimal management of Achilles tendon rupture. Wound complications have been significantly minimized since the emergence of percutaneous repairs when compared to traditional open methods. However, some studies suggested a higher incidence of rerupture rates and iatrogenic sural nerve injuries. The goal of this study was to present the clinical outcomes and ultrasonic evaluation of percutaneous Achilles tendon repair.MethodsBetween August 2015 and May 2018, 36 patients with an acute Achilles tendon rupture, treated in percutaneous repair, were studied retrospectively. American Orthopedic Foot and Ankle Society (AOFAS) score and the 10-point visual analogue scale (VAS) for pain questionnaires were sent to assess the clinical and functional outcomes. Ultrasonic evaluation was recorded using Möller grading system as an objective measurement.ResultsThe 25 male and 11 female (mean age 47.03 years) were clinically followed-up for a minimum of 12 months (average 28.97 months). No wound complications or reruptures occurred. Four(11.1%) patients reported sural nerve hypoesthesia and one of them required additional treatment. The mean AOFAS and VAS score was 92.6 and 1.8 respectively at the 12th postoperative month. Ultrasonic evaluation was performed at the average follow-up of 18.3 months and the mean points were 1.8. All treated tendons were healthily recovered and all patients were able to return to previous work or activities.ConclusionPercutaneous Achilles tendon repair offers good clinical outcome and no apparent increased risk of reruptures. The risk of iatrogenic sural nerve injury, however, remains the most occurred complication. Ultrasound can be used to visualize and examine the repaired tendon, which demonstrated satisfying healing process.

Functional Ankle Range of Motion but Not Peak Achilles Tendon Force Diminished With Heel-Rise and Jumping Tasks After Achilles Tendon Repair

Background: Deficits in sporting performance after Achilles tendon repair may be due to changes in musculotendinous unit structure, including tendon elongation and muscle fascicle shortening. Purpose/Hypothesis: The purpose was to discern whether Achilles tendon rupture reduces triceps surae muscle force generation, alters functional ankle range of motion, or both during sports-related tasks. We hypothesized that individuals who have undergone Achilles tendon repair lack the functional ankle range of motion needed to complete sports-related tasks. Study Design: Descriptive laboratory study. Methods: The study included individuals 1 to 3 years after treatment of Achilles tendon rupture with open repair. Participants (n = 11) completed a heel-rise task and 3 jumping tasks. Lower extremity biomechanics were analyzed using motion capture. Between-limb differences were tested using paired t test. Results: Pelvic vertical displacement was reduced during the heel-rise (mean difference, −12.8%; P = .026) but not during the jumping task ( P > .1). In the concentric phase of all tasks, peak ankle plantarflexion angle (range of mean difference, −19.2% to −48.8%; P < .05) and total plantar flexor work (defined as the area under the plantar flexor torque – ankle angle curve) (range of mean difference, −9.5% to −25.7%; P < .05) were lower on the repaired side relative to the uninjured side. No significant differences were seen in peak Achilles tendon load or impulse with any of the tasks. There were no differences in plantar flexor work or Achilles tendon load parameters during eccentric phases. Conclusion: Impaired task performance or increased demands on proximal joints were observed on the repaired side in tasks isolating ankle function. Tasks that did not isolate ankle function appeared to be well recovered, although functional ankle range of motion was reduced with rupture. Reduced plantar flexor muscle-tendon unit work supports previous reports that an elongated tendon and shorter muscle fascicles caused by Achilles tendon rupture constrain functional capacity. Achilles tendon peak load and impulse were not decreased, suggesting that reduced and shifted functional ankle range of motion (favoring dorsiflexion) underlies performance deficits. Clinical Relevance: These findings point to the need to reduce tendon elongation and restore muscle length of the triceps surae after Achilles tendon rupture in order to address musculature that is short but not necessarily weak for improved performance with sports-related activities.