Comparison of open repair and modified percutaneous repair techniques for the treatment of acute achilles tendon ruptures

Year 2022, Volume: 5 Issue: 1, 282 - 286, 17.01.2022

Lokman Kehribar , Sina Coşkun , Serkan Surucu

https://doi.org/10.32322/jhsm.1020281

Abstract

Background: This study compared acute Achilles tendon repairs' functional and clinical outcomes with two different surgical techniques; modified percutaneous and open repair.
Material and Method: This retrospective study analyzed 57 patients with an acute Achilles tendon rupture (AATR) who underwent modified percutaneous and open repair. 46 patients who met the eligibility criteria were enrolled and divided into two groups based on the surgical technique. 23 patients from Group 1 were treated using modified percutaneous repair under local anesthesia, and 23 patients from Group 2 were treated with an open repair under regional anesthesia. Postoperatively, patients were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot Questionnaire score at final follow-up. The other outcomes included return to work, return to sports activities, capacity to complete single heel rise, leg circumference, estimated limb symmetry indices, Achilles tendon resting angle (ATRA), complications, and timing of index surgery.
Results: At the time of surgery, the mean age of the patients was 35.9 7.5 years (range, 25–47 years). The average follow-up was 34.8±6.5 months (24–52 months). The mean age, gender, body mass index (BMI), rupture level, duration from injury to surgery, and mean follow-up time were similar in both groups. At a minimum 2-year follow-up, good pain relief was achieved for all patients. The AOFAS scores were 93.4±4.1 (88-100) in Group 1 and 92.2±5.2 (82-100) in Group 2. There was no statistically significant difference between groups concerning the Achilles tendon resting angle (ATRA), calf circumference, single-leg heel rise, return to work, and return to sports activities. However, the percutaneous repair procedure had a shorter surgical time than the open repair technique (p<0.05).
Conclusion: Modified percutaneous and open repair techniques provide similar clinical and functional outcomes, but the percutaneous repair technique showed faster surgical time than open procedures. Furthermore, the percutaneous technique may be more practical than the open technique, which may be performed under local anesthesia.

Keywords

Achilles, Tendon, Rupture, Repair, Percutaneous

References

• Meulenkamp B, Woolnough T, Cheng W, et al. What is the best evidence to guide management of acute Achilles tendon ruptures? a systematic review and network meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2021; 479: 2119-31.
• Deng S, Sun Z, Zhang C, Chen G, Li J. Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg 2017; 56: 1236-43.
• Makulavicius A, Mazarevicius G, Klinga M, et al. Outcomes of open "crown" type v. percutaneous Bunnell type repair of acute Achilles tendon ruptures. Randomized control study. Foot Ankle Surg 2020; 26: 580-4.
• Reda Y, Farouk A, Abdelmonem I, El Shazly OA. Surgical versus non-surgical treatment for acute Achilles' tendon rupture. A systematic review of literature and meta-analysis. Foot Ankle Surg 2020; 26: 280-8.
• Lerch TD, Schwinghammer A, Schmaranzer F, et al. Return to sport and patient satisfaction at 5-year follow-up after nonoperative treatment for acute Achilles tendon rupture. Foot Ankle Int 2020; 41: 784-92.
• Shi F, Wu S, Cai W, Zhao Y. Multiple comparisons of the efficacy and safety for six treatments in acute Achilles tendon rupture patients: A systematic review and network meta-analysis. Foot Ankle Surg 2021; 27: 468-79.
• Heikkinen J, Lantto I, Piilonen J, et al. Tendon length, calf muscle atrophy, and strength deficit after acute Achilles tendon rupture: long-term follow-up of patients in a previous study. J Bone Joint Surg Am 2017; 99: 1509-15.
• Stavenuiter XJR, Lubberts B, Prince RM, 3rd, Johnson AH, DiGiovanni CW, Guss D. Postoperative Complications Following Repair of Acute Achilles Tendon Rupture. Foot Ankle Int 2019; 40: 679-86.
• Carmont MR, Zellers JA, Brorsson A, Nilsson-Helander K, Karlsson J, Gravare Silbernagel K. Age and tightness of repair are predictors of heel-rise height after Achilles tendon rupture. Orthop J Sports Med 2020; 8: 2325967120909556.
• Schaarup SO, Wetke E, Konradsen LAG, Calder JDF. Loss of the knee-ankle coupling and unrecognized elongation in Achilles tendon rupture: effects of differential elongation of the gastrocnemius tendon. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2535-44.
• Yassin M, Myatt R, Thomas W, Gupta V, Hoque T, Mahadevan D. Does size of tendon gap affect patient-reported outcome following Achilles tendon rupture treated with functional rehabilitation? Bone Joint J 2020; 102: 1535-41.
• Yang B, Liu Y, Kan S, et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg 2017; 40: 178-86.
• Clanton TO, Haytmanek CT, Williams BT, et al. A biomechanical comparison of an open repair and 3 minimally invasive percutaneous Achilles tendon repair techniques during a simulated, progressive rehabilitation protocol. Am J Sports Med 2015; 43: 1957-64.
• Diniz P, Pacheco J, Fernandes RM, Pereira H, Castelo Ferreira F, Kerkhoffs G. Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques: a systematic review and network meta-analysis of human cadaveric studies. Knee Surg Sports Traumatol Arthrosc 2021.
• Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon: a new technique. Clin Orthop Relat Res 1977: 247-55.
• Cretnik A, Kosanovic M, Kosir R. Long-Term Results With the Use of Modified Percutaneous Repair of the Ruptured Achilles Tendon Under Local Anaesthesia (15-Year Analysis With 270 Cases). J Foot Ankle Surg 2019; 58: 828-36.
• McGee R, Watson T, Eudy A, et al. Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study. Foot Ankle Surg 2021; 27: 427-31.
• Wenning M, Mauch M, Heitner A, Streicher P, Ritzmann R, Paul J. Midterm functional performance following open surgical repair of acute Achilles tendon rupture. Arch Orthop Trauma Surg 2021.
• Maempel JF, Clement ND, Wickramasinghe NR, Duckworth AD, Keating JF. Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management. Bone Joint J 2020; 102: 933-40.
• 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: 383-401.
• Agres AN, Arampatzis A, Gehlen T, Manegold S, Duda GN. Muscle fascicles exhibit limited passive elongation throughout the rehabilitation of Achilles tendon rupture after percutaneous repair. Front Physiol 2020; 11: 746.
• Hurmeydan OM, Demirel M, Valiyev N, Sahinkaya T, Kilicoglu OI. Relationship of postoperative Achilles tendon elongation with plantarflexion strength following surgical repair. Foot Ankle Int 2020; 41: 140-6.
• Ververidis AN, Touzopoulos P, Drosos GI, Tilkeridis KE, Kazakos KI. Percutaneous repair of the Achilles tendon rupture in athletic population. Journal of orthopaedics 2016; 13: 57-61.