REPAIR OF ACUTE CLOSED ACHILLES TENDON RUPTURES BY CHANNEL-ASSISTED MINIMALLY INVASIVE REPAIR SYSTEM_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENHua , HAOMing , ZHANGWei , GAOYuan , LIANGXiangdang , ZHANGQun , GUOYizhu , ZHANGLihai ,  TANGPeifu

Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100358, P. R. China;

Corresponding author：

TANGPeifu, Email: tangpf301@163.com

Keywords：

Acute closed Achilles tendon rupture; Channel-assisted minimally invasive repair; Minimally invasive technology

DOI：

10.7507/1002-1892.20150009

Video：

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Objective To evaluate the effectiveness of channel-assisted minimally invasive repair (CAMIR) for acute closed Achilles tendon ruptures. Methods Between January 2011 and June 2012, 30 patients (30 sides)with acute closed Achilles tendon ruptures were treated with CAMIR technique. Among 30 patients, 18 were male and 12 were female with an average age of 30.4 years (range, 22-50 years); the locations were left side in 10 cases and right side in 20 cases. All the causes were sports injury. B-ultrasound was used to confirm the diagnosis, with the average distance from the rupture site to the Achilles tendon insertion of 4.4 cm (range, 2-8 cm). The time from injury to operation was 3 hours to 9 days (median, 4 days). All injuries were repaired by CAMIR technique. Results The average operation time was 17.0 minutes (range, 10-25 minutes), and the mean incision length was 2.0 cm (range, 1.5-2.5 cm). All the incisions healed by first intention. There was no complication of wound problem, deep vein thrombosis, re-rupture, or sural nerve injury. All cases were followed up 12-24 months with an average of 16 months. At last follow-up, the patients could walk normally with powerful raising heels and restored to normal activity level. MRI imaging suggested the continuity and healing of ruptured tendon. The circumference difference between affected leg and normal leg was less than 1 cm, and the ankle dorsi-extension was 20-30°, plantar flexion was 20-30°. Arner Lindholm score showed that the surgical results were excellent in 28 cases and good in 2 cases, with an excellent and good rate of 100%. Conclusion CAMIR is a safe and reliable method to repair acute closed Achilles tendon rupture, with many advantages of minimal injury, low re-rupture and infection. Sural nerve injury can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnel suture technique.

Citation： CHENHua, HAOMing, ZHANGWei, GAOYuan, LIANGXiangdang, ZHANGQun, GUOYizhu, ZHANGLihai, TANGPeifu. REPAIR OF ACUTE CLOSED ACHILLES TENDON RUPTURES BY CHANNEL-ASSISTED MINIMALLY INVASIVE REPAIR SYSTEM. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 35-38. doi: 10.7507/1002-1892.20150009 Copy

1.	Leppilahti J, Orava S. Total Achilles tendon rupture. A review. Sports Med, 1998, 25(2):79-100.
2.	Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland:a 15-year study. Clin J Sport Med, 1999, 9(3):157-160.
3.	Khan RJ, Fick D, Keogh A, et al. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10):2202-2210.
4.	Sölveborn SA, Moberg A. Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures. Am J Sports Med, 1994, 22(5):607-610.
5.	Carmont MR, Rossi R, Scheffler S, et al. Percutaneous & Mini Invasive Achilles tendon repair. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3:28.
6.	Ding WG, Zhu YP, Yan WH. Treatment of acute and closed Achilles tendon ruptures by minimally invasive tenocutaneous suturing. J Foot Ankle Surg, 2013, 52(2):143-146.
7.	姜楠, 相大勇, 余斌. 急性跟腱断裂治疗的研究进展. 中国修复重建外科杂志, 2013, 27(5):628-632.
8.	Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon:a new technique. Clin Orthop Relat Res, 1977, (128):247-255.
9.	Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair. Foot Ankle Int, 2004, 25(4):215-218.
10.	Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2):199-203.
11.	Maffulli N, Longo UG, Maffulli GD, et al. Achilles tendon ruptures in elite athletes. Foot Ankle Int, 2011, 32(1):9-15.
12.	Kakiuchi M. A combined open and percutaneous technique for repair of tendo Achillis. Comparison with open repair. J Bone Joint Surg (Br), 1995, 77(1):60-63.
13.	Assal M, Jung M, Stern R, et al. Limited open repair of Achilles tendon ruptures:a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg (Am), 2002, 84-A(2):161-170.
14.	Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a "mini-open" technique. Foot Ankle Clin, 2002, 7(3):611-619.
15.	Doral MN, Bozkurt M, Turhan E, et al. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control. Arch Orthop Trauma Surg, 2009, 129(8):1093-1101.
16.	杨永明, 史晓林, 张昊, 等. 小切口卵圆钳辅助穿针修复急性跟腱断裂. 国际骨科学杂志, 2011, 32(5):334-335.
17.	朱亚平, 韦兆祥, 李欢. 小切口加腱皮减张缝合法治疗闭合性跟腱断裂22例. 中华创伤骨科杂志, 2003, 5(3):278-279.
18.	陆生林, 白宇, 庄小强. 小切口皮下缝合修复新鲜跟腱断裂. 中国修复重建外科杂志, 2009, 23(8):1022-1023.
19.	Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5):793-798.
20.	Aibinder WR, Patel A, Arnouk J, et al. The rate of sural nerve violation using the Achillon device:a cadaveric study. Foot Ankle Int, 2013, 34(6):870-875.

1. Leppilahti J, Orava S. Total Achilles tendon rupture. A review. Sports Med, 1998, 25(2):79-100.
2. Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland:a 15-year study. Clin J Sport Med, 1999, 9(3):157-160.
3. Khan RJ, Fick D, Keogh A, et al. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10):2202-2210.
4. Sölveborn SA, Moberg A. Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures. Am J Sports Med, 1994, 22(5):607-610.
5. Carmont MR, Rossi R, Scheffler S, et al. Percutaneous & Mini Invasive Achilles tendon repair. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3:28.
6. Ding WG, Zhu YP, Yan WH. Treatment of acute and closed Achilles tendon ruptures by minimally invasive tenocutaneous suturing. J Foot Ankle Surg, 2013, 52(2):143-146.
7. 姜楠, 相大勇, 余斌. 急性跟腱断裂治疗的研究进展. 中国修复重建外科杂志, 2013, 27(5):628-632.
8. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon:a new technique. Clin Orthop Relat Res, 1977, (128):247-255.
9. Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair. Foot Ankle Int, 2004, 25(4):215-218.
10. Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2):199-203.
11. Maffulli N, Longo UG, Maffulli GD, et al. Achilles tendon ruptures in elite athletes. Foot Ankle Int, 2011, 32(1):9-15.
12. Kakiuchi M. A combined open and percutaneous technique for repair of tendo Achillis. Comparison with open repair. J Bone Joint Surg (Br), 1995, 77(1):60-63.
13. Assal M, Jung M, Stern R, et al. Limited open repair of Achilles tendon ruptures:a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg (Am), 2002, 84-A(2):161-170.
14. Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a "mini-open" technique. Foot Ankle Clin, 2002, 7(3):611-619.
15. Doral MN, Bozkurt M, Turhan E, et al. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control. Arch Orthop Trauma Surg, 2009, 129(8):1093-1101.
16. 杨永明, 史晓林, 张昊, 等. 小切口卵圆钳辅助穿针修复急性跟腱断裂. 国际骨科学杂志, 2011, 32(5):334-335.
17. 朱亚平, 韦兆祥, 李欢. 小切口加腱皮减张缝合法治疗闭合性跟腱断裂22例. 中华创伤骨科杂志, 2003, 5(3):278-279.
18. 陆生林, 白宇, 庄小强. 小切口皮下缝合修复新鲜跟腱断裂. 中国修复重建外科杂志, 2009, 23(8):1022-1023.
19. Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5):793-798.
20. Aibinder WR, Patel A, Arnouk J, et al. The rate of sural nerve violation using the Achillon device:a cadaveric study. Foot Ankle Int, 2013, 34(6):870-875.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF ACUTE CLOSED ACHILLES TENDON RUPTURES BY CHANNEL-ASSISTED MINIMALLY INVASIVE REPAIR SYSTEM

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