Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SUN Taicun , LU Biao , CAO Xingbing , CHEN Haining , XU Xiaofeng , CUI Xuewen

Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, 212001, P.R.China;

Corresponding author：

SUN Taicun, Email: tarzansun@126.com

Keywords：

Closed Achilles tendon rupture; laminated bevel suturing technique; preliminary effectiveness

DOI：

10.7507/1002-1892.201704117

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Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.

Citation： SUN Taicun, LU Biao, CAO Xingbing, CHEN Haining, XU Xiaofeng, CUI Xuewen. Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(12): 1447-1451. doi: 10.7507/1002-1892.201704117 Copy

1.	Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized controlled study comparing surgical and nonsurgical treatments using validated outcome measure. Am J Sports Med, 2010, 38(11): 2186-2193.
2.	Wang D, Sandlin MI, Cohen JR, et al. Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12, 570 patients in a large healthcare database. Foot Ankle Surg, 2015, 21(4): 250-253.
3.	Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma, 2003, 54(6): 1171-1180.
4.	van der Eng DM, Schepers T, Goslings JC, et al. Rerupture rate after early weight bearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg, 2013, 52(5): 622-628.
5.	中国医师协会骨科医师分会, 中国医师协会骨科医师分会《急性跟腱断裂循证临床诊疗指南》编辑委员会. 中国医师协会骨科医师分会循证临床诊疗指南: 急性跟腱断裂循证临床诊疗指南. 中华外科杂志, 2015, 53(8): 561-563.
6.	Sadoghi P, Rosso C, Valderrabano V, et al. Initial Achilles tendon repair strength——synthesized biomechanical data from 196 cadaver repairs. Int Orthop, 2012, 36(9): 1947-1951.
7.	王东, 孙彤. 改良腓肠肌腱膜瓣翻转修复新鲜跟腱断裂的临床疗效. 中华医学杂志, 2012, 92(17): 1206-1208.
8.	Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg (Am), 1999, 81(7): 1019-1036.
9.	Longo UG, Petrillo S, Maffulli N, et al. Acute Achilles tendon rupture in athletes. Foot Ankle Clin, 2013, 18(2): 319-338.
10.	Singh D. Acute Achilles tendon rupture. BMJ, 2015, 351: h4722.
11.	Jones MP, Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon rupture: key findings from a recent cochrane review. J Bone Joint Surg (Am), 2012, 94(12): e88.
12.	Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
13.	陈华, 郝明, 张巍, 等. 经通道辅助缝合系统微创修复急性闭合跟腱断裂的疗效观察. 中国修复重建外科杂志, 2015, 29(1): 35-38.
14.	Bartel AF, Elliott AD, Roukis TS. Incidence of complications after Achillon mini-open suture system for repair of acute midsubstance achilles tendon ruptures: a systematic review. J Foot Ankle Surg, 2014, 53(6): 744-746.
15.	Thomopoulos S, Parks WC, Rifkin DB, et al. Mechanisms of tendon injury and repair. J Orthop Res, 2015, 33(6): 832-839.
16.	Sorrenti SJ. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair. Foot Ankle Int, 2006, 27(6): 407-410.
17.	Jaakkola JI, Beskin JL, Griffith LH, et al. Early ankle motion after triple bundle technique repair vs. casting for acute Achilles tendon rupture. Foot Ankle Int, 2001, 22(12): 979-984.
18.	Bevoni R, Angelini A, D’Apote G, et al. Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol. Injury, 2014, 45(8): 1268-1274.
19.	Olsson N, Petzold M, Brorsson A, et al. Predictors of clinical outcome after acute Achilles tendon ruptures. Am J Sports Med, 2014, 42(6): 1448-1455.

1. Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized controlled study comparing surgical and nonsurgical treatments using validated outcome measure. Am J Sports Med, 2010, 38(11): 2186-2193.
2. Wang D, Sandlin MI, Cohen JR, et al. Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12, 570 patients in a large healthcare database. Foot Ankle Surg, 2015, 21(4): 250-253.
3. Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma, 2003, 54(6): 1171-1180.
4. van der Eng DM, Schepers T, Goslings JC, et al. Rerupture rate after early weight bearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg, 2013, 52(5): 622-628.
5. 中国医师协会骨科医师分会, 中国医师协会骨科医师分会《急性跟腱断裂循证临床诊疗指南》编辑委员会. 中国医师协会骨科医师分会循证临床诊疗指南: 急性跟腱断裂循证临床诊疗指南. 中华外科杂志, 2015, 53(8): 561-563.
6. Sadoghi P, Rosso C, Valderrabano V, et al. Initial Achilles tendon repair strength——synthesized biomechanical data from 196 cadaver repairs. Int Orthop, 2012, 36(9): 1947-1951.
7. 王东, 孙彤. 改良腓肠肌腱膜瓣翻转修复新鲜跟腱断裂的临床疗效. 中华医学杂志, 2012, 92(17): 1206-1208.
8. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg (Am), 1999, 81(7): 1019-1036.
9. Longo UG, Petrillo S, Maffulli N, et al. Acute Achilles tendon rupture in athletes. Foot Ankle Clin, 2013, 18(2): 319-338.
10. Singh D. Acute Achilles tendon rupture. BMJ, 2015, 351: h4722.
11. Jones MP, Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon rupture: key findings from a recent cochrane review. J Bone Joint Surg (Am), 2012, 94(12): e88.
12. Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
13. 陈华, 郝明, 张巍, 等. 经通道辅助缝合系统微创修复急性闭合跟腱断裂的疗效观察. 中国修复重建外科杂志, 2015, 29(1): 35-38.
14. Bartel AF, Elliott AD, Roukis TS. Incidence of complications after Achillon mini-open suture system for repair of acute midsubstance achilles tendon ruptures: a systematic review. J Foot Ankle Surg, 2014, 53(6): 744-746.
15. Thomopoulos S, Parks WC, Rifkin DB, et al. Mechanisms of tendon injury and repair. J Orthop Res, 2015, 33(6): 832-839.
16. Sorrenti SJ. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair. Foot Ankle Int, 2006, 27(6): 407-410.
17. Jaakkola JI, Beskin JL, Griffith LH, et al. Early ankle motion after triple bundle technique repair vs. casting for acute Achilles tendon rupture. Foot Ankle Int, 2001, 22(12): 979-984.
18. Bevoni R, Angelini A, D’Apote G, et al. Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol. Injury, 2014, 45(8): 1268-1274.
19. Olsson N, Petzold M, Brorsson A, et al. Predictors of clinical outcome after acute Achilles tendon ruptures. Am J Sports Med, 2014, 42(6): 1448-1455.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary effectiveness of laminated bevel suturing technique for treating acute closed Achilles tendon rupture

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