Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TIAN Jian , XU Yajun , CHEN Zheng , BAO Yuefeng , RUI Yongjun

Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital, Wuxi Orthopaedics Hospital, Wuxi Jiangsu, 214062, P.R.China;

Corresponding author：

TIAN Jian, Email: tianjian828@163.com

Keywords：

Achilles tendon rupture; minimally invasive operation; Krackow suture; modified operation

DOI：

10.7507/1002-1892.201705032

Video：

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Objective To explore the effectiveness of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture. Methods Between October 2013 and July 2016, 25 cases with acute Achilles tendon rupture were repaired by simple Krackow suture via limited small incision. There were 21 males and 4 females with an average age of 33.6 years (range, 25-39 years). The left side was involved in 15 cases and the right side in 10 cases. The injury caused by sport in 22 cases and by falling in 3 cases. The time from injury to operation was 3-7 days (mean, 4.4 days). Physical examination showed that the Thompson sign and single heel raising test were positive. Results The operation time was 30-60 minutes with an average of 39.2 minutes. All incisions healed by first intention. There was no complication of wound infection, deep vein thrombosis, tendon re-rupture, and sural nerve injury. All patients were followed up 9-20 months (mean, 14.2 months). The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 92-97 (mean, 94.9) after 9 months. The AOFAS score results were excellent in 13 cases, good in 9 cases, and fair in 3 cases. The range of motion of ankle joint was 49-58° with an average of 53.7°. All single heel raising tests were negative. Conclusion The method of simple Krackow suture via limited small incision has the advantages of minimal injury, less incidence of re-rupture and sural nerve injury, quicker recovery and so on.

Citation： TIAN Jian, XU Yajun, CHEN Zheng, BAO Yuefeng, RUI Yongjun. Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1322-1325. doi: 10.7507/1002-1892.201705032 Copy

1.	Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand, 1996, 67(3): 277-279.
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.	Bruggeman NB, Turner N, Dahm DL, et al. Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Relat Res, 2004, (427): 63-66.
4.	Hsu AR, Jones CP, Cohen BE, et al. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures. Foot Ankle Int, 2015, 36(11): 1279-1286.
5.	Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair. Foot Ankle Int, 2004, 25(4): 215-218.
6.	王旭, 王晨, 张超, 等. 有限切开卵圆钳辅助引线微创技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2014, 16(10): 858-861.
7.	杨明, 张晓萌, 张殿英, 等. 两种微创技术治疗跟腱断裂的比较研究. 中华创伤骨科杂志, 2016, 18(3): 192-196.
8.	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.
9.	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.
10.	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.
11.	高武长, 王英振. 小切口非对端缝合器修复急性闭合性跟腱断裂的近期疗效.中国修复重建外科杂志, 2015, 29(5): 563-566.
12.	柴明祥, 何泽阳, 吴希瑞. 经皮与开放缝合治疗急性闭合性跟腱断裂的临床研究. 中国矫形外科杂志, 2016, 24(8): 711-716.
13.	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(8): 1957-1964.
14.	Heitman DE, Ng K, Crivello KM, et al. Biomechanical comparison of the Achillon tendon repair system and the Krackow locking loop technique. Foot Ankle Int, 2011, 32(9): 879-887.
15.	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.
16.	Watson TW, Jurist KA, Yang KH. The strength of Achilles tendon repair: an in vitro study of the biomechanical behavior in human cadaver tendons. Foot Ankle Int, 1995, 16(4): 191-195.
17.	Labib SA, Hoffer CE 2nd, Shah JN, et al. The gift box open Achilles tendon repair method: a retrospective clinical series. J Foot Ankle Surg, 2016, 55(1): 39-44.
18.	Hahn JM, Inceoğlu S, Wongworawat MD. Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws. Am J Sports Med, 2014, 42(12): 3003-3008.

1. Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand, 1996, 67(3): 277-279.
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. Bruggeman NB, Turner N, Dahm DL, et al. Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Relat Res, 2004, (427): 63-66.
4. Hsu AR, Jones CP, Cohen BE, et al. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures. Foot Ankle Int, 2015, 36(11): 1279-1286.
5. Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo achillis repair. Foot Ankle Int, 2004, 25(4): 215-218.
6. 王旭, 王晨, 张超, 等. 有限切开卵圆钳辅助引线微创技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2014, 16(10): 858-861.
7. 杨明, 张晓萌, 张殿英, 等. 两种微创技术治疗跟腱断裂的比较研究. 中华创伤骨科杂志, 2016, 18(3): 192-196.
8. 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.
9. 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.
10. 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.
11. 高武长, 王英振. 小切口非对端缝合器修复急性闭合性跟腱断裂的近期疗效.中国修复重建外科杂志, 2015, 29(5): 563-566.
12. 柴明祥, 何泽阳, 吴希瑞. 经皮与开放缝合治疗急性闭合性跟腱断裂的临床研究. 中国矫形外科杂志, 2016, 24(8): 711-716.
13. 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(8): 1957-1964.
14. Heitman DE, Ng K, Crivello KM, et al. Biomechanical comparison of the Achillon tendon repair system and the Krackow locking loop technique. Foot Ankle Int, 2011, 32(9): 879-887.
15. 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.
16. Watson TW, Jurist KA, Yang KH. The strength of Achilles tendon repair: an in vitro study of the biomechanical behavior in human cadaver tendons. Foot Ankle Int, 1995, 16(4): 191-195.
17. Labib SA, Hoffer CE 2nd, Shah JN, et al. The gift box open Achilles tendon repair method: a retrospective clinical series. J Foot Ankle Surg, 2016, 55(1): 39-44.
18. Hahn JM, Inceoğlu S, Wongworawat MD. Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws. Am J Sports Med, 2014, 42(12): 3003-3008.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture

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