Clinical analysis of autogenous tendon reconstruction under total arthroscopy in treatment of chronic Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Bin ¹ , TAO Tianqi ² , LI Yang ² , JIANG Yiqiu ² ,  GUI Jianchao ²

1. Department of Orthopaedics, the Fourth Affiliated Hospital of Nanjing Medical University (Nanjing Pukou Hospital), Nanjing Jiangsu, 210031, P.R.China;
2. Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;

Corresponding author：

GUI Jianchao, Email: gui1997@126.com

Keywords：

Chronic Achilles tendon rupture; arthroscopy; autogenous tendon; repair and reconstruction

DOI：

10.7507/1002-1892.201911055

Video：

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Objective To investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture.Methods Between June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain.Results The average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant (P<0.05).Conclusion Autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.

Citation： ZHANG Bin, TAO Tianqi, LI Yang, JIANG Yiqiu, GUI Jianchao. Clinical analysis of autogenous tendon reconstruction under total arthroscopy in treatment of chronic Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 726-729. doi: 10.7507/1002-1892.201911055 Copy

1.	Thermann H. Achilles tendon rupture-Part 1: etiology and diagnostics. Chirurg, 2019, 90(10): 863-872.
2.	Deng S, Sun Z, Zhang C, et al. 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(6): 1236-1243.
3.	Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg, 2017, 34(2): 229-243.
4.	Periasamy M, Venkatramani H, Shanmuganathan RS. Management of chronic Achilles tendon injuries-review of current protocols and surgical options. Indian J Plast Surg, 2019, 52(1): 109-116.
5.	Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
6.	Stavenuiter XJR, Lubberts B, Prince RM 3rd, et al. Postoperative complications following repair of acute Achilles tendon rupture. Foot Ankle Int, 2019, 40(6): 679-686.
7.	Chiu CH, Yeh WL, Tsai MC, et al. Endoscopy-assisted percutaneous repair of acute Achilles tendon tears. Foot Ankle Int, 2013, 34(8): 1168-1176.
8.	Rungprai C, Phisitkul P. Outcomes and complications following endoscopically assisted percutaneous Achilles tendon repair. Arthroscopy, 2018, 34(4): 1262-1269.
9.	Malagelada F, Clark C, Dega R. Management of chronic Achilles tendon ruptures-A review. Foot (Edinb), 2016, 28: 54-60.
10.	Maffulli N, Via AG, Oliva F. Chronic Achilles tendon rupture. Open Orthop J, 2017, 11: 660-669.
11.	银春景, 陈泽群, 鄂丽芳. 探究陈旧性跟腱断裂的发生原因及手术治疗方案对比. 中国现代药物应用, 2019, 13(9): 20-21.
12.	Lin Y, Yang L, Yin L, et al. Surgical strategy for the chronic Achilles tendon rupture. Biomed Res Int, 2016, 2016: 1416971.
13.	Maffulli N, Oliva F, Maffulli GD, et al. Surgical management of chronic Achilles tendon ruptures using less invasive techniques. Foot Ankle Surg, 2018, 24(2): 164-170.
14.	Sarman H, Muezzinoglu US, Memisoglu K, et al. Comparison of semi-invasive “Internal Splinting” and open suturing techniques in Achilles tendon rupture surgery. J Foot Ankle Surg, 2016, 55(5): 965-970.
15.	Seker A, Kara A, Armagan R, et al. Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up. Arch Orthop Trauma Surg, 2016, 136(10): 1417-1423.
16.	赵峰, 胡跃林, 焦晨, 等. 踇长屈肌腱移位与腓肠肌腱翻瓣修复陈旧跟腱断裂的疗效比较. 中华医学杂志, 2019, 99(7): 542-546.
17.	Saku I, Kanda S, Saito T, et al. Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture. Int J Surg Case Rep, 2017, 37: 106-108.
18.	Sarzaeem MM, Lemraski MM, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc, 2012, 20(7): 1386-1391.
19.	赵嘉国, 郭文煊, 曾宪铁, 等. 急性跟腱断裂术后早期功能锻炼的研究进展. 中国修复重建外科杂志, 2019, 33(3): 382-386.

1. Thermann H. Achilles tendon rupture-Part 1: etiology and diagnostics. Chirurg, 2019, 90(10): 863-872.
2. Deng S, Sun Z, Zhang C, et al. 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(6): 1236-1243.
3. Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg, 2017, 34(2): 229-243.
4. Periasamy M, Venkatramani H, Shanmuganathan RS. Management of chronic Achilles tendon injuries-review of current protocols and surgical options. Indian J Plast Surg, 2019, 52(1): 109-116.
5. Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
6. Stavenuiter XJR, Lubberts B, Prince RM 3rd, et al. Postoperative complications following repair of acute Achilles tendon rupture. Foot Ankle Int, 2019, 40(6): 679-686.
7. Chiu CH, Yeh WL, Tsai MC, et al. Endoscopy-assisted percutaneous repair of acute Achilles tendon tears. Foot Ankle Int, 2013, 34(8): 1168-1176.
8. Rungprai C, Phisitkul P. Outcomes and complications following endoscopically assisted percutaneous Achilles tendon repair. Arthroscopy, 2018, 34(4): 1262-1269.
9. Malagelada F, Clark C, Dega R. Management of chronic Achilles tendon ruptures-A review. Foot (Edinb), 2016, 28: 54-60.
10. Maffulli N, Via AG, Oliva F. Chronic Achilles tendon rupture. Open Orthop J, 2017, 11: 660-669.
11. 银春景, 陈泽群, 鄂丽芳. 探究陈旧性跟腱断裂的发生原因及手术治疗方案对比. 中国现代药物应用, 2019, 13(9): 20-21.
12. Lin Y, Yang L, Yin L, et al. Surgical strategy for the chronic Achilles tendon rupture. Biomed Res Int, 2016, 2016: 1416971.
13. Maffulli N, Oliva F, Maffulli GD, et al. Surgical management of chronic Achilles tendon ruptures using less invasive techniques. Foot Ankle Surg, 2018, 24(2): 164-170.
14. Sarman H, Muezzinoglu US, Memisoglu K, et al. Comparison of semi-invasive “Internal Splinting” and open suturing techniques in Achilles tendon rupture surgery. J Foot Ankle Surg, 2016, 55(5): 965-970.
15. Seker A, Kara A, Armagan R, et al. Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up. Arch Orthop Trauma Surg, 2016, 136(10): 1417-1423.
16. 赵峰, 胡跃林, 焦晨, 等. 踇长屈肌腱移位与腓肠肌腱翻瓣修复陈旧跟腱断裂的疗效比较. 中华医学杂志, 2019, 99(7): 542-546.
17. Saku I, Kanda S, Saito T, et al. Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture. Int J Surg Case Rep, 2017, 37: 106-108.
18. Sarzaeem MM, Lemraski MM, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc, 2012, 20(7): 1386-1391.
19. 赵嘉国, 郭文煊, 曾宪铁, 等. 急性跟腱断裂术后早期功能锻炼的研究进展. 中国修复重建外科杂志, 2019, 33(3): 382-386.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical analysis of autogenous tendon reconstruction under total arthroscopy in treatment of chronic Achilles tendon rupture

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