Transverse small incision intrathecal “loop” minimally invasive suture for treatment of acute Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Aikeremu·Aierken ^1,2 , ZHANG Yu ^1,2 , GAO Wentian ^1,2 , QIN Jianghui ^1,2 ,  JIANG Qing ^1,2 ,  CHEN Dongyang ^1,2

1. Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

JIANG Qing, Email: jiangqing112@hotmail.com; CHEN Dongyang, Email: 28617621@qq.com

Keywords：

Acute Achilles tendon rupture; transverse small incision; oval forceps assisted; minimally invasive suture

DOI：

10.7507/1002-1892.202403070

Video：

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Objective To evaluate the effectiveness and feasibility of a transverse small incision intrathecal “loop” minimally invasive suture for acute Achilles tendon rupture. Methods The clinical data of 30 patients with acute Achilles tendon rupture treated with transverse small incision intrathecal “loop” minimally invasive suture between January 2022 and October 2023 was retrospectively analyzed. The patients were all male, aged from 29 to 51 years, with an average of 39.8 years. The cause of injury was acute sports injury, and the time from injury to operation was 1-14 days, with an average of 3.4 days. The operation time, incision length, intraoperative blood loss, intraoperative complications, wound healing, and hospital stay were recorded. Postoperative appearance and function of ankle were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Vancouver Scar Scale (VSS) score, and Arner-Lindholm score. Results The operation time ranged from 30 to 90 minutes, with an average of 54.2 minutes; the incision length ranged from 1.3 to 3.5 cm, with an average of 2.2 cm; the intraoperative blood loss ranged from 5 to 70 mL, with an average of 22.3 mL; and the hospital stay ranged from 2 to 6 days, with an average of 3.7 days. All incisions healed by first intention, and there was no incision infection, poor healing, and deep venous thrombosis. All patients were followed up 5.3-22.0 months (mean, 14.7 months). During the follow-up, all the 30 patients had returned to exercise, and there was no complication such as Achilles tendon re-rupture, postoperative infection, and gastrocnemius muscle injury. At last follow-up, the AOFAS ankle-hindfoot score was 82-100, with an average of 95.1; the VSS score was 1-4, with an average of 2.1; according to the Arner-Lindholm score, 24 cases were rated as excellent and 6 cases as good. Conclusion Transverse small incision intrathecal “loop” minimally invasive suture for the treatment of acute Achilles tendon rupture has the advantages of simple instrument, convenient operation, small trauma, quick recovery, and satisfactory effectiveness.

Citation： Aikeremu·Aierken, ZHANG Yu, GAO Wentian, QIN Jianghui, JIANG Qing, CHEN Dongyang. Transverse small incision intrathecal “loop” minimally invasive suture for treatment of acute Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1055-1058. doi: 10.7507/1002-1892.202403070 Copy

1.	Winnicki K, Ochała-Kłos A, Rutowicz B, et al. Functional anatomy, histology and biomechanics of the human Achilles tendon—A comprehensive review. Ann Anat, 2020, 229: 151461. doi: 10.1016/j.aanat.2020.151461.
2.	Thomopoulos S, Parks WC, Rifkin DB, et al. Mechanisms of tendon injury and repair. J Orthop Res, 2015, 33(6): 832-839.
3.	Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med, 2022, 386(15): 1409-1420.
4.	王振宇, 姜良勇, 李强, 等. 急性闭合性跟腱断裂治疗方法的研究进展. 山东化工, 2020, 49(20): 52-53.
5.	Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ, 2019, 364: k5120. doi: 10.1136/bmj.k5120.
6.	Holm C, Kjaer M, Eliasson P. Achilles tendon rupture—treatment and complications: a systematic review. Scand J Med Sci Sports, 2015, 25(1): e1-e10.
7.	Nair AV, Shamsuddin K, John PS, et al. Correlation of visual analogue scale foot and ankle (VAS-FA) to AOFAS score in malleolar fractures using Indian language questionnare. Foot Ankle Surg, 2015, 21(2): 125-131.
8.	Malviya A, Makwana N, Laing P. Correlation of the AOFAS scores with a generic health QUALY score in foot and ankle surgery. Foot Ankle Int, 2007, 28(4): 494-498.
9.	Eliasson P, Agergaard AS, Couppé C, et al. The ruptured Achilles tendon elongates for 6 months after surgical repair regardless of early or late weightbearing in combination with ankle mobilization: A randomized clinical trial. Am J Sports Med, 2018, 46(10): 2492-2502.
10.	Caldwell JE, Vosseller JT. Maximizing return to sports after Achilles tendon rupture in athletes. Foot Ankle Clin, 2019, 24(3): 439-445.
11.	King CM, Vartivarian M. Achilles tendon rupture repair: Simple to complex. Clin Podiatr Med Surg, 2023, 40(1): 75-96.
12.	骆艳飞, 唐冬旭, 万喻, 等. 带线锚钉经皮与开放缝合急性跟腱断裂的比较. 中国矫形外科杂志, 2023, 31(22): 2041-2046.
13.	宋江润, 吕泽斌, 石皓, 等. 小切口在自制导引器辅助下腱周内缝合法治疗新鲜闭合性跟腱断裂. 中国医药指南, 2017, 15(18): 43-44.
14.	Carvalho FA, Kamper SJ. Effects of early rehabilitation following operative repair of Achilles tendon rupture (PEDro synthesis). Br J Sports Med, 2016, 50(13): 829-830.

1. Winnicki K, Ochała-Kłos A, Rutowicz B, et al. Functional anatomy, histology and biomechanics of the human Achilles tendon—A comprehensive review. Ann Anat, 2020, 229: 151461. doi: 10.1016/j.aanat.2020.151461.
2. Thomopoulos S, Parks WC, Rifkin DB, et al. Mechanisms of tendon injury and repair. J Orthop Res, 2015, 33(6): 832-839.
3. Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med, 2022, 386(15): 1409-1420.
4. 王振宇, 姜良勇, 李强, 等. 急性闭合性跟腱断裂治疗方法的研究进展. 山东化工, 2020, 49(20): 52-53.
5. Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ, 2019, 364: k5120. doi: 10.1136/bmj.k5120.
6. Holm C, Kjaer M, Eliasson P. Achilles tendon rupture—treatment and complications: a systematic review. Scand J Med Sci Sports, 2015, 25(1): e1-e10.
7. Nair AV, Shamsuddin K, John PS, et al. Correlation of visual analogue scale foot and ankle (VAS-FA) to AOFAS score in malleolar fractures using Indian language questionnare. Foot Ankle Surg, 2015, 21(2): 125-131.
8. Malviya A, Makwana N, Laing P. Correlation of the AOFAS scores with a generic health QUALY score in foot and ankle surgery. Foot Ankle Int, 2007, 28(4): 494-498.
9. Eliasson P, Agergaard AS, Couppé C, et al. The ruptured Achilles tendon elongates for 6 months after surgical repair regardless of early or late weightbearing in combination with ankle mobilization: A randomized clinical trial. Am J Sports Med, 2018, 46(10): 2492-2502.
10. Caldwell JE, Vosseller JT. Maximizing return to sports after Achilles tendon rupture in athletes. Foot Ankle Clin, 2019, 24(3): 439-445.
11. King CM, Vartivarian M. Achilles tendon rupture repair: Simple to complex. Clin Podiatr Med Surg, 2023, 40(1): 75-96.
12. 骆艳飞, 唐冬旭, 万喻, 等. 带线锚钉经皮与开放缝合急性跟腱断裂的比较. 中国矫形外科杂志, 2023, 31(22): 2041-2046.
13. 宋江润, 吕泽斌, 石皓, 等. 小切口在自制导引器辅助下腱周内缝合法治疗新鲜闭合性跟腱断裂. 中国医药指南, 2017, 15(18): 43-44.
14. Carvalho FA, Kamper SJ. Effects of early rehabilitation following operative repair of Achilles tendon rupture (PEDro synthesis). Br J Sports Med, 2016, 50(13): 829-830.

Chinese Journal of Reparative and Reconstructive Surgery

Transverse small incision intrathecal “loop” minimally invasive suture for treatment of acute Achilles tendon rupture

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