OBJECTIVE To investigate the clinical result and influence factors of prognosis after repair of ruptured Achilles tendon with operative treatment. METHODS From 1961 to 1994, 62 cases with ruptured Achilles tendon were treated operatively. Among them, "8"-shaped suture was used in 8 cases, aponeurosis flap repair in 30 cases, transfer repair of tendon of peroneus longus muscle in 2 cases, reverse "V-Y" shaped tendon plastic operation in 10 cases, and mattress suture of opposite ends in 12 cases. RESULTS Followed up 3 to 33 years, there was excellent in 40 cases, better in 13 cases, moderate in 6 cases, poor in 3 cases, 85.5% in excellent rate. Postoperative infection and re-rupture were occurred in 6 cases respectively. CONCLUSION Different operative procedures are adopted to achieve better long-term clinical result according to the injury types.
Objective To summarize the cl inical appl ication and experience of repairing acute avulsion-type achilles tendon rupture by locking-loop stereoscopic suture. Methods Between January 2006 and June 2010, 41 cases of acute avulsion-type achilles tendon rupture were treated by locking-loop stereoscopic suture. Among 41 patients, 33 were male and 8were female with an average age of 41 years (range, 18-56 years); the locations were left side in 27 cases and right side in 14 cases. There was palpable defect in 33 cases, 7 cases underwent B-ultrasound, and 1 case underwent MRI to confirm the diagnosis. The time from injury to operation was 36 hours to 7 days. All cases were restored by locking-loop stereoscopic suture. Results All incisions healed by first intention. Thirty-one cases were followed up 12 months to 3 years and 10 months with an average of 17 months. The muscle strength reached grade 5; the patients could walk normally, and the heel raising was powerful at 1 year after operation. The circumference difference between wrong leg and good leg was less than 3 cm, and the ankle dorsiflexion was 20-30°, plantar flexion was 40-50°. No re-rupture of achilles tendon or deep infection occurred during follow-up period. At last follow-up, according to evaluation of curative effects by Arner-Lindholm standard, the results were excellent in 21 cases and good in 10 cases with an excellent and good rate of 100%. Conclusion Locking-loop stereoscopic suturing is a safe and effective method with avulsion-type control abil ity, tensile strength, l ittle effect on the blood supply of the achilles tendon for repairing acute avulsion-type achilles tendon rupture.
OBJECTIVE: To explore the methods of treatment for old achilles tendon rupture merging with skin defect. METHODS: By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm’s technique in 2 patients. RESULTS: All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing-shui’s criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1. CONCLUSION: Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.
Objective To investigate the effectiveness of a double-tsuge suture method with absorbable polydioxanone-cord (PDS-II) in repair of Achilles tendon ruptures. Methods Between January 2005 and December 2008, 36 patients suffering from Achilles tendon ruptures were treated operatively. Of 36 patients, there were 29 males and 7 females with a mean age of 36 years (range, 21-50 years), including 22 cases of acute closed injuries, 6 cases of fresh open injuries (the time between injury and hospital ization was 1-10 days, mean 6 days), and 8 cases of old closed injuries (the time between injury and hospital ization was 43-63 days, mean 51 days). The injury reasons were sport injury (25 cases), incisedinjury (6 cases), fall ing injury (4 cases), and other (1 case). The results of “heel test” and the Thompson sign were positive in all patients. Operation was performed by using a double-tsuge suture method with a No. 0 PDS-II. After the ankle joint was fixed with short leg plaster cast at 30° plantar flexion position for 6 weeks, the cast was removed and then functional exercises were done. Results Poor heal ing of incision occurred in 2 cases of old Achilles tendon ruptures and was cured after symptomatic treatment; heal ing of incision by first intention was achieved in the others. The patients were followed up 12 to 24 months (mean, 15 months). No rerupture, deep venous thromboembol ism, or reflex sympathetic dystrophy occurred during follow-up. When compared with the range of motion of ankle joint of normal side, 7 cases had no change, 16 cases had a loss of 1-10°, 12 cases had a loss of 10-20°, and 1 case had a loss of 25°. The average score was 90 (range, 74-96) according to Termann cl inical evaluation criterion; the results were excellent in 24 cases, good in 11 cases, and fair in 1 case, and the excellent and good rate was 97.2%. Conclusion The double-tsuge suture method is easy-to-operate, which has the smallest interference to the blood supply of Achilles tendon because of no crossing or transversal intratendon suture. PDSII can provide highly b stabil ity, furthermore, it can be degenerated completely with tiny foreign body reaction, so there is no tendency to develope local adhesion. This technique achieves good results and is associated with a low morbidity of compl ications.
Objective To probe into the surgical methods and therapeutic effect of repairing old calcaneal tendon rupture and defects with tissue engineered tendons. Methods The tissue engineered tendons were prefabricated by co-cultivatingallogeneic tendon cells with composite of carbon fiber and polyglycolic acid for 5 days. From August 1999 to June 2002, 7 patients with calcaneal tendon rupture and defects (5-7 cm in length) were treated with tissue engineered tendons. The defects were repaired by suturing repeatedly with tissue engineered tendons. Meanwhile, the defects were covered by gastrocnemius fascial flap for protection and strengthening. After surgery, the ankle joints were fixed with plaster 4to 6 weeks, and then the functional exercise was done. Results All the patients were followed up 22 to 56 months (46.9 months on average). Six patients achieved healing by the first intention, only one patient had delayed union. No local or systemic complication occurred in all the cases. No patients were given the second operation for adhesion. In accordance with YIN Qingshui’s criterion for therapeutic effect,the results were excellent in 5 cases, good in 1 case and moderate in 1 case. Conclusion Repairing old rupture and defects of calcaneal tendon withtissue engineered tendons can achieve good clinical outcome, it is an optional therapy.
ObjectiveTo explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture.MethodsThe clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by “V-Y”advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function.ResultsThe 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases.ConclusionThe treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve.
Old achilles tendon rupture accompanied by skin defect was a common amp; annoying problem in clinic. From June, 1985 to June, 1996, 18 cases with this kind of injury were treated by one stage repair of the tendon and skin defect. In this series, there were 15 males and 3 females, the length of tendon defects were ranged from 4 cm-6.1 cm, and the area of skin defect were ranged from 5.9 cm x 3 cm to 8.2 cm x 6 cm. The procedures were: (1) to debridement of the wound thoroughly; (2) to repair the achilles tendon; (3) to repair the skin defect with kinds of pedicle flap; (4) immobilization of ankle and knee for 6 weeks. No infection was occured after the operation. The flaps survived in all cases. After follow-up for one year in 15 cases, 12 patients went back to their work. It was concluded that (1) achilles tendon rupture should be treated carefully and properly during the emergency operation; (2) different methods should be selected according to the length of tendon defect; (3) because of its high survival and retained sensation after operation, the flap pedicled with posterior lateral malleolar artery is the best choice for repairing the skin defect.
ObjectiveTo investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture.MethodsBetween 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.ResultsThe 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).ConclusionAutogenous 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.