Objective To investigate the management of the soft tissue defect after the Achilles tendon repair. Methods From April 1996 to April 2006, 24 patients(17 males, 7 females; aged 16-59 years), who suffered from postoperative Achilles tendon exposure caused by local soft-tissue necrosis after the Achilles tendon repair, were treated and evaluated. Of the 24patients, 8 had an original open injury (machinecrush injury in 2 patients, heavy-object press injury in 3, motorcycle wheel crush injury in 3) and 16 patients had a closed injury (sports injury). In their treatment, the transferof the sural neurovascular flap was performed on 8 patients and the transfer ofthe saphenous neurovascular flap was performed on 3 patients. The secondary Achilles tendon repair was performed on 13 patients before the neurovascular flap transfer was performed. The time between the injury and the operation was 9-76 days, and the time between the Achilles tendon expousure and the operation was 3-65 days. Results All the flaps survived and the Achilles tendon exposure was well covered by the flaps of good texture. Eighteen patients followed up for 6 months to 24 months had no flap complication, and the two point discrimination of the flaps was 12-20 mm. The AOFASAnkleHindfoot Scale assessment revealed that 8 patients had an excellent result, 6 had a good result, 3 had a fair result, and just 1 had a poor result, with theexcellent and good results accounting for 77.8%. Sixteen patients (89%) were able toperform a tip-toe stance on their operative sides, and only 3 of them complained a loss of plantarflexion strength. However, 2 patients still could not perform the tip-toe stance. Conclusion The Achilles tendon repair, ifnot well performed, can result in the local soft-tissue necrosis and the subsequent Achilles tendon exposure. If those complications occur, the neurovascular flap transfer should be performed as soon as possible; if necessary, the secondary Achilles tendon repair should be performed, too.
Objective To investigate of effectiveness of free fascia lata flap assisted by indocyanine green angiography (ICGA) in treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures. Methods A clinical data of 14 patients with Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures between March 2020 and June 2024 was retrospectively analyzed. All Achilles tendon defects were repaired with the free fascia lata assisted by ICGA during operation. There were 12 males and 2 females with an average age of 45.4 years (range, 26-71 years). The causes of Achilles tendon rupture included sports injury in 10 cases, Achilles tendon-related tendinopathy in 3 cases, and glass laceration injury in 1 case. The time from Achilles tendon rupture to operation was 4-40 weeks (median, 4.5 weeks). Preoperative MRI examination showed that the defect length of the Achilles tendon was 2-5 cm (mean, 3.2 cm). The operation time and intraoperative blood loss were recorded. The color Doppler ultrasound (CDU) and MRI were taken to observe the foot blood vessels and the tendon healing. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Achilles Tendon rupture score (ATRS), and range of motion of the ankle joint were used to estimate the pain and function of ankle joint. Results All operations of the 14 patients were successfully completed. The operation time ranged from 3.00 to 4.50 hours (mean, 3.60 hours). The intraoperative blood loss ranged from 10 to 50 mL (mean, 36.4 mL). After operation, 1 patient had exudation at the recipient site, which healed after dressing change; the other incisions healed by first intention. All incisions at the donor sites healed by first intention. All patients were followed up 6-36 months (mean, 11.4 months). The CDU of the foot at 1 month after operation showed that the blood flow signal of the perforating vessels of the fascia lata flap was clear. The ankle MRI at 2 months after operation showed the good continuity of the Achilles tendon. No complication such as the Achilles tendon re-rupture, ankle stiffness, or scar contracture occurred during follow-up. Compared with preoperative score, the AOFAS score, ATRS score, and plantar flexion range of motion significantly increased at 1, 3, and 6 months after operation (P<0.05), while the VAS score and dorsiflexion range of motion significantly decreased (P<0.05). The AOFAS score, ATRS score, and VAS score at 3 and 6 months further improved when compared with those at 1 month (P<0.05); however, there was no significant difference in the range of motion of the ankle joint (P>0.05). There was no significant difference in above indicators between 3 and 6 months after operation (P>0.05). Conclusion The treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures with free fascia lata flaps under the guidance of ICGA has the advantages of precise design, fast healing, and a wide range of adaptability.
OBJECTIVE: To review the anatomy, etiology, therapy strategy of Achilles tendon injury and its related advances in recent years. METHODS: The related articles in recent years were extensively reviewed. RESULTS: There still were many arguments about the effect of corticosteroid on the treatment of tendon disease. Fluoqmnolone was found to be related with Achilles tendon injury. Acute rupture of Achilles tendon could be treated with open operation, percutaneous repair, or conservative therapy. For old rupture, many kinds of operations could be selected. CONCLUSION: The growth factors found in recent years provide us with new prospect for future treatment of Achilles tendon injury.
Objective To evaluate the biomechanical property of tendons repaired with the modified Kessler suture combined with " 8” suture, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture. Methods Forty frozen flexor digitorum longus tendons from fresh pork hind leg were randomly assigned into 4 groups, 10 specimens each group. In group A, the tendons were dissected transversely at the midpoint to forming the model of tendon with transversely cutting injury. The tendons in groups B, C, and D were dissected transversely at the midpoint, then a 2 cm segment of tendon from the incision in each side was dissected longitudinally with 1 mm internal to forming " frayed tendon” model. All the tendons were sutured with2-0 non-absorbable suture material with different suturing methods: in group A, the tendons with transversely cutting injury model with Krackow suture, and in the groups B, C, and D with Krackow suture, Kessler suture, and the modified Kessler suture combined with " 8” suture separately. All repaired tendons were fixed onto the biomechanical testing machine. The length, width, and thickness of each side and midpoint of the tendons were recorded, and the cross-sectional area was calculated. The tendons were stretched at a speed of 15 mm/minutes until failure (suture avulsion or rupture). The computer automatically recorded the maximum load, stress, strain, the failure displacement, and the stiffness. These biomechanical parameters of tendons in different groups were analyzed and compared. Results There was no significant difference in the length and cross-sectional area of each tendon among 4 groups (F=0.245, P=0.863; F=0.094, P=0.963). Two tendons in group B, 1 in group C, and 1 in group D were excluded because of tendon slipping; all tendons in group A and 8 tendons in group B failured due to suture rupture, 9 tendons in group C due to suture slipping, and 9 tendons in group D due to 3 sutures slipping from tendon tissue together. The maximum load, the maximum stress, the maximum strain, the failure displacement, and the stiffness of the tendons between groups A and B showed no significant difference (P>0.05). The maximum load, the maximum stress, and the stiffness of the tendons in group D were larger than those in both groups B and C (P<0.05), but no significant difference was found in the maximum strain and the failure displacement between groups B, C, and D (P>0.05). The maximum load, the maximum stress, the failure displacement, and the stiffness of the tendons in group B were larger than those in group C (P<0.05), but the difference of maximum strain between groups B and C was not significant (P>0.05). Conclusion The modified Kessler suture combined with " 8” suture can provide better biomechanical property of the repaired tendon compared with other suture approaches.
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 assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
Objective To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. Methods The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture(8 cases of complete rupture and 2 cases of incomplete rupture). Results The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5±2.5 cm. The width of origin tendon was 0.9±0.2 cm and the thickness was 0.3±0.1 cm; the width on apex of lateral malleolus was 0.7±0.1 cm and the thickness was 0.4±0.1 cm, the width on head of cuboid was 0.7±0.1 cm and the thickness was 0.3±0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2 292.4±617.3 Non tendon calcaneus, 1 020.4±175.4 N on long peroneal muscles tendon, 752.0±165.4 N on peroneus brevis tendon and 938.2±216.7 N on tibialis posteriortendon. Tencases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 1824 months. No Achilles tendon rerupture, necrosis of skin or other complications occurred. According to AmerLindholm criterion forcurative results, the results were excellent in 7 cases and good in 3 cases and the excellent and good rate was 100%. Conclusion The long peroneal muscles tendon transposition is a perfect and simple way to repair occlusive Achilles tendon rupture.
ObjectiveTo investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects.MethodsThe clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side.ResultsEighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° (t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° (t=0.444, P=0.660).ConclusionThe application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.