Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAN Junfeng , FANG Jialiu , ZHANG Jisen , CHENG Wendan , LÜ Hao ,  JING Juehua

Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230601, P.R.China;

Corresponding author：

JING Juehua, Email: jingjuehuapaper@163.com

Keywords：

Modified suture technique; acute Achilles tendon rupture; closed injury

DOI：

10.7507/1002-1892.201702090

Video：

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ObjectiveTo investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture.MethodsBetween December 2013 and December 2016, 29 cases with acute closed Achilles tendon rupture were treated with modified suture technique. There were 23 males and 6 females with an average age of 34 years (range, 22-45 years). All patients were sport injuries. The injury located at left side in 22 cases and right side in 7 cases. American Foot and Ankle Surgery Association (AOFAS) ankle and hind foot function score was 44.6±3.6. According to the Amer-Lindholm criteria, 29 cases were rated as poor. MRI showed the complete rupture of the Achilles tendon.ResultsThe operation time was 35-62 minutes (mean, 46 minutes). The intraoperative blood loss volume was 7-15 mL (mean, 10 mL). The incisions healed by first intention, and no sural nerve injury occured. All patients were followed up 5-38 months (mean, 18.4 months). AOFAS ankle and hind foot function score was 93.1±4.3 at 3 months after operation, showing significant difference when compared with the preoperative value (t=–49.581, P=0.000). According to the Amer-Lindholm criteria, the results were excellent in 24 cases and good in 5 cases, and the excellent and good rate was 100%; there was significant difference between pre- and post-operation (Z=–7.294, P=0.000). MRI showed the continuous and integrity of Achilles tendon. No Achilles tendon rupture recurred during the follow-up period.ConclusionModified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery.

Citation： ZHAN Junfeng, FANG Jialiu, ZHANG Jisen, CHENG Wendan, LÜ Hao, JING Juehua. Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 952-956. doi: 10.7507/1002-1892.201702090 Copy

1.	Ganestam A, Kallemose T, Troelsen A, et al. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3730-3737.
2.	高磊, 丁亮华, 孔繁林, 等. 经皮带线铆钉治疗急性闭合性跟腱断裂 28 例. 中华创伤杂志, 2014, 30(4): 336-338.
3.	Aktas S, Kocaoglu B, Nalbantoglu U, et al. End-to-end versus augmented repair in the treatment of acute Achilles tendon ruptures. J Foot Ankle Surg, 2007, 46(5): 336-340.
4.	王晓宁, 朱颖波, 黄鑫, 等. 新型微创缝合技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2016, 18(3): 187-191.
5.	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.
6.	Cukelj F, Bandalovic A, Knezevic J, et al. Treatment of ruptured Achilles tendon: Operative or non-operative procedure? Injury, 2015, 46 Suppl 6: S137-142.
7.	Ding WG, Zhu YP, Yan WH. Treatment of acute and closed Achilles tendon ruptures by minimally invasive tenocutaneous suturing. J Foot Ankle Surg, 2013, 52(2): 143-146.
8.	Wu Y, Lin L, Li H, et al. Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses. Int J Surg, 2016, 36(Pt A): 305-311.
9.	Zhao J, Yu B, Xie M, et al. An Alternative Bundle-to-Bundle Suturing Technique for Repairing Fresh Achilles Tendon Rupture. J Foot Ankle Surg, 2016, 55(4): 881-884.
10.	平安松, 顾洁夫, 徐振华. 跟腱断裂修复术后的并发症. 中国修复重建外科杂志, 2004, 18(6): 513-514.
11.	Massoud EI. Repair of fresh open tear of Achilles tendon Tension regulation at the suture line. Foot Ankle Surg, 2011, 17(3): 131-135.
12.	Laver L, Feldman V, Palmanovich E, et al. Treatment of Achilles tendon ruptures. Harefuah, 2016, 155(7): 443-447.
13.	徐海林, 王天兵, 党育, 等. 急性闭合性跟腱断裂的微创手术治疗. 中华创伤骨科杂志, 2012, 14(1): 36-39.
14.	Porter KJ, Robati S, Karia P, et al. An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg, 2014, 20(2): 90-93.
15.	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.
16.	Bartel AF, Elliot AD, Roukis TS. Incidence of complications after Achillon^® mini-open suture system for repair of acute midsubstance Achilles tendon ruptures: a systematic review. J Foot Ankle Surg, 2014, 53(6): 744-746.
17.	孙淑红, 孙臣友, 唐茂林. 跟腱周围软组织血供与跟腱断裂修补术入路选择的解剖学研究. 中国骨伤, 2007, 20(2): 106-107.

1. Ganestam A, Kallemose T, Troelsen A, et al. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3730-3737.
2. 高磊, 丁亮华, 孔繁林, 等. 经皮带线铆钉治疗急性闭合性跟腱断裂 28 例. 中华创伤杂志, 2014, 30(4): 336-338.
3. Aktas S, Kocaoglu B, Nalbantoglu U, et al. End-to-end versus augmented repair in the treatment of acute Achilles tendon ruptures. J Foot Ankle Surg, 2007, 46(5): 336-340.
4. 王晓宁, 朱颖波, 黄鑫, 等. 新型微创缝合技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2016, 18(3): 187-191.
5. 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.
6. Cukelj F, Bandalovic A, Knezevic J, et al. Treatment of ruptured Achilles tendon: Operative or non-operative procedure? Injury, 2015, 46 Suppl 6: S137-142.
7. Ding WG, Zhu YP, Yan WH. Treatment of acute and closed Achilles tendon ruptures by minimally invasive tenocutaneous suturing. J Foot Ankle Surg, 2013, 52(2): 143-146.
8. Wu Y, Lin L, Li H, et al. Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses. Int J Surg, 2016, 36(Pt A): 305-311.
9. Zhao J, Yu B, Xie M, et al. An Alternative Bundle-to-Bundle Suturing Technique for Repairing Fresh Achilles Tendon Rupture. J Foot Ankle Surg, 2016, 55(4): 881-884.
10. 平安松, 顾洁夫, 徐振华. 跟腱断裂修复术后的并发症. 中国修复重建外科杂志, 2004, 18(6): 513-514.
11. Massoud EI. Repair of fresh open tear of Achilles tendon Tension regulation at the suture line. Foot Ankle Surg, 2011, 17(3): 131-135.
12. Laver L, Feldman V, Palmanovich E, et al. Treatment of Achilles tendon ruptures. Harefuah, 2016, 155(7): 443-447.
13. 徐海林, 王天兵, 党育, 等. 急性闭合性跟腱断裂的微创手术治疗. 中华创伤骨科杂志, 2012, 14(1): 36-39.
14. Porter KJ, Robati S, Karia P, et al. An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg, 2014, 20(2): 90-93.
15. 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.
16. Bartel AF, Elliot AD, Roukis TS. Incidence of complications after Achillon^® mini-open suture system for repair of acute midsubstance Achilles tendon ruptures: a systematic review. J Foot Ankle Surg, 2014, 53(6): 744-746.
17. 孙淑红, 孙臣友, 唐茂林. 跟腱周围软组织血供与跟腱断裂修补术入路选择的解剖学研究. 中国骨伤, 2007, 20(2): 106-107.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture

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