WANG Song , LI Hao , TANG Jinlong , ZHU Zhengya , LIU Yong
  • Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China;
LIU Yong, Email: xyfyydyxk@163.com
Achilles tendon rupture; Achillon; minimally invasive repair
10.7507/1002-1892.202408075
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Objective  To compare the effectiveness of Achillon combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture. Methods  The clinical data of 38 patients with acute closed Kuwada type Ⅱ Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed. Krachow suture with posterolateral incision was used in 24 cases (traditional group), and Achillon combined with circuit suture under perineural channel was used in 14 cases (minimally invasive group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, time from injury to operation, characteristics of Achilles tendon injury (broken end distance, stump length), and preoperative Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score between the two groups (P>0.05). The operation time, incision length, hospital stay, and complications (re-tear, incision infection, sural nerve irritation, deep venous thrombosis) were recorded. ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation. Results  All patients successfully completed the operation. The operation time, incision length, and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group (P<0.05). Patients in both groups were followed up 8-16 months, with an average of 12.7 months. There was no sural nerve injury and secondary rupture of Achilles tendon in both groups. In the traditional group, 1 case had incision infection, 1 case had suture rejection, and 1 case had intermuscular venous thrombosis; in the minimally invasive group, no incision healing, suture knot discomfort, and thrombosis occurred. The postoperative ATRS score and AOFAS ankle and hindfoot function score of the two groups significantly improved when compared with those before operation, and further improved with time (P<0.05). Except that there was no significant difference in AOFAS ankle and hindfoot function scores between the two groups at 3 months after operation (P>0.05), the ATRS scores and AOFAS ankle and hindfoot function scores in the minimally invasive group were significantly better than those in the traditional group at other time points (P<0.05). Conclusion  The treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture with Achillon combined with circuit suture under the perineural channel has end-stage ankle function comparable to traditional operation, but the incision is smaller and the infection rate is lower, which is beneficial for patients to recover early ankle function.