Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up
Abstract
:1. Introduction
2. Materials and Methods
2.1. Open and Percutaneous Surgical Techniques
2.2. Postoperative Management
2.3. Statistical Analysis
3. Results
3.1. Achilles Tendon Total Rupture Score (ATRS)
3.2. Procedure Duration
3.3. Complications
- ♢
- p-value = 0.991 for temporary paralysis of the sural nerve;
- ♢
- p-value = 0.183 for superficial infections;
- ♢
- p-value = 0.104 for deep infections.
3.4. Return to Sport
4. Discussion
5. Conclusions
Limitations of the Study and Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ochen, Y.; Beks, R.B.; van Heijl, M.; Hietbrink, F.; Leenen, L.P.H.; van der Velde, D.; Heng, M.; van der Meijden, O.; Groenwold, R.H.H.; Houwert, R.M. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: Systematic review and meta-analysis. BMJ 2019, 364, k5120. [Google Scholar] [CrossRef]
- Thermann, H.; Becher, C.; Carmont, M.R.; Karlsson, J.; Maffulli, N.; Calder, J.; Van Dijk, C.N. (Eds.) The Achilles Tendon, an Atlas of Surgical Procedures; ESSKA; Springer: Berlin/Heidelberg, Germany, 2017; ISBN 978-3-662-54073-2. [Google Scholar]
- Gatz, M.; Driessen, A.; Eschweiler, J.; Tingart, M.; Migliorini, F. Open versus minimally-invasive surgery for Achilles tendon rupture: A meta-analysis study. Arch. Orthop. Trauma Surg. 2021, 141, 383–401. [Google Scholar] [CrossRef]
- Worth, N.; Ghosh, S.; Maffulli, N. Management of acute Achilles tendon ruptures in the United Kingdom. J. Orthop. Surg. (Hong Kong) 2007, 15, 311–314. [Google Scholar] [CrossRef] [PubMed]
- Nilsson-Helander, K.; Thomeé, R.; Grävare-Silbernagel, K.; Thomeé, P.; Faxén, E.; Eriksson, B.I.; Karlsson, J. The Achilles tendon Total Rupture Score (ATRS): Development and validation. Am. J. Sports Med. 2007, 35, 421–426. [Google Scholar] [CrossRef]
- Vascellari, A.; Spennacchio, P.; Combi, A.; Grassi, A.; Patella, S.; Bisicchia, S.; Canata, G.L.; Zaffagnini, S.; SIGASCOT Sport Committee. Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles tendon Total Rupture Score (ATRS). Knee Surg. Sports Traumatol. Arthrosc. 2018, 26, 854–861. [Google Scholar] [CrossRef] [PubMed]
- Amendola, F.; Barbasse, L.; Carbonaro, R.; Alessandri-Bonetti, M.; Cottone, G.; Riccio, M.; De Francesco, F.; Vaienti, L.; Serror, K. The Acute Achilles Tendon Rupture: An Evidence-Based Approach from the Diagnosis to the Treatment. Medicina 2022, 58, 1195. [Google Scholar] [CrossRef] [PubMed]
- Meulenkamp, B.; Woolnough, T.; Cheng, W.; Shorr, R.; Stacey, D.; Richards, M.; Gupta, A.; Fergusson, D.; Graham, I.D. What Is the Best Evidence to Guide Management of Acute Achilles Tendon Ruptures? A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Clin. Orthop. Relat. Res. 2021, 479, 2119–2131. [Google Scholar] [CrossRef] [PubMed]
- Stavenuiter, X.R.; Lubberts, B.; Prince, R.M., III; Johnson, A.H.; DiGiovanni, C.W.; Guss, D. Postoperative Complications Following Repair of Acute Achilles Tendon Rupture. Foot Ankle Int. 2019, 40, 679–686. [Google Scholar] [CrossRef]
- Khan, R.J.; Fick, D.; Keogh, A.; Crawford, J.; Brammar, T.; Parker, M. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J. Bone Jt. Surg. Am. 2005, 87, 2202–2210. [Google Scholar]
- Del Buono, A.; Volpin, A.; Maffulli, N. Minimally invasive versus open surgery for acute Achilles tendon rupture: A systematic review. Br. Med. Bull. 2014, 109, 45–54. [Google Scholar] [CrossRef]
- Delponte, P.; Potier, L.; De Poulpiquet, P.; Buisson, P. Traitement des ruptures sous-cutanées du tendon d’Achille par ténorraphie percutanée [Treatment of subcutaneous ruptures of the Achilles tendon by percutaneous tenorraphy]. Rev. Chir. Orthop. Reparatrice Appar. Mot. 1992, 78, 404–407. [Google Scholar]
- Laboute, E.; Thoreux, P.; Beldame, J.; Caubere, A.; Giunta, J.; Coursier, R.; Saab, M. Re-ruptures and early outcomes after surgical repair of acute Achilles tendon ruptures: Prospective, comparative multicenter study. Int. Orthop. 2023, 47, 1855–1861. [Google Scholar] [CrossRef] [PubMed]
- Charissoux, J.L.; Vernois, J.; Brulefert, K. Le traitment des ruptures du tendon d’Achille. Rev. Chir. Orthop. 2013, 99, S134–S142. [Google Scholar]
- Maes, R.; Copin, G.; Averous, C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop. Belg. 2006, 72, 179–183. [Google Scholar] [PubMed]
- Soubeyrand, M.; Serra-Tosio, G.; Campagna, R.; Molina, V.; Sitbon, P.; Biau, D.J. Intraoperative ultrasonography during percutaneous Achilles tendon repair. Foot Ankle Int. 2010, 31, 1069–1074. [Google Scholar] [CrossRef]
- Lacoste, S.; Féron, J.M.; Cherrier, B. Percutaneous Tenolig® repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture. Orthop. Traumatol. Surg. Res. 2014, 100, 925–930. [Google Scholar] [CrossRef]
- Yongliang, Y.; Honglei, J.; Wupeng, Z.; Shihong, X.; Fu, W.; Bomin, W.; Qinghu, L.; Yonghui, W.; Shumei, H. Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. J. Orthop. Surg. Res. 2020, 15, 258. [Google Scholar] [CrossRef] [PubMed]
- Ma, G.W.; Griffith, T.G. Percutaneous repair of acute closed ruptured achilles tendon: A new technique. Clin. Orthop. Relat. Res. 1977, 128, 247–255. [Google Scholar] [CrossRef] [PubMed]
- Biz, C.; Cerchiaro, M.; Belluzzi, E.; Bragazzi, N.L.; De Guttry, G.; Ruggieri, P. Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig. Medicina 2021, 57, 1073. [Google Scholar] [CrossRef]
- Gigante, A.; Moschini, A.; Verdenelli, A.; Del Torto, M.; Ulisse, S.; de Palma, L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: A randomized prospective study. Knee Surg. Sports Traumatol. Arthrosc. 2008, 16, 204–209. [Google Scholar] [CrossRef]
- Grassi, A.; Amendola, A.; Samuelsson, K.; Svantesson, E.; Romagnoli, M.; Bondi, A.; Mosca, M.; Zaffagnini, S. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J. Bone Jt. Surg. Am. 2018, 100, 1969–1981. [Google Scholar] [CrossRef]
- Yang, B.; Liu, Y.; Kan, S.; Zhang, D.; Xu, H.; Liu, F.; Ning, G.; Feng, S. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int. J. Surg. 2017, 40, 178–186. [Google Scholar] [CrossRef]
- Attia, A.K.; Mahmoud, K.; d’hooghe, P.; Bariteau, J.; Labib, S.A.; Myerson, M.S. Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am. J. Sports Med. 2023, 51, 825–836. [Google Scholar] [CrossRef] [PubMed]
- Vaidya, S.R.; Sharma, S.C.; Al-Jabri, T.; Kayani, B. Return to sport after surgical repair of the Achilles tendon. Br. J. Hosp. Med. 2023, 51, 825–836. [Google Scholar] [CrossRef]
- LaPrade, C.M.; Chona, D.V.; Cinque, M.E.; Freehill, M.T.; McAdams, T.R.; Abrams, G.D.; Sherman, S.L.; Safran, M.R. Return-to-play and performance after operative treatment of Achilles tendon rupture in elite male athletes: A scoping review. Br. J. Sports Med. 2022, 56, 515–520. [Google Scholar] [CrossRef] [PubMed]
- Lerch, T.D.; Schwinghammer, A.; Schmaranzer, F.; Anwander, H.; Ecker, T.M.; Schmid, T.; Weber, M.; Krause, F. Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture. Foot Ankle Int. 2020, 41, 784–792. [Google Scholar] [CrossRef] [PubMed]
- Wang, C.C.; Chen, P.Y.; Yang, K.C.; Wang, C.L.; Chen, H. Current treatment concepts for Achilles tendon rupture. Tzu Chi Med. J. 2024, 36, 46–52. [Google Scholar] [CrossRef]
Patients | Data |
---|---|
Number | 155 |
Sex | 143 males |
12 females | |
Age | 48.30 ±14.75 |
Side | 80 right 75 left |
Type of Trauma | 81 sports injuries 74 accidental events |
Follow up | 72.3 ± 31.6 3 months |
Complications (no effect on function) | 10 (6 superficial infections; 1 DVT *; 3 cases of temporary sural nerve palsy) |
Complications (with effect on function) | 11 (2 deep infections; 9 re-ruptures) |
Parameter | Percutaneous Surgery | Open Surgery | p-Value |
---|---|---|---|
Patients | 103 | 52 | – |
(male, female) | (98, 5) | (45, 7) | |
(left, right) | (51, 51) | (24, 28) | |
Age (years) | 48.9 ± 15.1 | 47.9 ± 14.5 | |
ASA ** | 1.5 ± 0.6 | 1.8 ± 0.5 | |
ATRS (points) | 92.5 ± 10.0 | 82.0 ± 7.5 | 0.156 |
Procedure time (min) | 19.4 ± 7.6 | 71.0 ± 26.7 | <0.001 |
Follow-up duration (months) | 73.1 ± 20.7 | 71.5 ± 18.5 | |
Complications | 12 (11.6%) | 9 (17.3%) | 0.478 |
Without effect on function | |||
Superficial infections | 2 (1.9%) | 4 (7.7%) | 0.183 |
Temporary sural nerve palsy | 2 (1.9%) | 1 (1.9%) | 0.991 |
DVT * | 1 (1.0%) | 0 (0%) | |
With effect on function | |||
Re-rupture | 7 (6.8%) | 2 (3.8%) | 0.507 |
Deep infections | 0 (0%) | 2 (3.8%) | 0.104 |
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Caruso, G.; Gambuti, E.; Saracco, A.; Spadoni, E.; Corso, E.; Pinotti, I.; Pisano, A.; Massari, L. Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up. Medicina 2024, 60, 1382. https://doi.org/10.3390/medicina60091382
Caruso G, Gambuti E, Saracco A, Spadoni E, Corso E, Pinotti I, Pisano A, Massari L. Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up. Medicina. 2024; 60(9):1382. https://doi.org/10.3390/medicina60091382
Chicago/Turabian StyleCaruso, Gaetano, Edoardo Gambuti, Achille Saracco, Elisa Spadoni, Elena Corso, Ilaria Pinotti, Alessandro Pisano, and Leo Massari. 2024. "Open vs. Percutaneous Achilles Tendon Repair: Experience of Single Orthopedic Institute with Long-Term Follow-Up" Medicina 60, no. 9: 1382. https://doi.org/10.3390/medicina60091382