Channel-assisted minimally invasive repair of acute Achilles tendon rupture
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RESEARCH ARTICLE
Open Access
Channel-assisted minimally invasive repair of acute Achilles tendon rupture Hua Chen, Xinran Ji, Qun Zhang, Xiangdang Liang and Peifu Tang*
Abstract Background: Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques. Method: Eighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing. Results: There was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred. Conclusion: CAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.
Introduction Repair of Achilles tendon (AT) ruptures include conservative management using a short-leg resting cast or brace in an equinus position as well as percutaneous, minimally invasive surgery and open sutures with or without augmentation [1, 2]. The best option is still controversial [3]. Some surgeons advocate operative repair because open treatment can ensure tendon approximation and has a lower rerupture rate [4]. However, it is associated with a higher complication rate, including wound infections, skin tethering, sural nerve lesions, and hypertrophic scars, which have caused anxiety for both doctors and patients [2]. Therefore, a percutaneous, minimally invasive suture technique has been developed, decreasing the risk of these complications. Especially,
the Achillon suture system has been widely used for minimally invasive suturing of AT ruptures [5, 6]. The major problem with a percutaneous, minimally invasive technique is sural nerve involvement [7–9]. Some techniques have described measures taken to avoid the risk of nerve injury, such as a modified Achillon technique with the help of an arthroscopic probe [10], endoscopy-assisted percutaneous repair [11], an internal splinting technique [12], and the Mayo needle technique [13–
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