Old achilles tendon rupture accompanied by skin defect was a common amp; annoying problem in clinic. From June, 1985 to June, 1996, 18 cases with this kind of injury were treated by one stage repair of the tendon and skin defect. In this series, there were 15 males and 3 females, the length of tendon defects were ranged from 4 cm-6.1 cm, and the area of skin defect were ranged from 5.9 cm x 3 cm to 8.2 cm x 6 cm. The procedures were: (1) to debridement of the wound thoroughly; (2) to repair the achilles tendon; (3) to repair the skin defect with kinds of pedicle flap; (4) immobilization of ankle and knee for 6 weeks. No infection was occured after the operation. The flaps survived in all cases. After follow-up for one year in 15 cases, 12 patients went back to their work. It was concluded that (1) achilles tendon rupture should be treated carefully and properly during the emergency operation; (2) different methods should be selected according to the length of tendon defect; (3) because of its high survival and retained sensation after operation, the flap pedicled with posterior lateral malleolar artery is the best choice for repairing the skin defect.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Objective To evaluate the effectiveness and feasibility of a transverse small incision intrathecal “loop” minimally invasive suture for acute Achilles tendon rupture. Methods The clinical data of 30 patients with acute Achilles tendon rupture treated with transverse small incision intrathecal “loop” minimally invasive suture between January 2022 and October 2023 was retrospectively analyzed. The patients were all male, aged from 29 to 51 years, with an average of 39.8 years. The cause of injury was acute sports injury, and the time from injury to operation was 1-14 days, with an average of 3.4 days. The operation time, incision length, intraoperative blood loss, intraoperative complications, wound healing, and hospital stay were recorded. Postoperative appearance and function of ankle were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Vancouver Scar Scale (VSS) score, and Arner-Lindholm score. Results The operation time ranged from 30 to 90 minutes, with an average of 54.2 minutes; the incision length ranged from 1.3 to 3.5 cm, with an average of 2.2 cm; the intraoperative blood loss ranged from 5 to 70 mL, with an average of 22.3 mL; and the hospital stay ranged from 2 to 6 days, with an average of 3.7 days. All incisions healed by first intention, and there was no incision infection, poor healing, and deep venous thrombosis. All patients were followed up 5.3-22.0 months (mean, 14.7 months). During the follow-up, all the 30 patients had returned to exercise, and there was no complication such as Achilles tendon re-rupture, postoperative infection, and gastrocnemius muscle injury. At last follow-up, the AOFAS ankle-hindfoot score was 82-100, with an average of 95.1; the VSS score was 1-4, with an average of 2.1; according to the Arner-Lindholm score, 24 cases were rated as excellent and 6 cases as good. Conclusion Transverse small incision intrathecal “loop” minimally invasive suture for the treatment of acute Achilles tendon rupture has the advantages of simple instrument, convenient operation, small trauma, quick recovery, and satisfactory effectiveness.
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 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.
ObjectiveTo evaluate the effectiveness of channel-assisted minimally invasive repair (CAMIR) for acute closed Achilles tendon ruptures. MethodsBetween January 2011 and June 2012, 30 patients (30 sides)with acute closed Achilles tendon ruptures were treated with CAMIR technique. Among 30 patients, 18 were male and 12 were female with an average age of 30.4 years (range, 22-50 years); the locations were left side in 10 cases and right side in 20 cases. All the causes were sports injury. B-ultrasound was used to confirm the diagnosis, with the average distance from the rupture site to the Achilles tendon insertion of 4.4 cm (range, 2-8 cm). The time from injury to operation was 3 hours to 9 days (median, 4 days). All injuries were repaired by CAMIR technique. ResultsThe average operation time was 17.0 minutes (range, 10-25 minutes), and the mean incision length was 2.0 cm (range, 1.5-2.5 cm). All the incisions healed by first intention. There was no complication of wound problem, deep vein thrombosis, re-rupture, or sural nerve injury. All cases were followed up 12-24 months with an average of 16 months. At last follow-up, the patients could walk normally with powerful raising heels and restored to normal activity level. MRI imaging suggested the continuity and healing of ruptured tendon. The circumference difference between affected leg and normal leg was less than 1 cm, and the ankle dorsi-extension was 20-30°, plantar flexion was 20-30°. Arner Lindholm score showed that the surgical results were excellent in 28 cases and good in 2 cases, with an excellent and good rate of 100%. ConclusionCAMIR is a safe and reliable method to repair acute closed Achilles tendon rupture, with many advantages of minimal injury, low re-rupture and infection. Sural nerve injury can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnel suture technique.
Objective To probe into the surgical methods and therapeutic effect of repairing old calcaneal tendon rupture and defects with tissue engineered tendons. Methods The tissue engineered tendons were prefabricated by co-cultivatingallogeneic tendon cells with composite of carbon fiber and polyglycolic acid for 5 days. From August 1999 to June 2002, 7 patients with calcaneal tendon rupture and defects (5-7 cm in length) were treated with tissue engineered tendons. The defects were repaired by suturing repeatedly with tissue engineered tendons. Meanwhile, the defects were covered by gastrocnemius fascial flap for protection and strengthening. After surgery, the ankle joints were fixed with plaster 4to 6 weeks, and then the functional exercise was done. Results All the patients were followed up 22 to 56 months (46.9 months on average). Six patients achieved healing by the first intention, only one patient had delayed union. No local or systemic complication occurred in all the cases. No patients were given the second operation for adhesion. In accordance with YIN Qingshui’s criterion for therapeutic effect,the results were excellent in 5 cases, good in 1 case and moderate in 1 case. Conclusion Repairing old rupture and defects of calcaneal tendon withtissue engineered tendons can achieve good clinical outcome, it is an optional therapy.