» Articles » PMID: 39085820

The Option of Transosseous Distal Suture Placement During Minimally Invasive Achilles Tendon Repair for High-risk Patients Can Improve Outcomes, However Does Not Prevent Re-rupture

Overview
Publisher Biomed Central
Specialties Orthopedics
Physiology
Date 2024 Jul 31
PMID 39085820
Authors
Affiliations
Soon will be listed here.
Abstract

Purpose: Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to suture pull-out from the distal tendon stump. The aim of this study was to describe the outcome of ATR patients who received transosseous distal suture placement using a standard technique as a reference.

Methods: Following ATR, patients were evaluated for pre-injury activity level, body weight, location of the tear and size of the distal Achilles tendon stump. Patients considered to be at high-risk of re-rupture: Tegner level ≥ 8, body weight ≥ 105Kg and distal ATR, received transosseous (TO) distal suture placement (n = 20) rather than the usual transtendinous (TT) technique (n = 55). Patient reported outcome measures and functional evaluation was performed at 12 months following repair.

Results: At 12 months follow up both methods resulted in good median (IQR) Achilles tendon Total Rupture Score TO 83.8 (74-88.3) vs. TT 90 (79-94), low increased relative Achilles Tendon Resting Angle TO -3.5˚ (3.6) vs. TT -3.5˚ (3.3) and mean (SD) Single leg Heel-Rise Height Index TO 88.2% (9.9) vs. TT 85.6% (9.9) (n.s.). There were 4 re-ruptures in the high-risk group and 2 in the group receiving TT distal suture placement. All but one of these were traumatic in nature. The mode of failure following TO distal suture placement was proximal suture pull out.

Conclusions: To distal suture placement during minimally-invasive Achilles tendon repair for higher-risk patients can lead to results equivalent to those in lower-risk patients treated with a standard TT MIR technique, except for the re-rupture rate which remained higher. There may be factors that have greater influence on outcome other than suture placement following ATR.

References
1.
McWilliam J, Mackay G . The Internal Brace for Midsubstance Achilles Ruptures. Foot Ankle Int. 2016; 37(7):794-800. DOI: 10.1177/1071100716653373. View

2.
Nilsson-Helander K, Thomee R, Silbernagel K, Gravare-Silbernagel K, Thomee P, Faxen E . The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2006; 35(3):421-6. DOI: 10.1177/0363546506294856. View

3.
Heikkinen J, Lantto I, Flinkkila T, Ohtonen P, Niinimaki J, Siira P . Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments. Am J Sports Med. 2017; 45(6):1395-1404. DOI: 10.1177/0363546517694610. View

4.
Maffulli N, Gougoulias N, Maffulli G, Oliva F, Migliorini F . Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture. Foot Ankle Int. 2021; 43(2):244-252. PMC: 8841642. DOI: 10.1177/10711007211038594. View

5.
Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V . A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. Am J Sports Med. 2016; 44(9):2406-14. DOI: 10.1177/0363546516651060. View