Abstract
Mini-incision surgical procedures in our institution have been developed by decreasing
the total skin incision length from the original mini half-Bunnell tendon repair technique.
We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair
technique, would promote the tendon healing process leading to better outcomes and
a reduced complication rate compared to the conventional open repair. The study sought
to determine the more optimal method by comparing 44 mini-incision sutures to the
99 sutures in the original open Achilles tendon repairs. The mean skin incision length
of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was
4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision
repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged
heel-rise movement and the time to return-to-play was not significantly different
between the 2 groups. Achilles Tendon Rupture Score was not significantly different
from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision
and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep
vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture
was showed equivalent clinical results to the original open repair, the technique
is recommended in terms of curtailment of the surgery time without increase of complication
ratio.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of acute Achilles tendon ruptures: asystematic review and metaanalysis.Clin Orthop Relat Res. 2002; 400: 190-200
- Acute rupture of tendon Achilles. A prospective randomised study of comparison between surgical and nonsurgical treatment.J Bone Joint Surg Br. 2001; 83: 843-848
- Surgical versus conservative intervention for acute Achilles tendon rupture: a PRISMA-compliant systematic review of overlapping meta-analyses.Medicine (Baltimore). 2015; 94: e1951
- Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures.Am J Sports Med. 2010; 38: 2186-2193
- Is operative treatment of Achilles tendon ruptures superior to nonoperative treatment? A systematic review of overlapping meta-analyses.Orthop J Sports Med. 2015; 32325967115579188
- The arterial anatomy of the Achilles tendon: anatomical study and clinical implications.Clin Anat. 2009; 22: 377-385
- Independent evaluation of a recently described Achilles tendon repair technique.Foot Ankle Int. 2006; 27: 93-96
- 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
- Open versus minimal invasive repair with Achillon device.Foot Ankle Int. 2009; 30: 391-397
- Primary Achilles tendon repair with mini-dorsolateral incision technique and accelerated rehabilitation.Foot Ankle Int. 2012; 33: 848-851
- Subcutaneous Achilles tendon rupture: a comparison between open technique and mini-invasive tenorrhaphy with Achillon suture system.Injury. 2016; 47: 2591-2595
- A modified operation for Achilles tendon ruptures.Am J Sports Med. 2007; 35: 1739-1743
- Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation.Yale J Bio Med. 2011; 84: 289-300
- The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon.J Bone Joint Surg Am. 2008; 90: 1876-1883
- Gravity equinus position to control the tendon length of reversed free tendon flap reconstruction forchronic Achilles tendon rupture.J Foot Ankle Surg. 2017; 56: 37-41
- Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis.BMJ. 2019; 364: k5120
- Surgical versus nonsurgical treatment of acute Achilles tendon rupture. a meta-analysis of randomized trials.J Bone Joint Surg Am. 2012; 94: 2136-2143
- Minimally invasive Achilles tendon repair: a modification of the Achillon technique.Foot Ankle Int. 2013; 34: 1683-1688
- Functional evaluation of professional athletes treated with a mini-open technique for Achilles tendon rupture.Muscles Ligaments Tendons J. 2014; 14: 177-181
- Knotless repair of Achilles tendon rupture in an elite athlete: return to competition in 18 weeks.J Foot Ankle Surg. 2017; 56: 121-124
- Long-term results of mini-open repair technique in the treatment of acute Achilles tendon rupture: a prospective study.J Foot Ankle Surg. 2016; 55: 971-975
- Mini-invasive surgical repair of the Achilles tendon-does it reduce post-operative morbidity?.Int Orthop. 2009; 33: 151-156
- A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture.Foot Ankle Surg. 2011; 17: 211-217
- Retrospective analysis of mini-open repair versus open repair for acute Achilles tendon ruptures.Foot Ankle Spec. 2013; 6: 15-20
- Acute Achilles tendon rupture: Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture.Surgeon. 2015; 13: 207-212
- Subcutaneous Achilles tendon rupture: a comparison between open technique and mini-invasive tenorrhaphy with achillon1 suture system.Injury. 2016; 47: 2591-2595
- Response of the injured tendon to growth factors in the presence or absence of the paratenon.Am J Sports Med. 2019; 47: 462-467
- Optimizing Achilles tendon repair: effect of epitendinous suture augmentation on the strength of Achilles tendon repairs.Foot Ankle Int. 2008; 29: 427-432
- The Achilles Tendon Total Rupture Score (ATRS). Development and validation.Am J Sports Med. 2007; 35: 421-426
- Predictors of clinical outcome after acute Achilles tendon ruptures.Am J Sports Med. 2014; 42: 1448-1455
- Is percutaneous repair better than open repair in acute Achilles tendon rupture?.Clin Orthop Relat Res. 2012; 470: 998-1003
Article info
Publication history
Published online: September 18, 2021
Footnotes
The Kanto Rosai Hospital Institutional Review Board had reviewed and approved the survey of this retrospective study in regard to the clinical outcomes in Achilles tendon repair.
Financial Disclosure: None reported.
Conflict of Interest: There is no conflict of interest.
Identification
Copyright
© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
