Acute Achilles Tendon Injury Treatment Using a Minimally Invasive Knotless Technique. Rehabilitation and Immediate Weight Bearing
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Published:
Jun 15, 2021
Keywords:
Achilles tendon, minimally invasive technique, knotless technique, early rehabilitation
Main Article Content
Abstract
Introduction: Modern surgical techniques seek to rehabilitate early for recovery in less time. Minimally invasive techniques are one option to accomplish this.
Objective: To evaluate the ability to start rehabilitation and weight bearing in the immediate postoperative period and the evolution at 6 months postoperative using a minimally invasive knotless technique.
Materials and Methods: 10 surgical repairs of acute Achilles tendon injuries were performed with a minimally invasive technique. The original Arthrex combination system (PARS - SpeedBridgeTM) was used. After 48 hours, weight bearing was progressively allowed according to tolerance. The final outcome at 6 months was evaluated using the ATRS score.
Results: On average, patients took 14 days to walk without crutches. All began rehabilitation with active and passive ankle range of motion during the first postoperative week. The average ATRS score was 79 points (between 60 and 90 points).
Conclusion: This technique has proven to be an excellent surgical option in acute midsubstance Achilles tendon injuries. The patients were able to start rehabilitation within the first postoperative week, whereas immediate weight bearing was not possible, due to the patients’ pain or fear.
Objective: To evaluate the ability to start rehabilitation and weight bearing in the immediate postoperative period and the evolution at 6 months postoperative using a minimally invasive knotless technique.
Materials and Methods: 10 surgical repairs of acute Achilles tendon injuries were performed with a minimally invasive technique. The original Arthrex combination system (PARS - SpeedBridgeTM) was used. After 48 hours, weight bearing was progressively allowed according to tolerance. The final outcome at 6 months was evaluated using the ATRS score.
Results: On average, patients took 14 days to walk without crutches. All began rehabilitation with active and passive ankle range of motion during the first postoperative week. The average ATRS score was 79 points (between 60 and 90 points).
Conclusion: This technique has proven to be an excellent surgical option in acute midsubstance Achilles tendon injuries. The patients were able to start rehabilitation within the first postoperative week, whereas immediate weight bearing was not possible, due to the patients’ pain or fear.
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How to Cite
Raimondi, N., Massetti, S., & Villada, A. (2021). Acute Achilles Tendon Injury Treatment Using a Minimally Invasive Knotless Technique. Rehabilitation and Immediate Weight Bearing. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(3), 356-364. https://doi.org/10.15417/issn.1852-7434.2021.86.3.1153
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Clinical Research
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References
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study. Clin Orthop Relat Res 1994;308:155-65. PMID: 7955677
4. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles ten- don rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop 2005;76:597-601. https://doi.org/10.1080/17453670510041619
5. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures: a metaanalysis of randomized, controlled trials. J Bone Joint Surg Am 2005;87:2202-10.
https://doi.org/10.2106/JBJS.D.03049
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Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am
2010;92(14):2466-8. PMID: 20962199
7. Nilsson-Helander K, Thomeé R, Silbernagel KG, Thomeé P, Faxén E, Eriksson BI, et al. The Achilles tendon Total
Rupture Score (ATRS): development and validation. Am J Sports Med 2007;35(3):421-6.
https://doi.org/10.1177/0363546506294856
8. Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden
instrument. Oper Orthop Traumatol 2006;18:287-99. https://doi.org/10.1007/s00064-006-1178-y
9. Joannas G, Arrondo G, Eslava S, Casola L, Drago J, Barousse R, et al. Percutaneous Achilles tendon repair with
the Dresden instrument. Clinical and MRI evaluation of 90 patients. Foot Ankle Surg 2020;26(2):209-17.
https://doi.org/10.1016/j.fas.2019.02.005
10. Arzac Ulla I, De Silvestri A, Fiorentini G. Roturas agudas del tendón de Aquiles tratadas con técnica mínimamente invasiva de Dresden. Rev Asoc Argent Ortop Traumatol 2016;82(1):48-53. https://doi.org/10.15417/539
11. De la Fuente C, Peña y Lillo M, Carreño G, Marambio H. Prospective randomized clinical trial of aggressive
rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique. Foot (Edinb) 2016;26:15-22.
https://doi.org/10.1016/j.foot.2015.10.003
12. Lee SJ, Sileo MJ, Kremenic IJ, Orishimo K, Ben-Avi S, Nicholas SJ, et al. Cyclic loading of 3 Achilles tendon
repairs simulating early postoperative forces. Am J Sports Med 2009;37(4):786-90. https://doi.org/10.1177/0363546508328595
13. Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MB, et al. A biomechanical
comparison of an open repair and 3 minimally invasive percutaneous Achilles tendon repair techniques during a
simulated, progressive rehabilitation protocol. Am J Sports Med 2015;43:1957-64.
https://doi.org/10.1177/0363546515587082
14. Demetracopoulos CA, Gilbert SL, Young E, Baxter JR, Deland JT. Limited-open Achilles tendon repair using
locking sutures versus nonlocking sutures: an in vitro model. Foot Ankle Int 2014;35(6):612-8.
https://doi.org/10.1177/1071100714524550
15. Byrne PA, Hopper GP, Wilson WT, Mackay GM. Knotless repair of Achilles tendon rupture in an elite athlete:
return to competition in 18 weeks. J Foot Ankle Surg 2017;56(1):121-4. https://doi.org/10.1053/j.jfas.2016.07.007
16. McWilliam JR, Mackay G. The internal brace for midsubstance Achilles ruptures. Foot Ankle Int 2016;37(7):794-
800. https://doi.org/10.1177/1071100716653373
2013;34(4):475-80. https://doi.org/10.1177/1071100713477621
2. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, et al. Treatment of acute Achilles tendon
ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res 2002;400:190-200.
https://doi.org//10.1097/00003086-200207000-00024
3. Cetti R, Henriksen LO, Jacobsen KS. A new treatment of ruptured Achilles tendons: a prospective randomized
study. Clin Orthop Relat Res 1994;308:155-65. PMID: 7955677
4. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles ten- don rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop 2005;76:597-601. https://doi.org/10.1080/17453670510041619
5. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures: a metaanalysis of randomized, controlled trials. J Bone Joint Surg Am 2005;87:2202-10.
https://doi.org/10.2106/JBJS.D.03049
6. Chiodo CP, Glazebrook M, Bluman EM, Cohen BE, Femino JE, Giza E, et al. American Academy of
Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg Am
2010;92(14):2466-8. PMID: 20962199
7. Nilsson-Helander K, Thomeé R, Silbernagel KG, Thomeé P, Faxén E, Eriksson BI, et al. The Achilles tendon Total
Rupture Score (ATRS): development and validation. Am J Sports Med 2007;35(3):421-6.
https://doi.org/10.1177/0363546506294856
8. Amlang MH, Christiani P, Heinz P, Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden
instrument. Oper Orthop Traumatol 2006;18:287-99. https://doi.org/10.1007/s00064-006-1178-y
9. Joannas G, Arrondo G, Eslava S, Casola L, Drago J, Barousse R, et al. Percutaneous Achilles tendon repair with
the Dresden instrument. Clinical and MRI evaluation of 90 patients. Foot Ankle Surg 2020;26(2):209-17.
https://doi.org/10.1016/j.fas.2019.02.005
10. Arzac Ulla I, De Silvestri A, Fiorentini G. Roturas agudas del tendón de Aquiles tratadas con técnica mínimamente invasiva de Dresden. Rev Asoc Argent Ortop Traumatol 2016;82(1):48-53. https://doi.org/10.15417/539
11. De la Fuente C, Peña y Lillo M, Carreño G, Marambio H. Prospective randomized clinical trial of aggressive
rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique. Foot (Edinb) 2016;26:15-22.
https://doi.org/10.1016/j.foot.2015.10.003
12. Lee SJ, Sileo MJ, Kremenic IJ, Orishimo K, Ben-Avi S, Nicholas SJ, et al. Cyclic loading of 3 Achilles tendon
repairs simulating early postoperative forces. Am J Sports Med 2009;37(4):786-90. https://doi.org/10.1177/0363546508328595
13. Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MB, et al. A biomechanical
comparison of an open repair and 3 minimally invasive percutaneous Achilles tendon repair techniques during a
simulated, progressive rehabilitation protocol. Am J Sports Med 2015;43:1957-64.
https://doi.org/10.1177/0363546515587082
14. Demetracopoulos CA, Gilbert SL, Young E, Baxter JR, Deland JT. Limited-open Achilles tendon repair using
locking sutures versus nonlocking sutures: an in vitro model. Foot Ankle Int 2014;35(6):612-8.
https://doi.org/10.1177/1071100714524550
15. Byrne PA, Hopper GP, Wilson WT, Mackay GM. Knotless repair of Achilles tendon rupture in an elite athlete:
return to competition in 18 weeks. J Foot Ankle Surg 2017;56(1):121-4. https://doi.org/10.1053/j.jfas.2016.07.007
16. McWilliam JR, Mackay G. The internal brace for midsubstance Achilles ruptures. Foot Ankle Int 2016;37(7):794-
800. https://doi.org/10.1177/1071100716653373