A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol

Clanton, Thomas O.; Haytmanek, C. Thomas; Williams, Brady T.; Civitarese, David; Turnbull, Travis Lee; Massey, Matthew B; Wijdicks, Coen A.; LaPrade, Robert F.

doi:10.1177/0363546515587082

Cited by 113 publications

(153 citation statements)

References 36 publications

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“…In a study by Hsu et al comparing percutaneous and open surgery techniques, complications were determined at the rate of 8.5% in all the patients who received surgery and no statistically significant difference was determined between the groups in respect of complication rates [10]. In a biomechanical evaluation of percutaneous and open surgical repair techniques, similar results were reported and it was suggested that there was a tendency for a longer postoperative rehabilitation period for clinical recovery in the percutaneous techniques compared to the open surgery techniques [11]. There are studies which have reported that there is a greater rate of sural nerve damage in the open surgical repair techniques [12].…”

Section: Discussionmentioning

confidence: 99%

A novel suture technique in the percutaneous repair of Achilles tendon rupture (TANSEL TECHNIQUE)

Mutlu¹

2020

Ann Clin Anal Med

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Aim: The aim of this study was to present the clinical results of patients treated with a sliding, wrapping suture technique (Tansel technique) which provides rapid recovery with fewer wound site problems compared to open surgery techniques. Material and Method: A total of 34 patients were included in the study. Following the initial diagnosis made on physical examination, routine dynamic ultrasonography (USG) was applied for the determination of the rupture gap and tendon length. All the patients were evaluated in respect of the time from trauma to surgery, etiological causes, affected side, postoperative AOFAS (The American Orthopaedic Foot & Ankle Score) and Tegner scores, cruris diameter, mean time to full weight-bearing, time of return to work, time to regain pretrauma activity level and complications. Results: The mean follow-up period was 27.7±16.8 months. According to clinical evaluations of the patients at the final follow-up examination, postoperative dorsiflexion angle and plantar flexion angle were determined as 16.3°±4.3°, 39.7°±7.1° respectively. While postoperative Tegner score was determined as 87.6±9, AOFAS score was found as 91.3±4.7. Postoperatively at sixth months, in the measurements of the cruris area diameter, 1.5±0.4 cm atrophy was detected. Of the defined major complications, tendon elongation was seen on USG in 1 (2.9%) patient. No re-rupture occurred in any patient. Discussion: Treatment of acute Achilles tendon ruptures with Tansel technique provides successful results such as resolving the problems of re-rupture and tendon elongation particularly in the postoperative tendon malacia stage. So, this technique was considered as an effective technique which could be used to resolve the disadvantages of minimally invasive percutaneous repair.

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Section: Discussionmentioning

confidence: 99%

A novel suture technique in the percutaneous repair of Achilles tendon rupture (TANSEL TECHNIQUE)

Mutlu¹

2020

Ann Clin Anal Med

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“…4,22 Prior studies have used initial linear stiffness as a surrogate measure of gapping. 10 The initial linear stiffness (N/mm) estimates the force (N) required to create a gap of 1 mm.…”

Section: Discussionmentioning

confidence: 99%

“…4 Repair strength was quantified in terms of number of cycles to failure. Significantly less early elongation was seen for open repair compared to the 3 limited open techniques, but no difference in cycles to failure was seen.…”

Section: Discussionmentioning

confidence: 99%

“…Although the PARS jig has shown greater suture placement accuracy than other limited open techniques, the concern for superficial suture placement remains. 4 With this in mind, our methodology must be taken into consideration when comparing our findings with other studies. A second limitation of our study is that biomechanical testing is a time zero representation of Achilles tendon rupture repair.…”

Section: Discussionmentioning

confidence: 99%

“…10,15 A previous study demonstrated comparable strength among 3 percutaneous repair constructs, including PARS, subjected to a cyclic loading protocol intended to simulate aggressive rehabilitation. 4 In this study, we biomechanically compared an open, 2-strand Krackow repair with epitendinous weave to the limited open PARS Achilles Jig System for simulated midsubstance tears in human cadaver Achilles tendons. 12,33 Our primary objective was to compare the ultimate strength, measured by load to failure, between techniques.…”

Section: Introductionmentioning

confidence: 99%

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A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture

Dekker

Qin

Lawton

et al. 2017

Foot & Ankle Orthopaedics

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Methods: A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results: The average load to failure (353.8 + 88.8 N vs 313.3 + 99.9 N; P ¼ .38) and work to failure (6.4 + 2.3 J vs 6.3 + 3.5 J; P ¼ .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 + 5.4 N/mm) was significantly greater than PARS repair (11.8 + 2.5 N/mm) (P ¼ .011). Conclusion: No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications.

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Progression of partial to complete ruptures of the Achilles tendon during rehabilitation: A study using a finite element model

Diniz,

Quental,

Pereira

et al. 2024

Journal Orthopaedic Research

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Substantial research on complete Achilles tendon ruptures is available, but guidance on partial ruptures is comparatively sparse. Conservative management is considered acceptable in partial tendon ruptures affecting less than 50% of the tendon's width, but supporting experimental evidence is currently lacking. Using a previously validated finite element model of the Achilles tendon, this study aimed to assess whether loading conditions simulating an early functional rehabilitation protocol could elicit progression to a complete rupture in partial ruptures of varying severity. In silico tendon rupture simulations were performed to locate the most likely rupture site for least, moderate, and extreme subtendon twist configurations. These three models were split at the corresponding rupture site and two sets of partial ruptures were created for each, starting from the medial and lateral sides, and ranging from 10% to 50% loss of continuity. Simulations were conducted with material parameters from healthy and tendinopathic tendons. Partial ruptures were considered to progress if the volume of elements showing a maximum principal strain above 10% exceeded 3 mm3. To assess whether the tendinopathic tendons typical geometric characteristics could compensate for the inferior material properties found in tendinopathy, an additional model with increased cross‐sectional area in the free tendon region was developed. Progression to complete ruptures occurred even with less than a 50% loss of continuity, regardless of subtendon twisting, and material parameters. The tendinopathic tendon model with increased cross‐sectional area showed similar results. These findings suggest the current criteria for surgical treatment of partial ruptures should be reconsidered. Statement of clinical significance: The clinical significance and most appropriate treatment of partial ruptures of the Achilles tendon is unclear. Despite the widespread use of the “50% rule” in treatment decisions of partial tendon ruptures, experimental evidence supporting it is missing. The present study provides new data, from a validated aponeurotic and free Achilles tendon finite element model, showing that partial ruptures may progress to complete ruptures under loading conditions elicited from functional rehabilitation protocols, even for partial ruptures affecting less than 50% of the tendon's width. Under these novel findings, the current criteria for surgical treatment of partial ruptures should be reconsidered.

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A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol

Cited by 113 publications

References 36 publications

A novel suture technique in the percutaneous repair of Achilles tendon rupture (TANSEL TECHNIQUE)

A novel suture technique in the percutaneous repair of Achilles tendon rupture (TANSEL TECHNIQUE)

A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture

Progression of partial to complete ruptures of the Achilles tendon during rehabilitation: A study using a finite element model

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