Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

Makulavicius, A.; Oliva, Xavier Martín; Mazarevicius, G.; Klinga, M.; Uvarovas, Valentinas; Porvaneckas, Narūnas; Planella, Mariano Monzo; Mazurek, Tomasz

doi:10.5603/fm.a2015.0067

Cited by 9 publications

(5 citation statements)

References 12 publications

(15 reference statements)

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“…Further distally, the nerve passes approximately 2 cm anterolaterally to the calcaneal insertion. Percutaneous and minimally invasive surgical techniques increase the risk of injury to the sural nerve due to perioperative impaired visualization and subsequent incarceration of the nerve 237 . In rare occasions, injuries to the deep peroneal nerve are caused by the positioning of the patient in the prone position in the operating room or from prolonged pressure produced by the cast, which result in sensory loss between the 1. and 2. toe.…”

Section: Treatment Optionsmentioning

confidence: 99%

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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Aufwerber and co-workers (2021) compared gait patterns between patients allowed to weight-bear immediately in an orthosis with patients deferring weight-bearing in a cast for two weeks followed by four weeks of weight-bearing in an orthosis. They found that immediate weight-bearing did not result in a more symmetrical gait pattern than deferring weight-bearing the first two weeks postoperatively 79 .

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Section: Treatment Optionsmentioning

confidence: 99%

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

et al. 2022

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“…The site of Achilles tendon rupture was marked under preoperative magnetic resonance imaging (MRI) measurement in the MIS group,2 and the plantar exion ankle joint was 30°, and a transverse incision of approximately 3 cm was made at the broken end of the Achilles tendon (following the method introduced by Tian et al [11], Krackow modi ed and made two incisions of approximately 2.5 cm in length at approximately 2 cm from the broken end of the Achilles tendon) and the lateral sural nerve was investigated. Different guides (thread guide for Krackow suture and lumbar puncture needle for Bunnell and Kessler) were used to guide the 0#ETHIBOND (Johnson & Johnson) suture.…”

Section: Surgical Methodsmentioning

confidence: 99%

“…The concept of rapid rehabilitation has become popular in recent years, and the reported tendon repair surgery has become more minimally invasive. Several studies [11,12] have been conducted on the percutaneous repair of ruptured Achilles tendons with simple instruments, and the therapeutic effect is good. However, these reports failed to comprehensively plan the variations in clinical e cacy due to different suture techniques and incision inconsistencies.…”

Section: Introductionmentioning

confidence: 99%

Clinical effect of three suture methods on acute Achilles tendon rupture under two types of incisions

You

Yang

et al. 2023

Preprint

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Background Modified Krackow, Bunnell, and Kessler sutures under different suture incisions can be used to directly suture ruptured Achilles tendons, but different suture techniques have various advantages and disadvantages. This study aimed to discuss the clinical effects of different suture techniques with different incision sizes. Methods This study retrospectively recruited and classified 159 patients with acute Achilles tendon injuries into minimally invasive surgery (MIS) and open surgery (OS) following operation incision size. Patients were subdivided into MIS-Krackow, MIS-Bunnell, MIS-Kessler, OS-Krackow, OS-Bunnell, and OS-Kessler. Age, sex, length of stay, creatine kinase levels (CK) pre- and postoperatively, incision length, operation time, intraoperative bleeding, AOFAS ankle-hindfoot scale, ATRS score, and range of ankle dorsalis and plantar flexion were collected and statistically compared, as well as motion, bilateral calf circumference difference, heel-rise repetition ratio, heel-rise height ratio, blood flow velocity in Achilles tendon, and complications. Results Length of stay, postoperative CK levels, surgical bleeding, and pain medication dosage demonstrated significant differences between the MIS and OS groups (P < 0.001). Operative time demonstrated significant differences between the MB:OKa, MB:OB, MKs:MKa, MKs:OKa, MKs:OB, MKs:OKs, and OKa:Oks groups (P < 0.05). Incision length demonstrated significant differences between the MB:MKa and MIS:OS groups (P < 0.05). The mean systolic blood flow velocity of the MB:MKa, MB:OKa, MB:OB, MKs:OKa, MKa:OB, MKa:OKs, OKa:OB, and OKa:OKs groups were different at 1 week postoperatively (P < 0.05). MB:MKs, MB:MKa, MB:OKa, MKs:OB, MKa:OKs, OKa:OB, and OKa:OKs groups demonstrated significant differences at 8 weeks postoperatively (P < 0.05). The dorsiflexion range of motion of MIS:OS was significantly different at 6 weeks postoperatively (P < 0.05). AOFAS demonstrated significant differences between the MIS and OS groups, except for the MKs:OKa and MKs:OB groups (P < 0.05). Only the AOFAS of the MB:OKs, MB:OB, MKa:OB, and MKa:OKs groups were significantly different at 24 postoperatively (P < 0.05). All indexes demonstrated no difference at 48 postoperatively (P > 0.05). Complications included Achilles tendon adhesion in 7 cases (1, 3, 1, and 2 cases in the OKa, OKs, OB, and MKs groups, respectively). Nerve injury occurred in two cases (MKa and MB groups, respectively). Incision infection occurred in 6 patients (3, 2, and 1 in the OKa, OB, and OKs groups, respectively). Achilles tendon re-rupture occurred in 7 cases (5 in the MKs group and 2 in the OKs group). The excellent and good rates of MKa, MB, MKs, Oka, OB, and OKs were 92.0%, 100%, 87.0%, 96.3%, 100%, and 93.1% as assessed by Arnerlind-holm, with no significant differences between the six groups. Conclusions Both OS and MIS are safe and effective in treating Achilles tendon rupture. Among them, MIS caused less secondary trauma and better ankle ROM and AOFAS scores in the previous period, but this difference was not significant at 24 and 48 weeks of follow-up. Krackow’s operation time was longer and the intensity was higher compared with the three suture methods of the two surgical methods, but the local blood flow rate of the Achilles tendon was significantly worse than Bunnell and Kessler. Additionally, Kessler was easier to operate and had better blood transport than Krackow, but the intensity was poor and the probability of complications was higher than the other two groups. Bunnell has better overall performance, less blood flow impact, and fewer complications, and is recommended as the choice of suture method for percutaneous surgery.

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“…Regarding to sural nerve injury, leading to sensational disturbance after treatment, the incidence in surgical treatment (7.8%) was signi cantly higher than conservative treatment. Direct injury in open repair or lack of visualization in minimally invasive operative procedures has been the potential reason causing injury and a modi ed medialization of percutaneous suture was reported with lower incidence of sural nerve injury [50].…”

Section: Exploration Of Complicationsmentioning

confidence: 99%

Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

She

Teng

et al. 2020

Preprint

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Background Achilles tendon is the strongest tendon in human and frequently injured mainly in young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategy widely adopted in ATR patients but the consensus of optimal treatment strategy is still debated. We aimed at fully reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs).Method We comprehensively searched database of PubMed, Embase, Cochrane and ClinicalTrial.gov and retrieved all randomized controlled trials comparing surgical and conservative treatment on achilles tendon rupture for further analysis. Data extraction was performed by two independent reviewer and random effect model was adopted when I2 > 50%, with data presentation of risk ratio, risk difference or mean difference and 95% confidence interval. Results A total of 13 randomized control trials were included in this meta-analysis. Significant difference was observed in events of re-rupture, complication rate, adhesion to underlying tendon, sural nerve injury and superficial infection. For surgical treatment, significant reduction in re-rupture rate could be observed while complication rate was higher compared with conservative treatment. Conclusion Surgical treatment was revealed significance in reduction of re-rupture rate but associated with higher complication rate while conservative treatment showed similar outcomes with lower complication rate. Collectively, we recommend conservative treatment if patients’ status and expectation are suitable, but surgeon as well as physician’s discretion is also important in decision making.

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Comparative anatomical study of standard percutaneous and modified medialised percutaneous Bunnell type repair for artificial Achilles tendon rupture: positive effect of medialisation of the stitches with lower risk of sural nerve injury

Cited by 9 publications

References 12 publications

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Clinical effect of three suture methods on acute Achilles tendon rupture under two types of incisions

Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs

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