Comparison of Semi-Invasive “Internal Splinting” and Open Suturing Techniques in Achilles Tendon Rupture Surgery

Jigless knotless internal brace technique for acute Achilles tendon rupture: a case series study

“…Two other studies [10, 24] described the internal brace concepts in Achilles tendon repair and reported excellent outcomes. To preserve the proximal stump blood supply, these two studies made additional incisions at the gastrocnemius myotendinous junction.…”

“…FWB with crutch was allowed. 3rd week ~: Early active range of motion and strength training.Non-surgical group: 0–2nd week : The same as the surgical group. 3rd–8th weeks: Immobilized in the brace for 8 weeks.Surgical group was significantly superior in the drop counter movement jump and hopping in following 1 year. No significant differences between the groups in symptoms, physical activity level, or quality of life.Six superficial infections in the surgical group.Sarman H et al [24]2016Retrospective analysis.Semi-invasive internal splinting (SIIS group, n = 24) compared with open end to end repair with Krackow sutures (open group, n = 21)Ankle immobilized in 30° plantar flexion with dorsal splint after operation. No further rehabilitation protocol was available in this article.No significant differences between the groups in functional outcome in 1 year following.One sural nerve injury in SIIS group (recovered 6 months later).Two deep wound infection in open surgery; one underwent debridement, and another one required additional soft tissue coverage.Bevoni R et al [8]2014Case seriesLongitudinal open incision; triple-bundle technique ( n = 66) 0–2nd week : non-weight-bearing with walking boot. 3rd week : partial weight bearing with boot locked in neutral position 4th–5th weeks : partial weight bearing with boot unlocked in in 20–30°of plantar flexion. 6th week : partial weight bearing without boot 8th week : full weight bearingThe mean American Orthopaedic Foot and Ankle Society scale score (AOFAS) at 36 months was 93.9 ± 5.9One patient had a significant amount of scar adhesion.McWilliam JR et al [25]2016Case seriesInternal brace (IB) with percutaneous Achilles repair system(PARS; Arthrex Inc., Naples, FL) ( n = 34) 0–1st week: Crutch-aided FWB with walking boot with heel wedge; 1/4 wedge removed every two weeks. 2nd–3rd weeks: FWB with boot only, active dorsiflexion of the ankle is allowed without passive dorsiflexion. 4th–5th weeks: Passive dorsiflexion is allowed to neutral. 6th–7th weeks: Remove boot 8th week: Passive dorsiflexion beyond neutral.The Achilles tendon total rupture score was 94 ± 14 in following range: 24–36 monthsNilYin L et al [10]2017Case seriesPanda rope bridge technique ( n = 11) 0–1st week: Active range of motion without weight-bearing. 2nd–6th weeks : FWB walking without crutches while wearing a 30-mm-height heel, which decreased 5 mm once a week. 7th–8th weeks : muscle strengthening exercises. 9th week : advised to take part in athletic exercises graduallyThe mean AOFAS score at 12 months was 100.NilCurrent study2019Case seriesJigless knotless internal brace technique ( n = 10) 0–1st week : FWB with crutches and wearing shoes with an added heel wedge (3 cm); non-weight-bearing range of motion exercise at least 1 h a day. 2nd week : walking without ambulatory aids was allowed.3rd–5th weeks : reducing the added heel wedge height by 1 cm per week. 5th–6th weeks : heel-raising exercise 7th week : exercise as tolerableThe mean AOFAS score at 12 months was 100.…”

Mini-Open Achilles Repair With a Flat Braided Suture in a Low-Profile Configuration

“…29 However, these and similar techniques require extra incisions, suture passing, and anchors to achieve their repair compared with open techniques. 30,31 The main advantages of a mini-open approach are the reduced risk of both sural nerve injury and wound complications. The rate of sural nerve injury with percutaneous systems has been controversial, with the most recent literature suggesting sural neuritis in up to 10% of patients.…”

Achilles Tendon Injuries: Comparison of Different Conservative and Surgical Treatment and Rehabilitation

“…Sarman et al [82] demonstrated that SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery.…”