Different Sutures in the Surgical Treatment of Acute Closed Achilles Tendon Rupture

Background: Acute Achilles tendon rupture (ATR) has increased in the past decade, and many new treatments and rehabilitation regimens have been introduced. But major complications in ATR management remain an unsolved problem. Purpose: To compare the risk of major complications of acute ATR after different combinations of treatments and rehabilitation regimens. Study Design: Systematic review and network meta-analysis. Method: The authors searched 4 databases (PubMed, Medline, Embase, and the Cochrane Library) from the date of inception until February 2018 for articles in English. The authors considered randomized controlled trials comparing interventions and rehabilitation protocols for acute ATR and restricted (1) interventions to nonoperative treatment, minimally invasive surgery, and open surgery and (2) rehabilitation protocols to accelerated rehabilitation and early immobilization. Major complications were assessed—namely, rerupture, deep infection, and deep vein thrombosis (DVT). Only patients with primary acute ATR were considered. Quality assessment was performed with the Cochrane “risk of bias” tool. A series of additional tests were conducted to ensure the validity of the results. Results: Twenty-nine randomized controlled trials with 2060 patients were included in this Bayesian network meta-analysis. The mean incidence of overall major complications from all managements was 9.13% (median, 6.67%). The mean incidence rates of rerupture, deep infection, and DVT from all managements were 5%, 1.50%, and 2.67%, respectively. According to relative risk, nonoperative treatment combined with early immobilization was significantly associated with a higher risk of major complications. According to the surface under the cumulative ranking curve, minimally invasive surgery with accelerated rehabilitation had the highest possibility (79.7%) of being the best management with regard to minimizing major complications. Conclusion: For treating acute ATR, management combining minimally invasive surgery with accelerated rehabilitation had the highest possibility of being superior in terms of major complication risks, according to the surface under the cumulative ranking curve. Management combining nonoperative treatment with early immobilization was statistically associated with a higher risk of complications as compared with the other methods of management.

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“…Mechanistic research would also contribute to our understanding of Achilles tendon healing. 15,18,21,53…”

Section: Discussionmentioning

confidence: 99%

Complications in the Management of Acute Achilles Tendon Rupture: A Systematic Review and Network Meta-analysis of 2060 Patients

Yuan

Liang

et al. 2019

Am J Sports Med

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“…However, based on the AOFAS score and pain score, the Ethibond suture performed better. 19 For six-strand repair, we used total three sutures with three knots (i.e. the most proximal suture will pass through both the most proximal and the most distal hole as well to create only one knot in a pair) instead of six sutures with six knots (i.e.…”

Section: Authors' Suggestion With This Devicementioning

confidence: 99%

Twelve-years’ experience in minimal invasive Achilles tendon repair using a suture-guiding device

Yeung

Man

2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Introduction: Minimal invasive Achilles tendon repair is becoming more and more popular recently. We have evaluated our results in Achilles tendon repair using minimally invasive method by a suture-guiding device. Methods: This is a retrospective review of patients with acute Achilles tendon rupture, which was repaired using minimally invasive method namely the suture-guiding device, that was performed during 2003 to 2015 in our department. Outcome parameters were the incidence of re-rupture, other complications, and the functional outcome. Results: There were 36 men (90%) and 4 women (10%) in this study. Mechanisms of injury were basketball (28%), football (15%), squash (15%), and trauma (13%). The mean operating time was 59 min (range 30–90 min). The mean follow-up time was 8 months (range 3–35 months). The mean duration with casting was 7 weeks. The mean range of movement at 3 months was 8° dorsiflexion and 33° plantar flexion. There was no major complication necessitating surgical re-interventions such as re-ruptures and infections. No patient suffered from dysfunction of the sural nerve or delay wound healing. Conclusion: Minimally invasive Achilles tendon repair using suture-guiding device is a safe and quick procedure with a low rate of re-rupture and a satisfactory short-term and long-term recovery. Level of evidence: IV.

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“…Rates of foreign body reaction in the included studies showed no heterogeneity ( P = .62; I 2 = 0%); that being the case, fixed effects model was used. Events assessed in Ji et al 6 were adhesion rates resulting from inflammation and the coagulation process. Results showed that patients in the nonabsorbable sutures group had no significantly different foreign body reaction than patients in the absorbable suture group (risk difference −0.02, 95% CI −0.11 to 0.07; P = .69) ( Figure 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool 6 for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) 10 for nonrandomized study by 2 authors (I.O., A.F.C.) independently and disagreement were resolved by discussion.…”

Section: Methodsmentioning

confidence: 99%

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis

Oesman,

Canintika

2023

Foot & Ankle Orthopaedics

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Background: Nonabsorbable sutures are still the main choice for acute Achilles tendon rupture (AATR) repair due to strength provided. However, the rerupture rates, infection risks, foreign body reaction, and postsurgical recovery differences between absorbable and nonabsorbable suture materials in AATR repair have not been carefully reviewed. Methods: A systematic review was done on PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Embase to find research studies in relation to complications associated with AATR repair using the PRISMA guidelines. The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) for nonrandomized study. Results: Five studies with a total of 255 patients, 105 in the absorbable suture group and 150 in the nonabsorbable suture group, were included for analysis. Risk of rerupture, infection, and foreign body reaction shown no significant difference between groups, and the mean difference of recovery scores were similar. Conclusion: Existing literature shows that absorbable sutures appear to be associated with similar outcomes to nonabsorbable sutures regarding rates of rerupture, infection, foreign body reaction, and outcomes grading following surgical repair of acute Achilles tendon repair.

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Different Sutures in the Surgical Treatment of Acute Closed Achilles Tendon Rupture

Cited by 6 publications

References 19 publications

Complications in the Management of Acute Achilles Tendon Rupture: A Systematic Review and Network Meta-analysis of 2060 Patients

Complications in the Management of Acute Achilles Tendon Rupture: A Systematic Review and Network Meta-analysis of 2060 Patients

Twelve-years’ experience in minimal invasive Achilles tendon repair using a suture-guiding device

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis

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