Mini-invasive surgical repair of the Achilles tendon—does it reduce post-operative morbidity?

Abstract

The surgical benefit of minimally invasive tendo Achilles repair (n=25) with early weight-bearing mobilisation after rupture of the tendo Achilles was compared with operative treatment using an open technique (n=34) with full weight-bearing after 8 weeks of surgical repair. The minimally invasive technique provided no evidence of wound problems and a functional benefit from early weightbearing mobilisation. However, we noted that increased postoperative morbidity in terms of wound infection (n=7) leading to delayed wound healing and wound pain requiring opiate-based analgesia post-operatively in the open repair group may have an additional impact on the patients and health care providers. This study showed that the mini-invasive open surgical repair of the Achilles tendon with the Achillon™ instrument and early weight-bearing mobilisation in an orthosis for the accelerated rehabilitation may offer cost-effectiveness and less financial burden on the health care provider in terms of associated nursing and physiotherapy costs.Résumé Le bénéfice chirurgical de la réparation du tendon d'Achille par voie mini-invasive (n=25), permettant un appui avec mobilisation précoce est comparé au traitement de la rupture par voie sanglante conventionnelle (n=34) avec un appui différé à 8 semaines après la réparation chirurgicale. Il est important de noter l'augmentation de la morbidité avec infection profonde (n=7), défaut de cicatrisation et douleur nécessitant, notamment des traitements analgésiques à base d'opiacés. Cependant cette technique par voie mini-invasive ne semble pas, à l'évidence, entraîner plus de problèmes mais, au contraire est bénéfique du fait de la mobilisation et de l'appui précoces. Ce travail montre que la réparation par voie mini-invasive du tendon d'Achille avec la technique Achillon™ et un appui précoce en orthèse permettent une récupération rapide et surtout un rapport coût bénéfice intéressant.

Everything Achilles: Knowledge Update and Current Concepts in Management

“…There was no difference in the number of reruptures compared with open repair 70 . Mini-open repair also had significantly fewer severe wound infections and superficial infections than open repair, as well as fewer minor surgical site infections 69 .…”

“…This approach involves small incisions that allow direct visualization of the ruptured tendon ends. Studies have found that patients who underwent mini-open repair returned to walking, stair climbing, and sports in significantly less time compared with those undergoing standard open repair 69,70 . There was no difference in the number of reruptures compared with open repair 70 .…”

Incidence of postoperative wound infections after open tendo Achilles repairs

“…Some studies have advocated a plantigrade or neutral position with restricted dorsiflexion, while others are in favour of keeping the ankle in maximum plantar flexion to reduce the strain on the TA repair site. (34)(35)(36) The American Academy of Orthopaedic Surgeons published its first clinical guidelines on the treatment of TA rupture in 2010. (37) The authors recognised that despite the range of protocols and 'protective devices' available, there was a lack of clinical consensus regarding which devices should be used, the degree of ankle plantar flexion these devices should facilitate and how long these devices should be worn.…”

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

“…In addition, there is disagreement about the degrees of plantar lexion that should be maintained within the orthoses. Some studies have advocated that the ankle should be positioned in neutral (plantar-grade) but with restricted dorsi lexion, while others have used three heel-wedge inserts such that the ankle joint is initially maintained at near full plantar lexion [101]. Finally, it is important to decide when weight-bearing should be permitted (day one or within 2 weeks), how long the orthoses should be worn and whether or not to allow active range of movement exercises throughout the period when the orthosis is worn [29,102,103].…”