Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques: a systematic review and network meta-analysis of human cadaveric studies

Diniz, Pedro; Pacheco, Jácome; Fernandes, Ricardo M; Pereira, Hélder; Ferreira, Frederico Castelo; Kerkhoffs, Gino M. M. J.

doi:10.1007/s00167-021-06613-9

Cited by 4 publications

(3 citation statements)

References 83 publications

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“…Current treatment recommendations emphasize functional rehabilitation protocols, regardless of conservative or operative treatment in complete ATRs. 28 As previously stated, there is a paucity of official guidelines for partial ruptures. Considering the findings of this study, physicians advocating surgical treatments of complete ATRs may consider applying the same rationale in partial ruptures, given the likelihood of tear progression with ruptures smaller than 50% of the AT mediolateral width.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Current treatment recommendations emphasize functional rehabilitation protocols, regardless of conservative or operative treatment in complete ATRs 28 . As previously stated, there is a paucity of official guidelines for partial ruptures.…”

Section: Discussionmentioning

confidence: 99%

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

Self Cite

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show abstract

“…and has shown least risk of elongation with cyclic loading compared with other techniques in a recent meta-analysis of biomechanical studies. 11…”

Section: Open Repairmentioning

confidence: 99%

Outcomes Following Repair of Achilles Midsubstance Tears: Percutaneous Knotless Repair vs Open Repair

et al. 2023

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Background: Optimum treatment for acute Achilles tendon rupture results in high mechanical strength, low risk of complications, and return to preinjury activity level. Percutaneous knotless repair is a minimally invasive technique with promising results in biomechanical studies, but few comparison clinical studies exist. Our study purpose was to compare functional outcomes and revision rates following acute Achilles tendon rupture treated between percutaneous knotless repair and open repair techniques. Methods: Patients 18 years or older with an acute Achilles tendon rupture, treated by a single surgeon with either open repair or percutaneous knotless repair, and more than 2 years after surgery were assessed for eligibility. Prospective clinical data were obtained from the data registry and standard electronic medical record. Additionally, the patients were contacted to obtain current follow-up questionnaires. Primary outcome measure was Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL). Secondary outcome measures were FAAM sports, 12-Item Short Form Health Survey (SF-12), Tegner activity scale, patient satisfaction with outcome, complications, and revisions. Postoperative follow-up closest to 5 years was used in this study. Results: In total, 61 patients were included in the study. Twenty-four of 29 patients (83%) in the open repair group and 28 of 32 patients (88%) in the percutaneous knotless repair group completed the questionnaires with average follow-up of 5.8 years and 4.2 years, respectively. We found no significant differences in patient-reported outcomes or patient satisfaction between groups (FAAM ADL: 99 vs 99 points, P = .99). Operative time was slightly longer in the percutaneous knotless repair group (46 vs 52 minutes, P = .02). Two patients in the open group required revision surgery compared to no patients in the percutaneous group. Conclusion: In our study, we did not find significant differences in patient-reported outcomes or patient satisfaction by treating Achilles tendon midsubstance ruptures with percutaneous knotless vs open repair. Level of Evidence: Level IlI, retrospective cohort study.

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Achilles Rupture Repair: Modified Gift-Box With a Proximal Myotendinous Backup Fixation Technique

Cominos,

Tramer,

Peace

et al. 2024

Arthroscopy Techniques

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Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques: a systematic review and network meta-analysis of human cadaveric studies

Cited by 4 publications

References 83 publications

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

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

Outcomes Following Repair of Achilles Midsubstance Tears: Percutaneous Knotless Repair vs Open Repair

Achilles Rupture Repair: Modified Gift-Box With a Proximal Myotendinous Backup Fixation Technique

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