Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study

Gatz, Matthias; Driessen, Arne; Eschweiler, Jörg; Tingart, Markus; Migliorini, Filippo

doi:10.1007/s00402-020-03437-z

Cited by 52 publications

(58 citation statements)

References 48 publications

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“…AT ruptures lead to functional impairment and reduced muscle strength and endurance, representing a cause of sport retirement and long-term functional impairment. 19,33 Management of these patients should aim to develop strategies increasing functional outcomes and avoiding possible complications. 10,11,13,19,29,37 To our knowledge, this is the first study that compares 2 modes of rehabilitation, both involving early weightbearing and mobilization, but one retaining longer protection in a removable boot.…”

Section: Discussionmentioning

confidence: 99%

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

et al. 2021

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Background: Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after percutaneous surgical repair. Methods: Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. Results: At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. Conclusion: Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study. Level of Evidence: Level II, prospective comparative study.

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Section: Discussionmentioning

confidence: 99%

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

et al. 2021

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“…Minimally invasive and traditional open Achilles repairs remain controversial as to which approach provides greater patient outcome. 9 Gatz et al 10 report that minimally invasive cases exhibited a reduction in operation time and wound complications with a greater rate of sural nerve palsy and postoperative palpable knot when compared with an open procedure. Single-row versus double-row suture anchor constructs also have been under discussion for which may provide greater strength.…”

Section: Discussionmentioning

confidence: 99%

Achilles Tendon Rip-Stop SpeedBridge Repair

Hoffman

Gupta

Amesur

et al. 2021

Arthroscopy Techniques

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Achilles tendon injuries have been on the rise secondary to our increased participation in sports, increase in societal obesity rates, and the growing elderly population. There has been disagreement in recent years about whether to treat injuries such as Achilles tendon ruptures operatively or nonoperatively with aggressive functional rehabilitation. For those opting to surgically manage Achilles tendon ruptures, insertional Achilles tendonitis, or augment the described SpeedBridge Achilles tendon repair, we propose a modified rip-stop technique. The goal of this technique is to provide a biomechanical advantage to our current operative interventions for these injuries, a greater load-to-failure and a speedier, more reliable return to sport in our athletic populations.

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“…When deciding to perform surgical repair after acute AT rupture, there are several surgical techniques: Open repair using variations of end-to-end Kessler suture, augmented repairs, different techniques of mini-open or percutaneous repair, and anatomical reconstruction have been described [18][19][20][21]. The differences, especially in early and midterm functional performance, have not shown significant differences between these techniques, and there is only a paucity of studies comparing different techniques [6,12,18]. Only the rate of major complications like necrosis has been shown to be less in percutaneous repair, while re-rupture rates and sural nerve irritation may be increased [18].…”

Section: Introductionmentioning

confidence: 99%

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

Mauch²,

Heitner³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. Materials and Methods This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. Results At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing. Conclusion In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. Level of evidence III, retrospective cohort study

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Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study

Cited by 52 publications

References 48 publications

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

Achilles Tendon Rip-Stop SpeedBridge Repair

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

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