Channel-assisted minimally invasive repair of acute Achilles tendon rupture.
BACKGROUND
Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques.


METHODS
Eighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing.


RESULTS
There was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred.


CONCLUSIONS
CAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.
The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
Hua
H
Chen
The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
Xinran
X
Ji
The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
Qun
Q
Zhang
The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
Xiangdang
X
Liang
The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China. tangpf301@163.com.
Peifu
P
Tang
D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000534:rehabilitation; D011182:Postoperative Care / Q000379:methods; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques / Q000295:instrumentation; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*