Skip to main content
SpringerLink
Log in

Modified mini-incision “internal splinting” versus percutaneous repair technique of acute Achilles tendon rupture: five year retrospective case-controlled study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Several kinds of minimally invasive surgical techniques are applied to acute Achilles tendon rupture. The risks of sural never injury and re-ruptures are still major issues. The purpose of this study was to compare the middle-term results of two different minimally invasive repair techniques for acute Achille tendon rupture.

Methods

Twenty-four cases underwent the modified mini-incision “internal splinting” repair technique in group A, and 29 cases underwent a percutaneous repair technique in group B and were evaluated. The intra-operative data, complications, the time of recovery, and the post-operative magnetic resonance imaging were analyzed. At the final follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Thermann score were evaluated.

Results

The mean follow-up time was 59.96 ± 4.16 months (range 48–67). At the final follow-up, the AOFAS score and Thermann score in both groups had similar feedback. No nerve injury, infection, or re-rupture was encountered in group A, except two cases with anchor irritation. One case with sural nerve injury and one with a re-rupture were recorded in group B, respectively. The final MRI showed thicker regeneration of the tendon in both groups.

Conclusions

The middle-term results indicated the modified mini-incision “internal splinting” technique for acute Achilles tendon rupture is similar to the percutaneous repair technique. A lower risk of sural nerve injury and re-rupture may be advantages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fischer S, Colcuc C, Gramlich Y, Stein T, Abdulazim A, von Welck S, Hoffmann R (2020) Prospective randomized clinical trial of open operative, minimally invasive and conservative treatments of acute Achilles tendon tear. Arch Orthop Trauma Surg 141(5):751–760. https://doi.org/10.1007/s00402-020-03461-z

    Article  PubMed  Google Scholar 

  2. Heikkinen J, Lantto I, Flinkkila T, Ohtonen P, Niinimaki J, Siira P, Laine V, Leppilahti J (2017) Soleus atrophy is common after the nonsurgical treatment of acute Achilles tendon ruptures: a randomized clinical trial comparing surgical and nonsurgical functional treatments. Am J Sports Med 45(6):1395–1404. https://doi.org/10.1177/0363546517694610

    Article  PubMed  Google Scholar 

  3. Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM (2019) Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ 364:k5120. https://doi.org/10.1136/bmj.k5120

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chan JJ, Chen KK, Sarker S, Hasija R, Huang HH, Guzman JZ, Vulcano E (2020) Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States. Int Orthop 44(3):585–594. https://doi.org/10.1007/s00264-019-04471-2

    Article  PubMed  Google Scholar 

  5. Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F (2021) Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study. Arch Orthop Trauma Surg 141(3):383–401. https://doi.org/10.1007/s00402-020-03437-z

    Article  PubMed  Google Scholar 

  6. Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P (2002) Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am 84(2):161–170 (PMID:11861720)

    Article  Google Scholar 

  7. Wei S, Chen J, Kong C, Xu F, Zhi X, Cai X (2021) Endoscopic “internal splinting” repair technique for acute Achilles tendon rupture. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03818-y

  8. Sarman H, Muezzinoglu US, Memisoglu K, Aydin A, Atmaca H, Baran T, Odabas Ozgur B, Ozgur T, Kantar C (2016) Comparison of semi-invasive “internal splinting” and open suturing techniques in Achilles tendon rupture surgery. J Foot Ankle Surg 55(5):965–970. https://doi.org/10.1053/j.jfas.2016.04.014

    Article  PubMed  Google Scholar 

  9. Noback PC, Jang ES, Cuellar DO, Seetharaman M, Malagoli E, Greisberg JK, Vosseller JT (2017) Risk factors for achilles tendon rupture: a matched case control study. Injury 48(10):2342–2347. https://doi.org/10.1016/j.injury.2017.08.050

    Article  PubMed  Google Scholar 

  10. Kupcha PC, Mackenzie WGS (2008) Percutaneous achilles tendon repair using ring forceps. Am J Orthop (Belle Mead NJ) 37(11):586 (PMID: 19104690)

    Google Scholar 

  11. Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB (2015) Clinical outcomes and complications of percutaneous achilles repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int 36(11):1279–1286. https://doi.org/10.1177/1071100715589632

    Article  PubMed  Google Scholar 

  12. Van Maele M, Misselyn D, Metsemakers WJ, Sermon A, Nijs S, Hoekstra H (2018) Is open acute Achilles tendon rupture repair still justified? A single center experience and critical appraisal of the literature. Injury 49(10):1947–1952. https://doi.org/10.1016/j.injury.2018.08.012

    Article  PubMed  Google Scholar 

  13. Meulenkamp B, Woolnough T, Cheng W, Shorr R, Stacey D, Richards M, Gupta A, Fergusson D, Graham ID (2021) What is the best evidence to guide management of acute Achilles tendon ruptures? A systematic review and network meta-analysis of randomized controlled trials. Clin Orthop Relat Res. https://doi.org/10.1097/CORR.0000000000001861

  14. Alcelik I, Saeed ZM, Haughton BA, Shahid R, Alcelik JC, Brogden C, Budgen A (2018) Achillon versus open surgery in acute Achilles tendon repair. Foot Ankle Surg 24(5):427–434. https://doi.org/10.1016/j.fas.2017.04.016

    Article  PubMed  Google Scholar 

  15. Clanton T, Stake IK, Bartush K, Jamieson MD (2020) Minimally invasive Achilles repair techniques. Orthop Clin North Am 51(3):391–402. https://doi.org/10.1016/j.ocl.2020.02.005

    Article  PubMed  Google Scholar 

  16. Joannas G, Arrondo G, Eslava S, Casola L, Drago J, Barousse R, Niño Gomez D, Amlang M, Rammelt S (2020) Percutaneous Achilles tendon repair with the Dresden instrument. Clinical and MRI evaluation of 90 patients. Foot Ankle Surg 26(2):209–217. https://doi.org/10.1016/j.fas.2019.02.005

    Article  PubMed  Google Scholar 

  17. Mavrodontidis A, Lykissas M, Koulouvaris P, Pafilas D, Kontogeorgakos V, Zalavras C (2015) Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthop Traumatol Turc 49(6):661–667

    PubMed  Google Scholar 

  18. Soubeyrand M, Serra-Tosio G, Campagna R, Molina V, Sitbon P, Biau DJ (2010) Intraoperative ultrasonography during percutaneous Achilles tendon repair. Foot Ankle Int 31(12):1069–1074. https://doi.org/10.3113/FAI.2010.1069

    Article  PubMed  Google Scholar 

  19. Severyns M, Andriamananaivo T, Rollet ME, Kajetanek C, Lopes R, Renard G, Noailles T, Odri GA, Rouvillain JL (2019) Acute Achilles tendon rupture: ultrasonography and endoscopy-assisted percutaneous repair. Arthrosc Tech 8(5):e489–e493. https://doi.org/10.1016/j.eats.2019.01.007

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zappia M, Berritto D, Oliva F, Maffulli N (2018) High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg 24(4):342–346. https://doi.org/10.1016/j.fas.2017.03.006

    Article  PubMed  Google Scholar 

  21. Cottom JM, Baker JS, Richardson PE, Maker JM (2017) Evaluation of a new knotless suture anchor repair in acute Achilles tendon ruptures: a biomechanical comparison of three techniques. J Foot Ankle Surg 56(3):423–427. https://doi.org/10.1053/j.jfas.2016.10.012

    Article  PubMed  Google Scholar 

  22. Yang B, Liu Y, Kan S, Zhang D, Xu H, Liu F, Ning G, Feng S (2017) Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis. Int J Surg 40:178–186. https://doi.org/10.1016/j.ijsu.2017.03.021

  23. Martinelli B, Cimarosti V, Valentini R (2002) Stabilometric analysis after percutaneous repair of ruptured Achilles tendon. Foot Ankle Surg 8(4):255–260. https://doi.org/10.1046/j.1460-9584.2002.00334.x

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express gratitude to John Valerius, an English native speaker, for taking the time to revise our paper.

Author information

Author notes

  1. Xiang Jiang, Shenglong Qian, and Cheng Chen contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People’s Republic of China

    Xiang Jiang, Shenglong Qian, Cheng Chen, Xiaosong Zhi, Junhong Lian, Ximing Liu, Shijun Wei & Feng Xu

  2. The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China

    Helin Wu, Ximing Liu, Shijun Wei & Feng Xu

  3. Department of Rehabilitation, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People’s Republic of China

    Dan Xu

Authors
  1. Xiang Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shenglong Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaosong Zhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Junhong Lian
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ximing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shijun Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Feng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Xiang Jiang: Manuscript preparation and literature research.

Shenglong Qian: Data review and literature research.

Cheng Chen: Data collection and follow-up assessment.

Helin Wu: Data collection and follow-up assessment.

Xiaosong Zhi: Data analysis and statistical analysis.

Dan Xu: Data collection and follow-up assessment.

Junhong Lian: Data review and Manuscript review.

Ximing Liu: Manuscript review.

Shijun Wei: Designed study and manuscript revision.

Feng Xu: Manuscript review.

All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Junhong Lian or Shijun Wei.

Ethics declarations

Ethics approval and consent to participate

All participating patients signed a written informative consent form. This research has been approved by the Institutional Review Board (IRB) of the authors’ affiliated institutions.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: Level-III, A retrospective case-controlled study

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 900 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, X., Qian, S., Chen, C. et al. Modified mini-incision “internal splinting” versus percutaneous repair technique of acute Achilles tendon rupture: five year retrospective case-controlled study. International Orthopaedics (SICOT) 45, 3243–3251 (2021). https://doi.org/10.1007/s00264-021-05185-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05185-0

Keywords

Search

Navigation