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Re-ruptures and early outcomes after surgical repair of acute Achilles tendon ruptures: prospective, comparative multicenter study

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Abstract

Purpose

The primary objective of this study was to compare the re-rupture rate, clinical results, and functional outcomes six months after the surgical repair of an acute Achilles tendon rupture between three different techniques (open repair, percutaneous repair with the Tenolig®, and minimally invasive repair).

Methods

A prospective, comparative, multicenter, non-randomized study was performed and included 111 patients who had an acute ruptured Achilles tendon: 74 underwent an open repair, 22 underwent a percutaneous repair using the Tenolig® and 15 had a minimally invasive repair. At six months follow-up we analyzed the number of re-ruptures, phlebitis, infections, complex regional pain syndrome, clinical outcomes (muscle atrophy, ankle dorsal flexion), functional scores (ATRS, VISA-A, EFAS, SF-12), and return to running.

Results

There were more re-ruptures (p=0.0001) after repair with the Tenolig® (27%) than with open repairs (1.3%) and minimally invasive repairs (0%). The rate of other complications was not different. No clinical differences were found between the three groups. Only some functional scores EFAS Total (p=0.006), and VISA-A (p=0.015) were worse in the Tenolig® group. All the other results were similar between the three groups.

Conclusion

Despite heterogeneous studies in literature, the results of this comparative and prospective study between three surgical techniques of Achilles tendon repair confirmed that Tenolig® repair increased the rate of early re-rupture compared to open or minimally invasive techniques.

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References

  1. Chan JJ, Chen KK, Sarker S et al (2020) Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States. Int Orthop 44:585–594. https://doi.org/10.1007/s00264-019-04471-2

    Article  PubMed  Google Scholar 

  2. Besch S, Rolland E, Khiami F (2008) Rupture récente et ancienne du tendon calcanéen de l’adulte. J Traum Sport 25(109-1):117. https://doi.org/10.1016/j.jts.2008.03.010

    Article  Google Scholar 

  3. Ochen Y, Beks RB, van Heijl M et al (2019) Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ 7:364–376. https://doi.org/10.1136/bmj.k5120

    Article  Google Scholar 

  4. Deng S, Sun Z, Zhang C et al (2017) Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg 56:1236–1243. https://doi.org/10.1053/j.jfas.2017.05.036

    Article  PubMed  Google Scholar 

  5. Metz R, Verleisdonk EJ, Van der Heijden GJ et al (2008) Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weight-bearing – a randomized controlled trial. Am J Sports Med 36:1688–1694. https://doi.org/10.1177/0363546508319312

    Article  PubMed  Google Scholar 

  6. Cetti R, Christensen SE, Ejsted R et al (1993) Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 21:791–799. https://doi.org/10.1177/036354659302100606

    Article  CAS  PubMed  Google Scholar 

  7. Ma G, Griffith T (1977) Percutaneous repair of acute closed ruptures Achilles tendon: a new technique. Clin Orthop Relat Res 128:247–255

    Google Scholar 

  8. Kakiuchi M (1995) A combined open and percutaneous technique for repair of tendo Achillis. Comparison with open repair. J Bone Joint Surg Br 77:60–63

    Article  CAS  PubMed  Google Scholar 

  9. Assal M, Jung M, Stern R et al (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 84:161–170

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Yang B, Liu Y, Kan S et al (2017) Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg (London, England) 40:178–186. https://doi.org/10.1016/j.ijsu.2017.03.021

    Article  Google Scholar 

  12. Idarraga AJ, Bohl DD, Barnard E et al (2020) Adverse Events Following Minimally Invasive Achilles Tendon Repair. Foot Ankle Spec 25:1938640020950895. https://doi.org/10.1177/1938640020950895

    Article  Google Scholar 

  13. Hsu AR, Jones CP, Cohen BE et al (2015) Clinical outcomes and complications of percutaneus achille repair system versus open technique for acute Achilles tendon ruptures. Foot Ankle Int 36:1279–1286. https://doi.org/10.1177/1071100715589632

    Article  PubMed  Google Scholar 

  14. Delponte P, Potier L, De Poulpiquet P, Buisson P (1992) Treatment of subcutaneous ruptures of the Achilles tendon by percutaneous tenorraphy. Rev Chir Orthop 78:404–407

    CAS  PubMed  Google Scholar 

  15. Boukhris J, Boussouga M, Benchakroune M et al (2010) Ténorraphie percutanée pour rupture fraîche sous cutanée du tendon calcanéen. A propos de 28 cas. J Traum Sport 27:103–106. https://doi.org/10.1016/j.jts.2010.07.002

    Article  Google Scholar 

  16. Jallageas R, Bordes J, Daviet JC et al (2013) Evaluation du traitement chirurgical de la rupture du tendon calcanéen sur une série de 31 athlètes. Rev Chir Orthop 99:482–489. https://doi.org/10.1016/j.rcot.2013.03.052

    Article  Google Scholar 

  17. Maes R, Copin G, Averous C (2006) Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 72:179–183

    PubMed  Google Scholar 

  18. Laboute E, Garrigou P, Ucay O, Verhaeghe E (2021) Récidive et reprise du sport après chirurgie pour rupture du tendon calcanéen : suture simple versus Tenolig. J Traum Sport 38:9–15. https://doi.org/10.1016/j.jts.2020.10.006

    Article  Google Scholar 

  19. Carmont MR, Maffulli N (2008) Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc 16:199–203. https://doi.org/10.1007/s00167-007-0411-z

    Article  PubMed  Google Scholar 

  20. Nilsson-Helander K, Thomeé R, Silbernagel KG et al (2007) The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 35:421–426. https://doi.org/10.1177/0363546506294856

    Article  PubMed  Google Scholar 

  21. Robinson JM, Cook JL, Purdam C et al (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341. https://doi.org/10.1136/bjsm.35.5.335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Richter M, Agren PH, Besse JL et al (2018) EFAS Score - Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS). Foot Ankle Surg 24:185–204. https://doi.org/10.1016/j.fas.2018.05.004

    Article  PubMed  Google Scholar 

  23. Gandek B, Ware JE, Aaronson NK et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1171–1178. https://doi.org/10.1016/s0895-4356(98)00109-7

    Article  CAS  PubMed  Google Scholar 

  24. Taglialavoro G, Biz C, Mastrangelo G, Aldegheri R (2011) The repair of the Achilles tendon rupture: comparison of two percutaneous techniques strategies. Trauma Limb Reconstr 6:147–154. https://doi.org/10.1007/s11751-011-0124-1

    Article  CAS  Google Scholar 

  25. Charissoux JL, Vernois J, Brulefert K et al (2013) Le traitement des ruptures du tendon d’Achille. Rev Chir Orthop 99:S134–S142. https://doi.org/10.1016/j.rcot.2013.03.019

    Article  Google Scholar 

  26. Maempel JF, White TO, Mackenzie SP et al (2022) The epidemiology of Achilles tendon re-rupture and associated risk factors: male gender, younger age and traditional immobilizing rehabilitation are risk factors. Knee Surg Sports Traumatol Arthrosc 30:2457–2469. https://doi.org/10.1007/s00167-021-06824-0

    Article  CAS  PubMed  Google Scholar 

  27. Aufwerber S, Edman G, Grävare Silbernagel K, Ackermann PW (2020) Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization. Am J Sports Med 48:3296–3305. https://doi.org/10.1177/0363546520956677

    Article  PubMed  Google Scholar 

  28. Naskar R, Oliver L, Velazquez-Ruta P et al (2022) Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis. Foot Ankle Surg 28:595–602. https://doi.org/10.1016/j.fas.2021.06.008

    Article  CAS  PubMed  Google Scholar 

  29. Diniz P, Pacheco J, Guerra-Pinto F et al (2020) Achilles tendon elongation after acute rupture: is it a problem? A systematic review. Knee Surg Sports Traumatol Arthrosc 28:4011–4030. https://doi.org/10.1007/s00167-020-06010-8

    Article  PubMed  Google Scholar 

  30. Soubeyrand M, Serra-Tosio G, Campagna R et al (2010) Intra-operative ultrasonography during percutaneous Achilles tendon repair. Foot Ankle Int 31:1069–1074. https://doi.org/10.3113/FAI.2010.1069

    Article  PubMed  Google Scholar 

  31. Lacoste S, Feron JM, Cherrier B (2014) Réparation percutanée par Tenolig sous contrôle échographique peropératoire dans les ruptures aiguës du tendon d’Achille. Rev Chir Orthop 100:672–677. https://doi.org/10.1016/j.rcot.2014.09.406

    Article  Google Scholar 

  32. Attia AK, Mahmoud K, d'Hooghe P et al (2023) Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med 51:825–836. https://doi.org/10.1177/03635465211053619

    Article  PubMed  Google Scholar 

  33. Khan RJ, Fick D, Keogh A et al (2005) Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87:2202–2210. https://doi.org/10.2106/JBJS.D.03049

    Article  PubMed  Google Scholar 

  34. Tasatan E, Emre TY, Demircioglu DT et al (2016) Long-term results of mini-open repair technique in the treatment of acute Achilles tendon rupture:a prospective study. Foot Ankle Surg 55:971–975. https://doi.org/10.1053/j.jfas.2016.04.016

    Article  Google Scholar 

  35. Kołodziej L, Bohatyrewicz A, Kromuszczyńska J et al (2013) Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study--preliminary report. Int Orthop 37:625–629. https://doi.org/10.1007/s00264-012-1737-9

    Article  PubMed  Google Scholar 

  36. Knobe M, Gradl G, Klos K et al (2015) Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture? Int Orthop 39:535–542. https://doi.org/10.1007/s00264-014-2615-4

    Article  PubMed  Google Scholar 

  37. Karabinas PK, Benetos IS, Lampropoulou-Adamidou K et al (2014) Percutaneous versus open repair of acute Achilles tendon ruptures. Eur J Orthop Surg Traumatol 24:607–613. https://doi.org/10.1007/s00590-013-1350-7

    Article  PubMed  Google Scholar 

  38. Lim CS, Lees D, Lees D, Gwynne-Jones DP (2017) Functional Outcome of Acute Achilles Tendon Rupture With and Without Operative Treatment Using Identical Functional Bracing Protocol. Foot Ankle Int 38:1331–1336. https://doi.org/10.1177/1071100717728687

    Article  PubMed  Google Scholar 

  39. Bergkvist D, Åström I, Josefsson P-O, Dahlberg LE (2012) Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients. J Bone Joint Surg Am 94:1229–1233. https://doi.org/10.2106/JBJS.J.01601

    Article  PubMed  Google Scholar 

  40. Trofa DP, Miller JC, Jang ES et al (2017) Professional athletes return to play and performance after operative repair of an Achilles tendon rupture. Am J Sports Med 45:2864–2871. https://doi.org/10.1177/0363546517713001

    Article  PubMed  Google Scholar 

  41. Arshad Z, Lau EJS, Leow SH, Bhatia M (2021) Management of chronic Achilles ruptures: a scoping review. Int Orthop 45:2543–2559. https://doi.org/10.1007/s00264-021-05102-5

    Article  PubMed  Google Scholar 

  42. Prejbeanu R, Vermesan D, Balanescu A et al (2021) Repair of acute Achilles tears with plantaris augmentation. Int Orthop 45:2285–2290. https://doi.org/10.1007/s00264-021-05169-0

    Article  PubMed  Google Scholar 

  43. Maffulli N, Oliva F, Del Buono A, Florio A, Maffulli G (2015) Surgical management of Achilles tendon re-ruptures: a prospective cohort study. Int Orthop 39:707–714. https://doi.org/10.1007/s00264-015-2686-x

    Article  PubMed  Google Scholar 

  44. Fischer S, Kutscher R, Gramlich Y et al (2021) Secondary reconstruction of chronic Achilles tendon rupture: flexor hallucis longus transfer versus plantaris longus augmentation. Int Orthop 45:2323–2330. https://doi.org/10.1007/s00264-021-05128-9

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank all the research sites that participated in the study and the various learned societies that made this work possible: French Society of Sports Traumatology (SFTS), French Society of Orthopedic and Traumatological Surgery (SOFCOT), French Association of Foot Surgery (AFCP), Traumatology Study Group (GETRAUM). We are grateful to C. Charpail, A. Kaba, D. Mainard, C. Maynou, C. Verdeau, A. Ghorbani for their participation and to Joanne Archambault, PhD for English language assistance.

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Authors and Affiliations

  1. Directeur scientifique Société Française de Traumatologie du Sport (SFTS), C.E.R.S. Groupe Ramsay Santé, 83 av Maréchal de Lattre de Tassigny, 40130, Capbreton, France

    E. Laboute

  2. Hôpital Hôtel Dieu-APHP, Université Sorbonne Paris Nord, 1 place du Parvis Notre –Dame, 75004, Paris, France

    P. Thoreux

  3. Institut de la Cheville et du Pied, Clinique Blomet, 136 rue Blomet, 75015, Paris, France

    J. Beldame

  4. Service de Chirurgie Orthopédique et Traumatologie, Hôpital d’Instruction des Armées Sainte-Anne, 2, Bd Sainte Anne, 83800, Toulon, France

    A. Caubere

  5. Clinique du Parc Lyon, 155 Boulevard de Stalingrad, 69006, Lyon, France

    J.C. Giunta

  6. GHICL Hôpital Saint Vincent, 51 Boulevard de Belfort, 59462, Lille, France

    R. Coursier

  7. CHU Lille, Service d’Orthopedie–Traumatologie, F-59000, Lille, France

    M. Saab

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  1. E. Laboute
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by E. Laboute, P. Thoreux, J. Beldame, and M. Saab. The first draft of the manuscript was written by E. Laboute and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to E. Laboute.

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Authors disclose any financial and non-financial competing interests.

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Ethics approval

This study was approved by our regional ethics committee (CPP Paris Ile de France 1; N-2019-AO2365-52). Informed consent was obtained from all individual participants included in this study.

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Laboute, E., Thoreux, P., Beldame, J. et al. Re-ruptures and early outcomes after surgical repair of acute Achilles tendon ruptures: prospective, comparative multicenter study. International Orthopaedics (SICOT) 47, 1855–1861 (2023). https://doi.org/10.1007/s00264-023-05827-5

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