SLR - February 2019 - Melissa Rossi
Reference: Ling, Samuel K.K., Slocum, Amanda., Lui, T.H. Five-Year Results of the 1.5 cm Incision Achilles Tendon Repair. The Foot. 2017 Dec; 33.Scientific Literature Review
Reviewed By: Melissa Rossi, DPM
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: Achilles tendon ruptures are common injuries encountered in a podiatric surgical practice. Surgical repair techniques can be divided into three categories: open, mini-open and percutaneous, each with their advantages and disadvantages. An open approach allows for the best exposure but is known to have increased wound complications postoperatively. Percutaneous techniques have decreased repair strengths and increased sural nerve injuries due to decreased visualization and a blind approach. A mini-open approach serves as a compromise, allowing for enough exposure for a direct repair while at the same time decreasing wound complications. This article investigates a mini-open technique with a medial incisional approach that was economically conscious and would have good functional outcomes after five years.
Methods: A level IV prospective case series, including 20 patients with Achilles tendon ruptures, was performed. Patients were excluded based on mental incapacitation, comorbidities affecting limb function or rehab and on the need for additional procedures. Of the 20 patients, eight were excluded based on this criteria, leaving 12 available for analysis. Achilles tendon injuries were repaired using a 1.5 cm medial incisional approach and a double-row Krackow locking stitch by passing a needle with an eye through the skin. Patients were placed in a plantarflexed cast for three weeks with gradual mobilization and partial weightbearing. Full weightbearing and rehab began at seven weeks postoperatively. The numeric pain scale, AOFAS ankle-hindfoot score and Medical Research Council scale for muscle strength were used as outcome measures, and the minimum follow-up was five years.
Results: Out of 12 patients, there were no reruptures or sural nerve injuries after five years. There was one case of a superficial stitch abscess that was treated and resolved after a course of oral antibiotics. After the five years, the pain score was averaged 0.5/10 (range 0–3), the mean calf power was 4.75/5 (range 4–5), the mean plantarflexion was 38.33 degrees (range 30–40), the mean dorsiflexion was 20.83 (range 10–30) and the mean AOFAS score was 97.42 (range 91–100).
Conclusions: The authors concluded that the 1.5 cm medial incision Achilles tendon repair is an economically sound mini-open technique that provides a biomechanically strong construct while maintaining good cosmetic results with minimal complications and great functional outcomes with gains that last more than years. Limitations of the study include small sample size, poor inclusion/exclusion criteria and the lack of published results throughout the five-year postoperative period. The study additionally looks at a single group of surgeons’ experience with this procedure, with outcomes collected and reported by the same surgeons. A stronger study to future analyze the effects and results of this technique would be a large prospective randomized study comparing open Achilles tendon repairs to mini-open Achilles tendon repairs.