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Percutaneous repair of Achilles tendon rupture under ultrasound surveillance - new intraoperative visualization approach with two years follow up
ESSKA Academy. Wróbel M. Nov 8, 2019; 284447; epESMA-47 Topic: Sports Related Injuries
Dr. Mikolaj Wróbel
Dr. Mikolaj Wróbel
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Percutaneous repair of Achilles tendon rupture under ultrasound surveillance - new intraoperative visualization approach with two years follow up

ePoster - epESMA-47

Topic: Sports Trauma

Wróbel M., Mioduszewski A., Sroczynski J., Swierczynski R., Kłos G., Mazek J.
Ortopedika, Warsaw, Poland

Background: Open repair of ruptured Achilles tendon is a standard procedure, however complications may occure due to extensive approach, especially in older patients with general conditions. Different systems for minimally invasive procedures were introduced to the market but the risk of damaging sural nerve was pointed out.
Aims: We developed percutaneous repair of Achilles tendon rupture under ultrasound surveillance and assessed safety and results of the procedure, comparing to a matched group of patients who underwent open repair.
Methods: Between May 2011 and September 2018 we performed 23 percutaneous procedures, and 34 open procedures. The tendons were repaired with nonabsorbable suture loop passed through the tendon tissue below and above rupture through the skin with elastic needle under direct ultrasound visualization.
We analyzed results of patients with minimally 2 years follow up (30 open and 18 percutaneous procedures). Few patients from percutaneous group were also burden with diabetes, cardiac diseases, psychiatric disorders and thrombocytopenia, which are confirmed contraindications for open approach. We qualified for treatment only acute ruptures (up to 12 days).
Results: We assessed function of repaired tendon in clinical examination and ultrasound exam 6 weeks and three months after surgery. Also AOFAS score was used. 16 of 18 patients healed tendon without complications. In one case conversion to open surgery was necessary as patient experienced another trauma in postoperative period. In one case deep infection occurred three months after the surgery, requiring open revision and debridement of the tendon. Another patient reported persisting pain due to suture conflict with soft tissues. Release of the suture was necessary six months after surgery. There was no sural nerve entrapment nor any skin healing problems. AOFAS score raised from 57,8 to 92,8 three months after surgery and was comparable to open procedure.
Conclusions: Percutaneous repair of Achilles tendon rupture under ultrasound surveillance is minimally invasive and effective method of treatment of acute ruptures. It is safe and allows to avoid both sural nerve entrapment and skin healing problems. However, it requires some experience with ultrasound diagnostics. The results of tendon healing and patient satisfaction are similar to open surgery, but with lower complication rate.
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