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A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
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Open Achilles Tendon Repair
M Lane Moore1, Jordan R Pollock1, Phillip J Karsen2
1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
JBJS Essential Surgical Techniques
|January 26, 2024
Summary
Open Achilles tendon repair offers faster return to activity for athletes with acute ruptures. While effective, it carries a higher complication risk than nonoperative methods, necessitating careful patient selection for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Rehabilitation
Background:
- Acute Achilles tendon ruptures require careful consideration of treatment options, including open operative repair and functional rehabilitation.
- Open repair is often preferred for high-level athletes and delayed presentations due to faster return to activity.
- This injury typically affects young to middle-aged patients and athletes, emphasizing the need for timely and effective treatment.
Purpose of the Study:
- To evaluate the outcomes of open Achilles tendon repair compared to alternative treatments.
- To identify patient populations that benefit most from operative intervention.
- To discuss the surgical technique, potential pitfalls, and expected results of open Achilles tendon repair.
Main Methods:
- Description of the open surgical technique, including incision, dissection, tendon identification, and repair using fiber tape sutures.
- Reinforcement of the repair with Vicryl suture and closure of the paratenon layer to minimize wound complications.
- Postoperative immobilization in a splint with the ankle in maximum plantar flexion.
Main Results:
- Literature review indicates good to excellent functional outcomes following open repair, with high rates of return to baseline activity.
- Operative repair is associated with a faster return to sport and potentially greater peak torque (explosiveness) compared to nonoperative methods.
- While open repair may have a higher complication rate than nonoperative treatment, it is associated with a lower risk of rerupture compared to primary immobilization.
Conclusions:
- Open Achilles tendon repair is an effective treatment for acute ruptures, particularly in athletes seeking rapid return to sport.
- Careful patient selection is crucial, balancing the benefits of faster recovery against potential surgical complications.
- Adherence to proper surgical technique and postoperative management is essential to optimize outcomes and prevent rerupture.
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