Minimally invasive internal splinting technique for acute closed Achilles tendon rupture

Although non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture.

A retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up.

We bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant (p < 0.05).

The procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon.