The Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Shropshire, UK.
The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):1109-1117. doi: 10.1007/s00167-021-06767-6. Epub 2021 Oct 18.
Operative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions.
From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have been prospectively evaluated using the Achilles tendon Total Rupture Score (ATRS) and Heel-Rise Height Index (HRHI), following acute Achilles tendon rupture.
Fourteen (5.6%) patients were identified as having adhesions. Four patients reported superficial adhesions and ten patients reported a deeper tightness of the tendon. At a mean (SD) of 10.5 (2.3) months following repair, the overall ATRS was at a median (IQR) 65 (44.5-78) points and (HRHI) was mean (SD) 81.5 (13.5)%. Of those deemed to have deep adhesions the antero-posterior diameter of the tendon was at mean (SD) 15.6 (4.6) mm. Open release of superficial adhesions resulted in improved ATRS in all patients. Endoscopic debridement anterior to the Achilles tendon led to alleviation of symptoms of tightness and discomfort from deep adhesions and improved outcome in terms of the ATRS score. At a mean (SD) of 15.9 (3.3)-month follow-up from initial rupture and repair, the patients reported at median (IQR) ATRS scores of 85 (64.8-92.8) points, Tegner level 5 (3-9) and mean (SD) HRHI 86.2 (9.5)%. Patients significantly improved both ATRS and HRHI following release at median (IQR) of 16.5 (- 1.8-29.3) points (p = 0.041) and mean (SD) 5.6 (8.3)% (p = 0.043).
The incidence of patient-reported adhesions following minimally invasive repair of Achilles tendon rupture was estimated to be 5.6%. The occurrence of superficial adhesions was associated with a lower outcome scores as well as symptoms of anterior tendon tightness and stiffness were associated with a lower score in most patients. Surgical release of adhesions led to a significant improvement in outcome.
跟腱断裂的手术修复可能会导致并发症，从而对结果产生不利影响。本研究的目的是确定术后粘连的发生率、影响和治疗反应。
从 2009 年 2 月至 2021 年，对 248 例采用经皮或微创外科修复的急性跟腱断裂患者前瞻性评估，采用跟腱总断裂评分（ATRS）和足跟抬高高度指数（HRHI）。
发现 14 例（5.6%）患者存在粘连。4 例患者报告有浅表粘连，10 例患者报告跟腱深部紧绷。在修复后平均（SD）10.5（2.3）个月时，整体 ATRS 中位数（IQR）为 65（44.5-78）分，（HRHI）平均值（SD）为 81.5（13.5）%。在被认为有深部粘连的患者中，肌腱的前后直径平均（SD）为 15.6（4.6）mm。开放松解浅表粘连可使所有患者的 ATRS 得到改善。在跟腱前方进行内镜下清创可减轻深部粘连引起的紧绷和不适症状，并改善 ATRS 评分。在初次破裂和修复后平均（SD）15.9（3.3）个月的随访中，患者报告 ATRS 中位数（IQR）评分为 85（64.8-92.8）分，Tegner 水平为 5（3-9）分，平均（SD）HRHI 为 86.2（9.5）%。患者在平均（SD）16.5（-1.8-29.3）分（p=0.041）和平均（SD）5.6（8.3）%（p=0.043）时 ATRS 和 HRHI 显著改善。
微创修复跟腱断裂后患者报告粘连的发生率估计为 5.6%。浅表粘连的发生与较低的评分结果以及前肌腱紧绷和僵硬的症状相关，大多数患者的评分较低。粘连松解术可显著改善结果。
