Associate Professor, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Podiatrist in Private Practice, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
J Foot Ankle Surg. 2022 Sep-Oct;61(5):927-931. doi: 10.1053/j.jfas.2021.12.015. Epub 2021 Dec 12.
Insertional Achilles tendinopathy represents a chronic degenerative condition affecting the insertion of the Achilles. Surgery is indicated in recalcitrant cases and often involves extensive debridement followed by subsequent repair of the insertion. In the present study, we evaluate the results of knotted and knotless double-row suture systems for Achilles reattachment. Despite the popularity of double-row repairs, there is a relative paucity of clinic data regarding efficacy of the available implants. In a retrospective cohort study, 38 patients (40 Achilles tendons) who received double-row repairs between November 2012 and December 2016 were evaluated. In addition to demographic information, preoperative pain scores and symptom duration were recorded. Perioperative and postoperative records were reviewed, and telephone interviews were conducted to assess patient satisfaction, functional status, postoperative pain, and information regarding surgical complications. At a mean follow-up of 32.5 months, 35 (92.1%) patients reported satisfaction with the outcome. Decreased pain levels were reported in 38 (95%) ankles, with 21 (52.5%) ankles being rated pain-free postoperatively. Of the patients working prior to surgery, 20 (95.2%) were able to return to normal work duties, and all 11 (100%) patients who engaged in sports preoperatively were able to return to the same level of activity. Two patients developed postoperative infections, one of which required operative debridement. No Achilles avulsions were encountered. No significant differences were noted between the 2 operative techniques. Considering the available biomechanical data, along with high patient satisfaction rates and low rate of complications, double-row repair offers a viable option for recalcitrant insertional Achilles tendinopathy.
插入性跟腱病是一种影响跟腱止点的慢性退行性疾病。对于难治性病例，手术是指征，通常包括广泛的清创，随后进行跟腱止点修复。在本研究中，我们评估了用于跟腱再附着的带结和无结双排缝线系统的结果。尽管双排修复术很流行，但关于现有植入物疗效的临床数据相对较少。在一项回顾性队列研究中，评估了 2012 年 11 月至 2016 年 12 月期间接受双排修复的 38 例患者（40 条跟腱）。除了人口统计学信息外，还记录了术前疼痛评分和症状持续时间。回顾了围手术期和术后记录，并进行了电话访谈，以评估患者满意度、功能状态、术后疼痛以及有关手术并发症的信息。平均随访 32.5 个月后，35 例（92.1%）患者对结果表示满意。38 条（95%）踝关节报告疼痛减轻，21 条（52.5%）踝关节术后无疼痛。在术前工作的患者中，20 例（95.2%）能够恢复正常工作，所有 11 例（100%）术前从事运动的患者均能够恢复到相同的活动水平。2 例患者发生术后感染，其中 1 例需要手术清创。未发生跟腱撕脱。两种手术技术之间无显著差异。考虑到现有的生物力学数据，以及高患者满意度和低并发症发生率，双排修复为难治性插入性跟腱病提供了可行的选择。
