AUSL of the Romagna, Ravenna, Italy.
Rizzoli Institute, Bologna, Italy.
Orthop Surg. 2023 Dec;15(12):3300-3308. doi: 10.1111/os.13871. Epub 2023 Sep 28.
Misdiagnosed/chronic Achilles tendon injuries are rare and disabling for patients. The surgical treatment of these rare injuries aims to ensure the tendon heals mechanically and biologically. This is the prerequisite for a good clinical and functional outcome and reduces recurrences. The main aim of the study is to present a surgical technique that has proven to be original, reproducible, and capable of guaranteeing solid tendon repair and optimal tissue regeneration.
We treated five patients, four males and one female, with the one-step double augmentation technique. All patients of this study complained of pain, but above all severe functional limitation that Achilles tendon injury had been causing for more than a month. In this study, we widely described the surgical technique, original and not found in the literature, which provides a biological graft (allograft of decellularized dermis) and homologous, thrombin-activated, platelet-rich plasma (H-PRP) in a single step. Surgical approach, always used by the first author, respected predefined steps: careful dissection and preparation of the peritendinous tissues from suture to the end of the procedure, tenorrhaphy, and augmentation with allopatch to obtain a mechanically effective repair to avoid recurrences, and finally "biological" augmentation with a unit of homologous, thrombin activated, PRP. We offered to all patients a regenerative rehabilitation program post-operatively.
All patients were evaluated clinically (functional clinical tests and questionnaires) and instrumentally (elastic-sonography and perfusion MRI). The obtained results have been evaluated at a minimum follow-up of 18 months and a maximum of 24 months. In all patients pain was resolved, and district function and kinetic chains improved with resumption of daily activities, work, and sports.
The present study confirmed the regenerative potential of decellularized dermis allograft and PRP (homologous and thrombin-activated). The same approach can also be exploited in cases of severe tendon destructuring and limited "intrinsic" regenerative potential at any age. The proposed one-step surgical technique of a double augmentation therefore appears useful, safe, reproducible, and applicable in all chronic tendon lesions with low regenerative potential.
误诊/慢性跟腱损伤对患者来说罕见且致残。这些罕见损伤的手术治疗旨在确保肌腱在机械和生物学上愈合。这是获得良好临床和功能结果并降低复发率的前提。本研究的主要目的是介绍一种已被证明具有原创性、可重复性且能够保证牢固的肌腱修复和最佳组织再生的手术技术。
我们使用一步双增强技术治疗了五名患者，其中四名男性，一名女性。本研究中的所有患者均主诉疼痛，但更严重的是功能受限，跟腱损伤已持续一个多月。在本研究中，我们广泛描述了一种手术技术，该技术是原创的，在文献中未找到，它提供了一种生物移植物（脱细胞真皮同种异体移植物）和同源、凝血酶激活的富含血小板血浆（H-PRP），一步完成。手术方法始终由第一作者使用，遵循预定义的步骤：仔细解剖和准备腱周组织，从缝线到手术结束，肌腱修复，并用同种异体补丁增强以获得有效的机械修复以避免复发，最后用单位同源、凝血酶激活的 PRP 进行“生物”增强。我们为所有患者提供了术后再生康复方案。
所有患者均进行了临床评估（功能临床测试和问卷调查）和仪器评估（弹性超声和灌注 MRI）。在至少 18 个月且最长 24 个月的随访中评估了获得的结果。所有患者的疼痛均得到缓解，区域功能和运动链得到改善，恢复了日常活动、工作和运动。
本研究证实了脱细胞真皮同种异体移植物和 PRP（同源和凝血酶激活）的再生潜力。在任何年龄段，对于严重的肌腱破坏和有限的“内在”再生潜力的情况，也可以利用相同的方法。因此，所提出的一步双增强手术技术似乎在所有具有低再生潜力的慢性肌腱病变中是有用、安全、可重复且适用的。
