Carmont Michael R, Nilsson-Helander Katarina, Carling Malin
Department of Trauma & Orthopaedic Surgery, Shrewsbury & Telford Hospital NHS Trust, Shropshire, UK.
University of Keele, Staffordshire, UK.
BMC Musculoskelet Disord. 2024 Aug 1;25(1):610. doi: 10.1186/s12891-024-07630-8.
Achilles tendon ruptures (ATRs) close to the insertion, in high-level athletes, and in patients at high risk of re-rupture, may be better suited to operative repair. Minimally Invasive Repair (MIR) of the Achilles tendon has excellent outcome and low complication rates. Traditionally MIR has showed lower repair strength, failing due to suture pull-out from the distal tendon stump. The aim of this study was to describe the outcome of ATR patients who received transosseous distal suture placement using a standard technique as a reference.
Following ATR, patients were evaluated for pre-injury activity level, body weight, location of the tear and size of the distal Achilles tendon stump. Patients considered to be at high-risk of re-rupture: Tegner level ≥ 8, body weight ≥ 105Kg and distal ATR, received transosseous (TO) distal suture placement (n = 20) rather than the usual transtendinous (TT) technique (n = 55). Patient reported outcome measures and functional evaluation was performed at 12 months following repair.
At 12 months follow up both methods resulted in good median (IQR) Achilles tendon Total Rupture Score TO 83.8 (74-88.3) vs. TT 90 (79-94), low increased relative Achilles Tendon Resting Angle TO -3.5˚ (3.6) vs. TT -3.5˚ (3.3) and mean (SD) Single leg Heel-Rise Height Index TO 88.2% (9.9) vs. TT 85.6% (9.9) (n.s.). There were 4 re-ruptures in the high-risk group and 2 in the group receiving TT distal suture placement. All but one of these were traumatic in nature. The mode of failure following TO distal suture placement was proximal suture pull out.
To distal suture placement during minimally-invasive Achilles tendon repair for higher-risk patients can lead to results equivalent to those in lower-risk patients treated with a standard TT MIR technique, except for the re-rupture rate which remained higher. There may be factors that have greater influence on outcome other than suture placement following ATR.
对于靠近止点处的跟腱断裂、高水平运动员以及再断裂高风险患者，手术修复可能更为合适。跟腱微创修复（MIR）效果良好且并发症发生率低。传统上，MIR的修复强度较低，常因缝线从远端肌腱残端拔出而失败。本研究的目的是描述采用标准技术进行经骨远端缝线置入的跟腱断裂患者的治疗结果，作为参考。
跟腱断裂后，对患者进行损伤前活动水平、体重、撕裂部位和跟腱远端残端大小的评估。被认为再断裂高风险的患者：Tegner水平≥8、体重≥105kg且为远端跟腱断裂，接受经骨（TO）远端缝线置入（n = 20）而非常规的经肌腱（TT）技术（n = 55）。在修复后12个月进行患者报告的结局测量和功能评估。
在12个月的随访中，两种方法均产生了良好的中位数（IQR）跟腱总断裂评分，TO为83.8（74 - 88.3），TT为90（79 - 94）；相对跟腱静息角增加较低，TO为 - 3.5˚（3.6），TT为 - 3.5˚（3.3）；单腿足跟抬高高度指数平均（SD），TO为88.2%（9.9），TT为85.6%（9.9）（无显著差异）。高风险组有4例再断裂，接受TT远端缝线置入组有2例。除1例之外，所有这些再断裂均为创伤性。TO远端缝线置入后的失败模式为近端缝线拔出。
对于高风险患者，在微创跟腱修复术中进行经骨远端缝线置入可导致与采用标准TT MIR技术治疗的低风险患者相当的结果，但再断裂率仍然较高。跟腱断裂后，可能存在比缝线置入对结局影响更大的因素。
