Maffulli Nicola, Christidis George, Gougoulias Nikolaos, Christidis Panagiotis, Poku Daryl, Hassan Rifat, Migliorini Filippo, Oliva Francesco
Faculty of Medicine and Psychology, Department of Trauma and Orthopaedic Surgery, University "La Sapienza", Via di Grottarossa, 00189, Rome, Italy.
Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Thornburrow Dirve, Stoke-On-Trent, Staffordshire ST4 7QB, United Kingdom.
Br Med Bull. 2025 Jan 16;153(1). doi: 10.1093/bmb/ldae019.
The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots.
All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group A), and 33 patients underwent percutaneous repair with one knot (Group B). All patients were treated by a single surgeon between 2019 and 2021 and were followed prospectively for 24 months.
Patients' characteristics at baseline were similar between the two groups, except for age [38.0(15.0) vs 32.0(15.0) years, P = 0.028]. The procedure took longer for the two knots technique [19.0(4.0) vs 13.0(3.0) min, P < 0.001]. The Achilles tendon total rupture score was not different between the two techniques (90.7 ± 3.26 vs 90.5 ± 2.18, P = 0.737), as was the elongation of the gastrosoleus-Achilles tendon complex measured by the Achilles tendon resting angle [-1.0(2.0) vs - 1.0(2.0), P < 0.380]. The calf circumference of the injured and non-injured leg did not differ between the groups. Plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups. The European Foot and Ankle Society and patient reported outcome measures score by Piedade et al. scores were not statistically significant different between the two groups. No patient experienced a re-rupture, a venous thrombo-embolism episode, or injury to the sural nerve.
The modified technique offered similar objective and subjective outcome measures, in addition to reduced operative time.
本前瞻性对照研究纳入了急性跟腱断裂（ATR）患者，比较单结经皮修复与双结经皮修复的效果。
所有患者均在局部麻醉下接受手术。共29例患者接受双结经皮修复（A组），33例患者接受单结经皮修复（B组）。所有患者均由同一位外科医生在2019年至2021年期间进行治疗，并进行了为期24个月的前瞻性随访。
两组患者的基线特征相似，但年龄除外[38.0(15.0)岁 vs 32.0(15.0)岁，P = 0.028]。双结技术的手术时间更长[19.0(4.0)分钟 vs 13.0(3.0)分钟，P < 0.001]。两种技术的跟腱总断裂评分无差异（90.7±3.26 vs 90.5±2.18，P = 0.737），跟腱静息角测量的腓肠肌-跟腱复合体伸长情况也无差异[-1.0(2.0) vs -1.0(2.0)，P < 0.380]。两组患者受伤侧和未受伤侧的小腿周长无差异。两组患者手术侧的跖屈力量均明显弱于未手术侧。欧洲足踝协会评分和皮耶达等人报告的患者结局测量评分在两组之间无统计学显著差异。没有患者发生再断裂、静脉血栓栓塞事件或腓肠神经损伤。
改良技术除了缩短手术时间外，还提供了相似的客观和主观结局测量结果。
