SLR - November 2020 - Taylor Tesoro

Intraoperative Ultrasonography Assistance for Minimally Invasive Repair of the Acute Achilles Tendon Rupture

Reference: Yongliang, Y., Honglei, J., Wupeng, J., Shihong, X., Fu, W., Bomin, W., Qinghu, L., Yonghui, W., and Shumei, H. Intraoperative Ultrasonography Assistance for Minimally Invasive Repair of the Acute Achilles Tendon Rupture. Journal of Orthopaedic Surgery and Research. 2020 July 11, 15(1), 258.

Scientific Literature Review

Reviewed By: Taylor Tesoro, DPM
Residency Program: Central Michigan University Educational Partners – Saginaw, MI

Podiatric Relevance: Achilles tendon rupture are a common injury seen within the podiatric medical field. Depending on the severity of the injury, they can be treated either conservatively or surgically. Surgical treatment options include open repair with or without augmentation, minimally invasive and percutaneous repairs. Regardless of the surgical technique used, one of the major complications associated with open repair is injury to the sural nerve. Surgeons are always looking for the best way to avoid surgical complications, whether it’s through advanced imaging, such as an MRI to help map out the location of the sural nerve and small saphenous vein. Or utilizing something new, like intraoperative ultrasonography.

Methods: In this retrospective study, 36 patients diagnosed as an acute Achilles tendon rupture were treated with minimally invasive repair assisted with intraoperative ultrasonography. Inclusion criteria consisted of an acute close Achilles tendon rupture with no calcaneal fracture, a palpable gap between the ruptured ends, a positive Thompson test and a distal stump more than 2 cm from the insertion confirmed by ultrasonography. Surgical methods included intraoperative ultrasonography to determine the location of the stump, medial and lateral edges of the tendon, small saphenous vein and the sural nerve which were all marked on the posterior skin of the calf. A 2-centimeter vertical or horizontal skin incision was made at the gap in the substance of the ruptured tendon, the proximal and distal ends were identified a three longitudinal stab incisions were made on the lateral and medial side of the tendon as well as four longitudinal stab incisions on the distal end of the tendon, proximal to the insertion. The rupture was repaired applying a modified Bunnell suture technique, utilizing No.2 ETHIBOND suture. 

Results: The preoperative AOFAS ankle-hindfoot scores improved from 59.17 ±5.31 to 98.92 ± 1.63 at 12 months follow up. All patients could return to work and light sporting activities at the time of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks. No difference was found between the injured extremity and health extremity in the “single extremity jump-landing” test. No patient developed superficial or deep infection in the surgical site. No sensory loss in the foot or ankle associated with sural nerve injury or re-rupture was observed during the surveillance period.

Conclusions: Utilizing a minimally invasive repair with assisted intraoperative ultrasonography has potential to yield food clinical outcomes, less surgical time and less complications, specifically sural nerve injuries. Its an easy and effective way to help identify anatomical structures for mapping out surgical incision placement to avoid unwanted complications and injuries. 

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