Use of a Central Splitting Approach and Near Complete Detachment for Insertional Calcific Achilles Tendinopathy Repaired With an Achilles Bridging Suture.

After 3 to 6 months of conservative management for insertional calcific Achilles tendinopathy, operative intervention might be warranted. Despite a success rate of 75% to 100% with surgery, no consensus has been reached on the amount of acceptable detachment of the Achilles tendon. The present case series reports on the results of a central splitting approach with 80% to 90% detachment of the Achilles insertion repaired with a double-row bridging suture device. A total of 14 patients (16 heels) for whom nonoperative management for insertional calcific Achilles tendinopathy had previously failed were enrolled in the present study they had undergone surgical management. The patients were followed up for a mean of 18 (range 11 to 25) months postoperatively and were evaluated using the American Orthopaedic Foot and Ankle Society Hind Foot scoring system, 36-item Short Form Health Survey questionnaire, and pre- and postoperative visual analog pain scale. The mean visual analog pain scale core had decreased 5.84 (range 1 to 9) points postoperatively (p < .001). The mean postoperative American Orthopaedic Foot and Ankle Society Hind Foot score was 87 ± 19.7 (range 52 to 105) points. One patient reported moderate pain with no limitation of activities. The mean 36-item Short-Form Health Survey score for physical functioning was 77.7 (range 30 to 100) points postoperatively in 11 patients. No patient reported incisional discomfort. All 14 patients (16 heels) reported being satisfied and had returned to their previous functional status. Thus, the central splitting Achilles approach with anchoring of the Achilles insertion using the double-row suture device is a safe and reasonable option in the operative treatment of insertional calcific Achilles tendinopathy.

Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty.

Total knee arthroplasty (TKA) continues to advance as innovative devices become available. #2 PDO Quill SRS (Angiotech, Reading, Pa) bidirectional barbed suture was used for 161 primary TKAs at our facility. We report on 3 separate cases of extensor mechanism repair failure after primary TKA in which a barbed suture was used for extensor mechanism closure. Before the implementation of this device, there were no reported failures in 385 primary TKAs. We recommend that surgeons who use this device for extensor mechanism repair of a medial parapatellar arthrotomy in TKA exercise caution when operating on patients with morbid obesity, diabetes, and rheumatoid arthritis. We have discontinued use of the bidirectional barbed suture until more definitive large orthopedic studies establish its efficacy and safety.