Percutaneous woven modified kessler suture for a small medial incision of the achilles tendon in treatment of acute closed achilles tendon rupture

Xiaolong WANG

ABSTRACT

BACKGROUND:

Traditional open suture for the treatment of acute closed Achilles tendon rupture can significantly reduce the risk of gastrocnemius nerve injury and re-rupture of Achilles tendon, but this suture method can increase incision-related complications and result in tissue adhesion. Although the Krackow suture method is more powerful, it is difficult to perform minimally invasive surgery with small incisions, and excessive locks to strengthen the suture may affect the blood supply in the Achilles tendon. The percutaneous woven modified Kessler suture method is not only smooth, flat, and relatively strong, but also has strong tension. This is a minimally invasive method that can achieve good functional recovery of the Achilles tendon.

OBJECTIVE:

To investigate the clinical effect of percutaneous woven modified Kessler suture of a small medial incision of the Achilles tendon in the treatment of acute closed Achilles tendon rupture in comparison with the open suture method.

METHODS:

Clinical data of 72 patients with acute closed Achilles tendon rupture diagnosed at Department of Hand and Foot Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University between June 2015 and June 2018 were retrospectively analyzed. All patients were divided into open group and minimally invasive group of medial Achilles tendon (n=36 per group). The operation time, hospitalization time, blood loss, length of incision, wound healing, complications, and clinical efficacy were compared between the two groups. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University in China. RESULTS AND

CONCLUSION:

Compared with the open group, the minimally invasive group of medial Achilles tendon had shorter operation time and hospitalization time, less blood loss, and shorter incision length (P < 0.05). The American Orthopaedic Foot and Ankle Society (AOFAS) and Achilles tendon total rupture (ATRS) scores of the minimally invasive group of medial Achilles tendon were significantly higher than that of the open group at 6 months after surgery (P < 0.05), but there was no significant difference between the two groups in the ATRS score and the AOFAS score at 1 year after surgery (P 0.05). There was no significant difference in the excellent and good rate between the two groups at 1 year after surgery (P 0.05). The overall complication rate of the minimally invasive group of medial Achilles tendon was significantly lower than that of the open group (P < 0.05), and incision-related complications were confirmed to be the main postoperative complications. To conclude, compared with the open modified Kessler suture, percutaneous woven modified Kessler suture for the small medial incision of the Achilles tendon has some benefits, including simpler operation, lower price, more prominent perioperative index, lower incidence of postoperative incision-related complications, and better short-term efficacy.