Results of Mini-Open Technique

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Results of the Mini-Open Achilles Tendon Repair Technique with Early

Functional Rehabilitation

• Presenter: Wenjay Sung, DPM• Lowell Weil, Jr., DPM, MBA• Lowell Scott Weil, Sr., DPM

[email protected]@weil4feet.com


Disclosures

Full disclosure can be found in the Final AOFAS Program Book and the AAOS website for all authors.

I have no potential conflicts with this presentation.

LWJ is a consultant for Arthrex, Inc.



Purpose

To present our results using the mini-open technique for Achilles tendon repair and early post-operative functional rehabilitation.

EBM Level of evidence IV, therapeutic,

retrospective case series



Methods

We retrospectively reviewed medical records for 40 consecutive patients who underwent an acute Achilles tendon repair between January 2002 and December 2009.

There were 19 patients (19 cases) who underwent a mini-open technique.

They had an average post-operative follow up time of 24.4 months (range 12 to 68 months).



Procedure

Based on description by Assal et al (2002).



Post-Operative Post-operatively,

Non-weight bearing short leg cast for 2 weeks

Physical therapy begins at week 2

Protected weight-bearing walking boot for additional 2-4 weeks

Goal at week 6 Neutral ankle Running shoe



MethodsClinical

Assessment

Victorian Institute of Sports Assessment - Achilles (VISA-A) score5

Visual Analog Scale (VAS)

Statistical Analysis A paired student t-test

was used to determine significance with p < 0.01.



ResultsDemographics

There were 13 males and 6 females with an average age of 45.2

All 19 patients returned to their previous professional or sporting activities.

All 19 patients reported either satisfied or very satisfied with outcome.

Complications

Complications occurred in two patients (11%). One patient had a minor

dehiscence that resolved with local wound care.

Another patient had a re-rupture four weeks post-operative. This was re-repaired

using the mini-open technique.



Results

The mean post-operative VISA-A score was 92 out of 100 (range, 66 to 100 points).

Pre-operative score: 5.5

Post-operative score: 0.9

P < 0.01

Clinical outcomes Average VAS

Average Total Score

Stiffness AM

Pain w/ Step

Stretching

Pain @ 30 min walking

Pain downstairs

Pain Heel

raises

Pain Leg

Hops

Level of Activity

Length of

Activity

92 10 10 10 10 10 10 8 25



Discussion

Our series demonstrated few complications with a high clinical outcome.

We did not experience any incidence of sural nerve injury although this has been reported in the literature with both mini-open and percutaneous repair2, 8-10

We believe the benefits of lower morbidity, minimal minor complications, and high satisfaction are the strengths of this procedure.



References1. Willits K et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a

multicenter randomized trial using accelerated functional rehabilitation. JBJS AM. 2010 Dec 1;92(17):2767-75. Epub 2010 Oct 29

2. Calder JDF, Saxby TS Early, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study. Br J Sports Med 2005;39:857–859.

3. Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P Limited Open Repair of Achilles Tendon Ruptures : A Technique with a New Instrument and Findings of a Prospective Multicenter Study. J. Bone Joint Surg. Am. 84:161-170, 2002.

4. Calder JDF, Saxby T.S. Independent Evaluation of a Recently Described Achilles Tendon Repair Technique. Foot Ankle Int. 27(2):93-6

5. Robinson JM et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001;35:335–341

6. Costa M.L., Macmillan K., Halliday D., Chester R., Shepstone L., Robinson A.H.N., Donell S.T. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg [Br] 2006;88-B:69-77.

7. Chiodo C, Wilson M Current Concepts Review: Acute Ruptures of the Achilles Tendon. Foot Ankle Int. 27(4):305-13

8. Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon. A new technique. Clin Orthop 1977;128:247–55.

9. Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int 2000;21(6):475–7.

10. Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon – a prospective randomised controlled study. Foot Ankle Int 2001;22(7):559–68.

Results of Mini-Open Technique

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