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Modified Percutaneous Repair of Acute Achilles Tendon Rupture: A Sliding Knot Technique Using Absorbable Suture

Lokman Kehribar, Huseyin Sina Coskun, Serkan Surucu.


Abstract

Purpose
The purpose of this study was to describe our technique and to assess its clinical efficacy. The modified percutaneous approach, we hypothesized, would provide additional resistance to tendon lengthening during the healing process.

Material and Methods
Between 2017 and 2019, 28 patients with an acute achilles tendon rupture received treatment with a sliding-locking knot and absorbable suture in a modified percutaneous technique. After eligibility criteria, a total of 23 consecutive patients enrolled in this study. Participants in the study ranged in age from 18 to 50 years.Polydioxanone suture (PDS) was utilized in all patients. From the middle medial stab incision to the proximal lateral incision, an oblique injection with a PDS-loaded semicurved needle was made. Samsung Medical Center (SMC) sliding knot was used to form a self-locking loop by pulling the post strand. At final follow-up, patients were evaluated postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot Questionnaire score.

Results
The mean age of the patients was 37.5±6.1 years (range, 28-47 years). The mean AOFAS score, ATRA degree, calf circumference and single leg heel raise count at the last follow-up were 93.4±4.1 (range, 88-100), 55.4±6.2 degrees (range, 45–74 degrees), 38.4±7.1 cm (range, 28–49 cm) and 39.5±8.3 (range, 27–96). The mean operation duration was 14.4±3.2 minutes (range, 10–23 min). Temporarily, sural nerve damage was found in 2 patients (8.7%). The neurological symptoms resolved within three months of the surgery.

Conclusion
A modified percutaneous method utilizing an absorbable suture and a sliding-locking knot may be an acceptable treatment option for AATR due to its low complication rate and rapid return to work.

Key words: Achilles tendon rupture, surgery, modified percutaneous repair techniques, sliding knot,






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