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- Title
Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery.
- Authors
Bąkowski, Paweł; Ciemniewska-Gorzela, Kinga; Talaśka, Krzysztof; Górecki, Jan; Wojtkowiak, Dominik; Kerkhoffs, Gino M. M. J.; Piontek, Tomasz
- Abstract
<bold>Purpose: </bold>Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique.<bold>Methods: </bold>Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment.<bold>Results: </bold>All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10-100 N load followed by additional 250 cycles of 10-200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20-400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509-1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006).<bold>Conclusions: </bold>The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases.<bold>Level Of Evidence: </bold>III.
- Subjects
ACHILLES tendon injuries; TENDON injuries; BIOMECHANICS; MUSCLE injuries; ORTHOPEDIC surgery; ACHILLES tendon; SUTURES; ENDOSCOPIC surgery; CONVALESCENCE; ANKLE; TREATMENT effectiveness; WALKING; HEEL (Anatomy)
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2020, Vol 28, Issue 1, p305
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-019-05723-9