Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review
An acute Achilles tendon rupture poses a difficult treatment strategy in both young and old patients. Commonly considered an injury of the middle aged “weekend warrior,” an Achilles tendon tear in a sedentary patient is quite debilitating. An open surgical repair has many advantages including direct...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
|
| Series: | Foot & Ankle Surgery: Techniques, Reports & Cases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667396724000636 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850111194618134528 |
|---|---|
| author | James C. Connors, DPM, FACFAS Mark A. Hardy, DPM, FACFAS Halle L. Krebs Ali A. Manji, DPM Cory M. Jarosi, DPM |
| author_facet | James C. Connors, DPM, FACFAS Mark A. Hardy, DPM, FACFAS Halle L. Krebs Ali A. Manji, DPM Cory M. Jarosi, DPM |
| author_sort | James C. Connors, DPM, FACFAS |
| collection | DOAJ |
| description | An acute Achilles tendon rupture poses a difficult treatment strategy in both young and old patients. Commonly considered an injury of the middle aged “weekend warrior,” an Achilles tendon tear in a sedentary patient is quite debilitating. An open surgical repair has many advantages including direct tendon visualization as well as the ability to interlock the suturing technique. Unfortunately, the extensive incision needed for proper tendon exposure creates a tenuous scenario primed for an increased risk of complications. The classic surgical incision disrupts the paratenon, the main blood supply to the watershed area of the tendon at the rupture site which is the weakest point of the repair. The minimal subcutaneous layer between the distal skin incision and the tendon has notoriously been a site of dehiscence. An infection in this area spreads quickly along the tendon planes with devasting consequences. These grave complications have led to a paradigm shift in repair techniques. Minimally invasive procedures utilize a percutaneous jig suturing system placed through a small incision at the site of rupture. Unfortunately, a distinct set of complications are associated with blind placement of fiber wire including sural nerve entrapment and incomplete tendon capture in the repair technique. A new technique merges the advantages of a small incision with the ability to directly visualize the tendon repair. The paratenon is maintained at the rupture site while being able to utilize an asymmetric offset classic suturing technique to add strength to the repair. |
| format | Article |
| id | doaj-art-c76c06a809de4e9dabecb4fd82b79025 |
| institution | OA Journals |
| issn | 2667-3967 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Foot & Ankle Surgery: Techniques, Reports & Cases |
| spelling | doaj-art-c76c06a809de4e9dabecb4fd82b790252025-08-20T02:37:39ZengElsevierFoot & Ankle Surgery: Techniques, Reports & Cases2667-39672024-01-014410042310.1016/j.fastrc.2024.100423Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique reviewJames C. Connors, DPM, FACFAS0Mark A. Hardy, DPM, FACFAS1Halle L. Krebs2Ali A. Manji, DPM3Cory M. Jarosi, DPM4Associate Professor, Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH, USA; Corresponding author at: 6000 Rockside Woods Blvd. Independence, OH 44131, USA.Assistant Dean of Clinical Education, Division Head of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH, USA; Podiatric Surgery Residency Director, Mercy Regional Medical Center, Lorain, OH, USAPodiatric Medical Student, Kent State University College of Podiatric Medicine, Independence, OH, USAPodiatric Surgery Resident, Mercy Regional Medical Center, Lorain, OH, USAPodiatric Surgery Resident, Mercy Regional Medical Center, Lorain, OH, USAAn acute Achilles tendon rupture poses a difficult treatment strategy in both young and old patients. Commonly considered an injury of the middle aged “weekend warrior,” an Achilles tendon tear in a sedentary patient is quite debilitating. An open surgical repair has many advantages including direct tendon visualization as well as the ability to interlock the suturing technique. Unfortunately, the extensive incision needed for proper tendon exposure creates a tenuous scenario primed for an increased risk of complications. The classic surgical incision disrupts the paratenon, the main blood supply to the watershed area of the tendon at the rupture site which is the weakest point of the repair. The minimal subcutaneous layer between the distal skin incision and the tendon has notoriously been a site of dehiscence. An infection in this area spreads quickly along the tendon planes with devasting consequences. These grave complications have led to a paradigm shift in repair techniques. Minimally invasive procedures utilize a percutaneous jig suturing system placed through a small incision at the site of rupture. Unfortunately, a distinct set of complications are associated with blind placement of fiber wire including sural nerve entrapment and incomplete tendon capture in the repair technique. A new technique merges the advantages of a small incision with the ability to directly visualize the tendon repair. The paratenon is maintained at the rupture site while being able to utilize an asymmetric offset classic suturing technique to add strength to the repair.http://www.sciencedirect.com/science/article/pii/S26673967240006364 |
| spellingShingle | James C. Connors, DPM, FACFAS Mark A. Hardy, DPM, FACFAS Halle L. Krebs Ali A. Manji, DPM Cory M. Jarosi, DPM Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review Foot & Ankle Surgery: Techniques, Reports & Cases 4 |
| title | Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review |
| title_full | Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review |
| title_fullStr | Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review |
| title_full_unstemmed | Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review |
| title_short | Limited open repair for achilles tendon rupture in the setting of co-morbidities: A case series and technique review |
| title_sort | limited open repair for achilles tendon rupture in the setting of co morbidities a case series and technique review |
| topic | 4 |
| url | http://www.sciencedirect.com/science/article/pii/S2667396724000636 |
| work_keys_str_mv | AT jamescconnorsdpmfacfas limitedopenrepairforachillestendonruptureinthesettingofcomorbiditiesacaseseriesandtechniquereview AT markahardydpmfacfas limitedopenrepairforachillestendonruptureinthesettingofcomorbiditiesacaseseriesandtechniquereview AT hallelkrebs limitedopenrepairforachillestendonruptureinthesettingofcomorbiditiesacaseseriesandtechniquereview AT aliamanjidpm limitedopenrepairforachillestendonruptureinthesettingofcomorbiditiesacaseseriesandtechniquereview AT corymjarosidpm limitedopenrepairforachillestendonruptureinthesettingofcomorbiditiesacaseseriesandtechniquereview |