Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot
Category: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-10-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011419S00131 |
| _version_ | 1818502226322128896 |
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| author | Daniel Carpenter MD Katherine Dederer MD Paul Weinhold PhD Joshua N Tennant MD, MPH |
| author_facet | Daniel Carpenter MD Katherine Dederer MD Paul Weinhold PhD Joshua N Tennant MD, MPH |
| author_sort | Daniel Carpenter MD |
| collection | DOAJ |
| description | Category: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of a cohort of non-operatively treated Achilles tendon ruptures. The PEAT repair technique described is a novel method which avoids a proximal lateral incision. We sought to determine clinical outcomes from a cohort undergoing this procedure as well as its basic biomechanical properties. Methods: Clinical: With IRB approval a cohort of operatively treated patients was assessed with the following PROs: Return to sport, VAS pain score, Satisfaction Likert, patient reported complications, single heel lift, patient reported medical & smoking history, ATRS (Achilles Tendon Rupture Score). Chart review of diagnostic modality, injury mechanism, time to surgery, tourniquet times, and surgeon reported complications were also collected. Biomechanical: 6 pairs (12) of age and sex matched fresh frozen lower extremity specimens (mid tibia to toes) with average age 71.5 (48-89) (8 F specimens, 4 M specimens) underwent either open (Kessler) repair or percutaneous repair. Specimens were cycled 10N-43 N for 100 cycles, and 20N-86 N for 200 cycles, measuring displacement and ultimate load to failure. Results: Clinical: 30 patients operatively treated with the PEAT procedure, 22 contacted by phone. Avg. follow up 2.5 years (1.2- 3.8); Avg ATRS 94.1 (81-100, SD 4.8); “very satisfied” 19/20; Avg VAS 0.3. We had a re-rupture rate of 3.33% (1/30). Biomechanical data: At 10-43 N for 100 cycles, all 12 specimens survived for duration of testing with biomechanical equivalence. At 20-86 N for 200 cycles, percutaneous repairs with greater cyclical displacement (1.7 cm vs 1.0 cm); 1/6 percutaneous with early failure; 11/12 specimens survived. Conclusion: The PEAT repair of Achilles tendon rupture showed excellent clinical outcomes with low complications and with biomechanical testing suggesting equivalent strength at low loads. |
| first_indexed | 2024-12-10T21:07:03Z |
| format | Article |
| id | doaj.art-7e761d78415c4e1b99a875b6a34e2096 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-10T21:07:03Z |
| publishDate | 2019-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-7e761d78415c4e1b99a875b6a34e20962022-12-22T01:33:35ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142019-10-01410.1177/2473011419S00131Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical PilotDaniel Carpenter MDKatherine Dederer MDPaul Weinhold PhDJoshua N Tennant MD, MPHCategory: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of a cohort of non-operatively treated Achilles tendon ruptures. The PEAT repair technique described is a novel method which avoids a proximal lateral incision. We sought to determine clinical outcomes from a cohort undergoing this procedure as well as its basic biomechanical properties. Methods: Clinical: With IRB approval a cohort of operatively treated patients was assessed with the following PROs: Return to sport, VAS pain score, Satisfaction Likert, patient reported complications, single heel lift, patient reported medical & smoking history, ATRS (Achilles Tendon Rupture Score). Chart review of diagnostic modality, injury mechanism, time to surgery, tourniquet times, and surgeon reported complications were also collected. Biomechanical: 6 pairs (12) of age and sex matched fresh frozen lower extremity specimens (mid tibia to toes) with average age 71.5 (48-89) (8 F specimens, 4 M specimens) underwent either open (Kessler) repair or percutaneous repair. Specimens were cycled 10N-43 N for 100 cycles, and 20N-86 N for 200 cycles, measuring displacement and ultimate load to failure. Results: Clinical: 30 patients operatively treated with the PEAT procedure, 22 contacted by phone. Avg. follow up 2.5 years (1.2- 3.8); Avg ATRS 94.1 (81-100, SD 4.8); “very satisfied” 19/20; Avg VAS 0.3. We had a re-rupture rate of 3.33% (1/30). Biomechanical data: At 10-43 N for 100 cycles, all 12 specimens survived for duration of testing with biomechanical equivalence. At 20-86 N for 200 cycles, percutaneous repairs with greater cyclical displacement (1.7 cm vs 1.0 cm); 1/6 percutaneous with early failure; 11/12 specimens survived. Conclusion: The PEAT repair of Achilles tendon rupture showed excellent clinical outcomes with low complications and with biomechanical testing suggesting equivalent strength at low loads.https://doi.org/10.1177/2473011419S00131 |
| spellingShingle | Daniel Carpenter MD Katherine Dederer MD Paul Weinhold PhD Joshua N Tennant MD, MPH Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot Foot & Ankle Orthopaedics |
| title | Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot |
| title_full | Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot |
| title_fullStr | Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot |
| title_full_unstemmed | Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot |
| title_short | Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot |
| title_sort | endoscopically assisted percutaneous achilles tendon repair a biomechanical and clinical pilot |
| url | https://doi.org/10.1177/2473011419S00131 |
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