Modified Surgical Treatment for Achilles Tendon Rupture Secondary to Insertional Achilles Tendinopathy Using Midline Dorsal Approach

Nagesh Naik, Vaijanath Rahate, Kapil R. Ghorpade, Jaydeep Patil, Shantanu Patil

Abstract


Objective: To assess the pain relief and functional outcomes of patients who undergo surgical management of Achilles tendon rupture secondary to insertional Achilles tendinopathy and associated conditions using a midline dorsal approach.

Methods: This prospective observational study included 30 patients diagnosed with Achilles tendon rupture secondary to insertional Achilles tendinopathy. This study recorded risk factors, predisposing factors, and co-morbidities for all cases. Pain relief and functional improvement were assessed by comparing Visual Analogue Scale (VAS) scores and American Orthopedic Foot and Ankle Score (AOFAS) at the time of presentation and at the final follow-up. This study conducted statistical analysis using SPSS 21.0 software, with a significance level of p<0.05.

Results: Of the participants, 17 (56.67%) were male and 13 (43.13%) were female, resulting in a male-to-female ratio of 1:0.76. The mean age of male and female patients was comparable (p=0.7515). The majority of patients (60%) were overweight, while 9 (30%) were obese, and 3 (10%) had a normal body mass index. This study observed a significant reduction in pain and functional improvement in the studied cases, as evidenced by a statistically significant reduction in VAS scores and improvements in AOFAS. Eight (26.66%) patients experienced minor complications that could be managed conservatively, but no major complications were observed.

Conclusion: Modified surgical treatment of Achilles tendon rupture secondary to insertional Achilles tendinopathy using a midline dorsal approach leads to significant improvements in pain and functional outcomes, with an acceptable complication rate.


Keywords


Achilles Tendon Rupture; Functional Outcome; Midline Dorsal Approach; Surgical Management

Full Text:

PDF

References


  1. Patch DA, Andrews NA, Scheinberg M, Jacobs RA, Harrelson WM, Rallapalle V, et al. Achilles tendon disorders: An overview of diagnosis and conservative treatment. JAAPA. 2023;36(10):1–8. doi:10.1097/01.JAA.0000977720.10055.c4
  2. Xergia SA, Tsarbou C, Liveris NI, Hadjithoma Μ, Tzanetakou IP. Risk factors for achilles tendon rupture: an updated systematic review. Phys Sportsmed. 2023;51(6):506–16. doi:10.1080/00913847.2022.2085505
  3. Kayce J. Gross anatomy: achilles tendon. Clin Podiatr Med Surg. 2022;39(3):405-10. doi:10.1016/j.cpm.2022.03.003
  4. Knapik JJ, Pope R. Achilles tendinopathy: pathophysiology, epidemiology, diagnosis, treatment, prevention, and screening. J Spec Oper Med. 2020;20(1):125–40. doi:10.55460/QXTX-A72P
  5. Rice H, Patel M. Manipulation of foot strike and footwear increases achilles tendon loading during running. Am J Sports Med. 2017;45(10):2411–17. doi:10.1177/0363546517704429
  6. Bleakney RR, White LM. Imaging of the achilles tendon. foot ankle clin. 2005;10(2):239–54. doi:10.1016/j.fcl.2005.01.006
  7. Baik S, Lau J, Huser V, McDonald CJ. Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries. BMJ Open. 2020;10(12):e034844. doi:10.1136/bmjopen-2019-034844
  8. Somford MP, Hoornenborg D, Wiegerinck JI, Nieuwe Weme RA. Are you positive that the simmonds-thompson test is negative? a historical and biographical review. J Foot Ankle Surg. 2016;55(3):682–3. doi:10.1053/j.jfas.2016.01.021
  9. Reda Y, Farouk A, Abdelmonem I, El Shazly OA. Surgical versus non-surgical treatment for acute Achilles’ tendon rupture. A systematic review of literature and meta-analysis. Foot Ankle Surg. 2020;26(3):280–8. doi:10.1016/j.fas.2019.03.010
  10. Nageshwaram J, Ganesan GR, SubburayanRB. Outcome analysis of surgically treated Tendo Achilles rupture. Int J Res Med Sci 2015;3:161–4. doi: 10.5455/2320-6012.ijrms20150128
  11. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2016;13:67–75. doi:10.1016/j.sjpain.2016.06.012
  12. Van Lieshout EM, De Boer AS, Meuffels DE, Den Hoed PT, Van der Vlies CH, et al. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version. BMJ Open. 2017;7(2):e012884. doi:10.1136/bmjopen-2016-012884
  13. Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of achilles tendon rupture in a Danish county. Injury. 1998;29(9):651–4. doi:10.1016/s0020-1383(98)00147-8
  14. Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3730–7. doi:10.1007/s00167-015-3544-5
  15. Weinfeld SB. Achilles tendon disorders. Med Clin North Am. 2014;98(2):331–8. doi:10.1016/j.mcna.2013.11.005
  16. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current concepts review update: insertional achilles tendinopathy. Foot Ankle Int. 2017;38(10):1160–9. doi:10.1177/1071100717723127
  17. Zhuang Z, Yang Y, Chhantyal K, Chen J, Yuan G, Ni Y, et al. Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy. Biomed Res Int. 2019;2019:4920647. doi:10.1155/2019/4920647
  18. Hammit MD, Hobgood ER, Tarquinio TA. Midline posterior approach to the ankle and hindfoot. Foot Ankle Int. 2006;27(9):711–5. doi:10.1177/107110070602700910
  19. Pellegrini MJ, Schiff AP, Adams SB Jr, DeOrio JK, Easley ME, Nunley JA. 2nd. Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach. Foot Ankle Int. 2016;37(3):312–9. doi:10.1177/1071100715615398
  20. Tejwani NC, Lee J, Weatherall J, Sherman O. Acute achilles tendon ruptures: a comparison of minimally invasive and open approach repairs followed by early rehabilitation. Am J Orthop (Belle Mead NJ). 2014;43(10):E221–5.




DOI: https://doi.org/10.15850/ijihs.v12.n1.3698

Article Metrics

Abstract view : 265 times
PDF - 107 times


 

This Journal indexed by

                   

 


Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



View My Stats