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

Abstract

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\rresistance to tendon lengthening during the healing process. Between 2017 and 2019, 28 patients with an acute Achilles tendon rupture received treatment with a sliding-\rlocking knot and absorbable suture in a modified percutaneous technique. After eligibility criteria, a total of 23 consecutive patients enrolled in this study. Participants\rin 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,\ran oblique injection with a PDS-loaded semi-curved needle was made. Samsung Medical Center (SMC) sliding knot was used to form a self-locking loop by pulling\rthe post strand. At the final follow-up, patients were evaluated postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot Questionnaire\rscore. 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\rat 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\roperation duration was 14.4±3.2 minutes (range, 10–23 min). Temporarily, the sural nerve damage was found in 2 patients (8.7%). The neurological symptoms resolved\rwithin three months of the surgery. A modified percutaneous method utilizing an absorbable suture and a sliding-locking knot may be an acceptable treatment option for\rAATR due to its low complication rate and rapid return to work.