Short Term Results of the Mini-Open Achilles Tendon Repair Technique using a validated Outcome Scale

2. Lowell Weil, Jr., DPM, MBA

4. Purpose To present our results using the mini-open technique for Achilles tendon repair and early post-operative functional rehabilitation. EBM Level of evidence IV, therapeutic, retrospective case series

5. Methods We retrospectively reviewed medical records for 40 consecutive patients who underwent an acute Achilles tendon repair between January 2002 and December 2009. There were 19 patients (19 cases) who underwent a mini-open technique. They had an average post-operative follow up time of 24.4 months (range 12 to 68 months).

6. Procedure Based on description by Assal et al (2002).

7. Post-Operative Post-operatively, Non-weight bearing short leg cast for 2 weeks Physical therapy begins at week 2 Protected weight-bearing walking boot for additional 2-4 weeks Goal at week 6 Neutral ankle Running shoe

8. Methods Clinical Assessment Victorian Institute of Sports Assessment - Achilles (VISA-A) score5 Visual Analog Scale (VAS) Statistical Analysis A paired student t-test was used to determine significance with p < 0.01.

9. Results Demographics There were 13 males and 6 females with an average age of 45.2 All 19 patients returned to their previous professional or sporting activities. All 19 patients reported either satisfied or very satisfied with outcome. Complications Complications occurred in two patients (11%). One patient had a minor dehiscence that resolved with local wound care. Another patient had a re-rupture four weeks post-operative. This was re-repaired using the mini-open technique.

11. Post-operative score: 0.9

13. References Willits K et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. JBJS AM. 2010 Dec 1;92(17):2767-75. Epub 2010 Oct 29 Calder JDF, Saxby TS Early, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study. Br J Sports Med 2005;39:857–859. Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P Limited Open Repair of Achilles Tendon Ruptures : A Technique with a New Instrument and Findings of a Prospective Multicenter Study. J. Bone Joint Surg. Am. 84:161-170, 2002. Calder JDF, Saxby T.S. Independent Evaluation of a Recently Described Achilles Tendon Repair Technique. Foot Ankle Int. 27(2):93-6 Robinson JM et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001;35:335–341 Costa M.L., Macmillan K., Halliday D., Chester R., Shepstone L., Robinson A.H.N., Donell S.T. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendoAchillis. J Bone Joint Surg [Br] 2006;88-B:69-77. Chiodo C, Wilson M Current Concepts Review: Acute Ruptures of the Achilles Tendon. Foot Ankle Int. 27(4):305-13 Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achilles tendon. A new technique. ClinOrthop 1977;128:247–55. Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int 2000;21(6):475–7. Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon – a prospective randomised controlled study. Foot Ankle Int 2001;22(7):559–68.