Acute closed midsubstance Achilles tendon rupture (ACMATR) is common, with various treatment methods developed over time. These authors retrospectively compared the 2 mini transverse-incision repair (2MTIR) with percutaneous repair (PR) to determine which method yields better results. (See Figures 1 and 2.)
Figure 1: Surgical procedure step by step. Keys Red Dash — Stab Wound, Blue Dots Line – Suture, Blue Cross — Knots
All cases meeting criteria from 2018 to 2021 in the University of Hong Kong-Shenzhen Hospital were included and followed up for 1 to 5 years. A final questionnaire with multiple indexes was conducted via phone call. Comparative analysis of these indexes between the 2 groups was performed using IBM SPSS Statistics (V.26). Continuous variables that passed tests for normality and equal variance were compared using the Student’s t-test. Ranked data were compared using the Mann-Whitney U test. Categorical variables were tested with the chi-square test or Fisher’s exact test. A P-value of less than 0.05 was considered statistically significant.
Figure 2: The 2MTIR technique. (a) Two stumps were exposed through separate transverse mini incisions. One suture (1b and 2b) was placed in a Krackow pattern in each of the stumps. (b) A second, different color suture (1r and 2r) was placed in each of the stumps. (c) Sutures 1r and 2r were threaded through the tunnel to the opposite incision to pull the two stumps together, and the 2b suture ends were threaded through the tunnel to the proximal incision and tied in knots with 1b. (d) The 1r ends were threaded to the proximal incision and tied in knots with 2r
Their results showed 1 re-rupture in the PR group. The final indexes for “Tightness Feeling”, “Heel Rising Strength”, and “Foot Numbness” were statistically different (P < 0.05) between the 2 groups. The “Re-rupture” and “Return to Sports” indexes showed no statistical difference (P > 0.05).
The authors concluded that the 2MTIR technique provided a technically straightforward, minimally invasive procedure with well preserved paratenon and direct end-to-end firm fixation in cases of ACMATR. It resulted in very low complications, easy rehabilitation, and full weight-bearing as early as 5–6 weeks postoperatively, yielding better functional outcomes compared to the PR technique in the 1–5 year follow-up.
Source: Jin WT, Huang LF, Guo HH, Wang L, Li X, Wang ZJ. Two mini transverse-incision repair yields better results than percutaneous repair for acute closed midsubstance Achilles tendon rupture: a retrospective case-control study. J Orthop Surg Res. 2024;19(1):452. doi: 10.1186/s13018-024-04904-8. Use is per Creative Commons Attribution 4.0 International License.
