| 1.In vitro mechanical experiment on repairing the torn sites of Achilles tendon between single suture anchor combined with “Circuit” suture method and traditional modified Kessler methodObjective: To compare the mechanical differences of single suture anchor combined with “Circuit” suture method with traditional modified Kessler method after repairing the torn ends of Achilles tendon.We aslo verify the mechanical feasibility of using single anchor to repair Achilles tendon rupture in clinic.Methods:A total of 16 Achilles tendon specimens obtained from 8 adult cadavers were randomly divided into two groups(A,B)with 8 specimens respectively,and Achilles tendon rupture models were made in each group.In group A,a suture anchor was inserted into the calcaneus along the medial direction of Achilles tendon and the torn sites were repaired by “Circuit” suture method using the sutures of anchor,wheras the identical sutures were used to repair the torn ends through modified Kessler method in group B without applying the anchor.The repaired specimens of each group were placed on a mechanical test machine and properly fixed,then mechanical testing were carried out according to the steps of pre-compression,cyclic loading and maximum tension while keeping the specimen moist during the process.The displacement of the torn ends was respectively recorded after 10,100,500 and 1000 cycles in the cyclic loading protocal.Maximum load,the displacement of maximum load,the failure mode,load-elongation curve as well as stiffness and yield load were solely documented in maximum tension testing.The statistical analysis of mechanical indexes between two groups was performed after the experimental protocal.Results: During the cyclic testing,there was no significant difference between the displacement of group A and group B after 10 cycles,while the displacement of group A was less than group B after 100,500,1000 cycles(p<0.01,p<0.01,p<0.01).In the maximum loading test,group A demonstrated significantly more maximum load and the displacement of maximum load when compared with group B(p<0.01,p<0.01).No significant difference was observed in the failure mode between both groups.Analysis of load-displacement curve shows that group A has greater stiffness and yield load than group B(p<0.01,p<0.01).Conclusion: The single anchor combined with “Circuit” suture method has some mechanical advantages when compared with traditional modified Kessler method,which can increase the maximum load,tensile strength and mechanical stability of the torn sites after repairing,thus providing the possibility of early loading in clinic and reducing the potential risks of re-rupture after operation to some extent.2.Clinical study on the management of acute closed Achilles tendon rupture through limited-open procedure with single suture anchor and “Circuit” suture methodObjective:To compare the clinical outcome and complications of limited-open procedure with single suture anchor and “Circuit” suture method with traditional incision and modified Kessler method in the treatment of acute closed Achilles tendon rupture.We also addressed the feasibility,validity,and limitations of the new and minimally invasive techque.Methods:A retrospective study of 64 patients with acute closed Achilles tendon rupture who were were treated by different methods at Changhai Hospital between January 2014 and January 2017.According to surgical methods,patients were divided into single anchor minimally invasive group(n=28)and traditional group(n=36).Single anchor minimally invasive group repair the torn sites through limited-open procedure using single suture anchor and “Circuit” suture method while traditional group using traditional incision and modified Kessler method.Perioperative indicators and the incidence of complications were registered.Clinical outcome was measured by the American Orthopedic Foot & Ankle Society(AOFAS)scoring system and Arner-Lindholm scale.AOFAS score,the range of motion(ROM),Leppilahti score(LS),calf circumference difference(CCD),the time to return work and exercise were registered and compared between the two groups.Results:The average follow-up time of single anchor minimally invasive group and traditional group was 21.4 ±4.7 months and 21.8 ±4.3 months respectively.Perioperative indicators: there was no significant difference in preoperative hospital stay while the operation time of single anchor minimally invasive group was longer than traditional group(p<0.01).The length of incision,intraoperative blood loss and hospital stay of single anchor minimally invasive group were lower than traditional group(p<0.01,p<0.01,p<0.01).The incidence of complications: the soft tissue complication of single anchor minimally invasive group was significantly lower than traditional group(p<0.05)whereas there was no significant difference in the incidence of re-rupture of Achilles tendon,sural nerve injury and deep venous thrombosis(DVT).Postoperative outcome: the time to return to wok and activity of single anchor minimally invasive group was shorter than traditional group(p<0.01,p<0.01).AOFAS score,ROM,LS and CCD between injured and uninjured sides at 3 months after surgery were advantageous than traditional group(p<0.01,p<0.01,p<0.01,p<0.01)while there was no significant difference in 12-month AOFAS score,12-month ROM,12-month LS and 12-month CCD between injured and uninjured sides.Conclusion:The limited-open procedure with single suture anchor and “Circuit” suture method could be used to repair torn Achilles sites,with a low occurrence of soft tissue complications,low trauma,short hospital stay,short recovery period and good short-term clinical outcome.Thus it could be an alternative for minimally invasive treatment of acute closed Achilles tendon rupture,which is particularly suitable for the young patients with high functional requirements. |
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