Comparison Of Clinical Efficacy Of Three Open Surgeries For Fresh Closed Achilles Tendon Rupture

Objective:To compare the clinical effects of direct end-to-end suture,suture with wire anchor,suture with wire anchor combined with gastrocnemius muscle membrane inversion strengthened suture in the treatment of fresh closed Achilles tendon rupture,so as to provide a basis for the selection of surgical methods and postoperative rehabilitation..Methods: A total of 158 patients with fresh closed Achilles tendon rupture who met the inclusion criteria from March 2019 to February 2021 were selected and divided into three groups according to the differences in surgical methods: direct end-to-end suture(group A)(58 cases),suture with wire anchor(group B)(52 cases),suture with wire anchor combined with gastrocnemius muscle membrane inversion strengthening(group C)(48 cases).Incision length,intraoperative blood loss,postoperative braking time,normal flat walking time,complications and other perioperative conditions were recorded.The American Society for Foot and Ankle Surgery(AOFAS-AH)score,Leppilahti Achilles tendon repair score,the difference in circumference between the Achilles tendon rupture on the affected side and the healthy side at the same level,and the positive rate of the heel lift test were recorded at 6,12,24,48,and 96 weeks after surgery.The strength recovery of the triceps muscle of the affected leg was tested at 24 weeks,48 weeks and 96 weeks,and the differences in the above clinical results among the three groups were compared.When comparing the three treatment groups,according to the different data types and data distribution characteristics:(1)For continuous variables,one-way analysis of variance(ANOVA),Kruskal-Wallis H test or Brown-Forsyte test were used;(2)For categorical variables,Pearson’s Chi-square test,Fisher’s exact probability method or Kruskal-Wallis nonparametric rank sum test were used for analysis.Multiple post-hoc comparisons were then made between any two groups.Results:There were no significant differences among the three groups in gender,age,injury side,mean preoperative time,type of Achilles tendon tear,and overall postoperative complication rate(P>0.05).There were no significant differences between group A and group B in average length of hospital stay,operation time,length of surgical incisionand intraoperative blood loss(P>0.05),but group C was significantly greater than group A and group B,the difference was statistically significant(P<0.05).There were no significant differences in postoperative braking time and normal flat walking time between group B and group C(P>0.05),which were significantly lower than those in group A(P<0.05).The AOFAS-AH score and Leppilahti Achilles tendon repair score of the three groups were improved gradually with the passage of time.At four time points within 1 year after surgery,functional scores of patients in group B and Group C were significantly better than those in group A(P<0.05),but there was no significant difference between the two groups(P>0.05).At 96 weeks after surgery,there was no significant difference in functional scores among the three groups(P>0.05).There was no significant difference between the three groups in the same horizontal circumferential diameter difference between the injured side and the healthy side at the same time node(P>0.05).With the passage of time,the triceps muscle strength of the three groups gradually improved,and the positive rate of single foot heel lift test gradually decreased,but there was no significant difference between groups at each time node(P>0.05).Conclusion:1.In the open surgical treatment of fresh closed Achilles tendon rupture,anchor suture with thread has reliable suture fastness,moderate surgical trauma,short postoperative braking time,allowing patients to perform functional exercise in early stage and recover walking function quickly.Functional results within1 year are superior to direct end-to-end suture,which has obvious advantages in preventing postoperative recurrence of reruptures.It is more suitable for patients who are unable to tolerate prolonged immobilization and want to recover function as soon as possible,and doctors who are concerned about Achilles tendon rerupture after surgery.2.On the basis of suture with wire anchors,gastrocnemius muscle membrane inversion did not show significant advantages in functional results.Although the postoperative braking time was short,the surgical trauma was large,and it was not suitable for the treatment of fresh closed Achilles tendon rupture.3.After direct end-to-end suture for patients with fresh closed Achilles tendon rupture,short leg cast was used to fix the affected limb at 20° plantar flexion of ankle for 6 weeks on the dorsal side of the affected limb.Suture with wire anchor was safe for 3 weeks in the same way after gastrocnemius muscle membrane inversion or not.