Our Summary

This paper describes a study on a new surgical procedure for repairing Achilles tendon ruptures that have been left untreated for over four weeks. Traditionally, these surgeries involve removing the scar tissue that forms between the torn ends of the tendon and using healthy tissue from the patient’s body to reconstruct the tendon. However, this new procedure directly repairs the tear using the scar tissue itself, eliminating the need for transplanting healthy tissue.

The researchers trialed this new procedure on 30 patients and monitored their recovery over an average of 33 months. They measured the patients’ clinical outcomes before and after the surgery using two scoring systems: the Achilles Tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. They also performed pre- and post-surgery MRI scans and examined the scar tissue under a microscope.

Overall, the study found that the new procedure was effective. The patients’ AOFAS scores improved from an average of 82.8 before the surgery to 98.1 afterwards, and their average post-surgery ATRS was 92.0. None of the patients experienced a re-tear of the tendon or had difficulty walking or climbing stairs, and all except two could perform a single-limb heel rise. The athletes among the patients were able to return to their pre-injury level of sport. The MRI scans showed that the tendons had thickened and healed well, and the scar tissue was found to be made up of dense collagen fibers.

FAQs

  1. What is the new surgical procedure for repairing untreated Achilles tendon ruptures?
  2. How did the researchers measure the effectiveness of the new surgical procedure?
  3. What were the results of the study on the new surgical procedure for Achilles tendon repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tendon repair is to follow a comprehensive rehabilitation program post-surgery. This may include physical therapy exercises to strengthen the tendon and surrounding muscles, as well as gradually increasing activity levels to avoid re-injury. It is important to follow all post-operative instructions provided by the healthcare team to ensure optimal healing and a successful recovery.

Suitable For

Patients who are typically recommended tendon repair include those with Achilles tendon ruptures, especially those that have been left untreated for an extended period of time (over four weeks). These patients may experience difficulty walking, climbing stairs, or participating in sports, and may have a significant amount of scar tissue between the torn ends of the tendon. Other patients who may benefit from tendon repair surgery include those with chronic tendon injuries, severe tendonitis, or tendon tears that have not healed properly with conservative treatments. In some cases, tendon repair surgery may also be recommended for patients with tendon injuries resulting from trauma or overuse.

Timeline

Before tendon repair:

  • Patient experiences a rupture of the tendon, leading to pain, swelling, and difficulty walking or moving the affected joint.
  • Patient may undergo imaging tests such as MRI to confirm the diagnosis and determine the extent of the injury.
  • Patient may undergo non-surgical treatment such as rest, ice, physical therapy, and immobilization with a cast or brace.
  • If non-surgical treatment is unsuccessful or if the tendon rupture is severe, patient may undergo surgery to repair the tendon.

After tendon repair:

  • Patient undergoes the new surgical procedure for tendon repair, which directly repairs the tear using scar tissue.
  • Patient is monitored post-surgery for an average of 33 months, with clinical outcomes measured using scoring systems and imaging tests.
  • Patient experiences improvement in clinical outcomes, with increased AOFAS and ATRS scores, improved ability to walk and perform daily activities, and successful tendon healing.
  • Patient may need to undergo physical therapy and rehabilitation to regain strength and function in the repaired tendon.
  • Patient is able to return to normal activities, including sports, without experiencing re-tear of the tendon or significant difficulties.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tendon repair include:

  1. What are the risks and potential complications associated with the new surgical procedure for tendon repair?
  2. How does the recovery process differ between traditional tendon repair surgeries and the new procedure described in the study?
  3. How long does it typically take to recover and return to normal activities after undergoing this new procedure?
  4. Will physical therapy be necessary after the surgery, and if so, what will the rehabilitation process entail?
  5. What are the long-term outcomes and success rates of the new procedure compared to traditional tendon repair methods?
  6. Are there any specific lifestyle changes or precautions I should take to ensure optimal healing and prevent re-injury?
  7. How will my progress be monitored and evaluated after the surgery, and what signs should I look out for that may indicate a complication?
  8. Are there any alternative treatment options available for my tendon injury, and how do they compare in terms of effectiveness and recovery time?
  9. Will I need to make any modifications to my daily activities or exercise routine during the recovery period?
  10. Can you provide me with more information about the specific techniques and technology used in the new procedure for tendon repair, and how they contribute to better outcomes for patients?

Reference

Authors: Yasuda T, Shima H, Mori K, Kizawa M, Neo M. Journal: J Bone Joint Surg Am. 2016 Jul 20;98(14):1168-75. doi: 10.2106/JBJS.15.00865. PMID: 27440564