Ultrasound-assisted minimally invasive repair of acute Achilles tendon rupture with a shuttling needle.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2025-08-30 DOI:10.1186/s13018-025-06239-4

Chaonan Wang, Yajing Lin, Lina Ye, Zhanghuan Chi, Zhongliang Su

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引用次数: 0

Abstract

Background: The optimal management of acute Achilles tendon ruptures remains controversial. Open surgical repair (OSR) carries high complication rates, while minimally invasive techniques reduce risks but pose concerns regarding sural nerve injury. This study evaluates the clinical outcomes of ultrasound-assisted minimally invasive repair (MIR) using a double-ended shuttling needle.

Methods: A retrospective cohort of 41 patients (2017-2022) was analyzed: 19 underwent OSR (8-10 cm midline incision, Krackow suture), and 22 received MIR (2 cm incision, ultrasound-guided Bunnell suture with shuttling needle). Operative time, scar length, American Orthopaedic Foot & Ankle Society (AOFAS) score, Achilles Tendon Rupture Score (ATRS), calf circumference, and complications were compared. Statistical analyses included independent t-tests, Mann-Whitney U tests, and chi-square tests (α = 0.05).

Results: MIR demonstrated significantly shorter operative time (18.8 ± 3.0 min vs. 55.2 ± 6.5 min; p = 0.010) and smaller scars (2.02 ± 0.39 cm vs. 10.2 ± 1.9 cm; p = 0.005) versus OSR. No significant functional differences existed at 12 months (AOFAS: 90.2 ± 4.3 vs. 88.6 ± 3.8, p = 0.558; ATRS: 90.9 ± 3.3 vs. 89.7 ± 2.6, p = 0.601). Zero complications occurred with MIR, whereas the OSR had 1 superficial infection, 3 sural nerve injuries, and 2 cases of scar adhesion. MIR patients initiated controlled training at 3 months, showing superior trends in activity resumption.

Conclusion: Ultrasound-assisted MIR reduces operative time by 69.9%, minimizes scarring by 80.2%, and eliminates nerve injury risks while achieving functional parity with OSR. Long-term biomechanical performance and resource accessibility warrant further investigation.

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超声辅助下穿梭针微创修复急性跟腱断裂。

背景：急性跟腱断裂的最佳治疗方法仍然存在争议。开放手术修复（OSR）具有较高的并发症发生率，而微创技术降低了风险，但存在腓肠神经损伤的问题。本研究评估超声辅助下双端穿刺针微创修复（MIR）的临床效果。方法：回顾性分析2017-2022年41例患者，其中OSR （8-10 cm中线切口，Krackow缝合）19例，MIR （2 cm切口，超声引导Bunnell穿线缝合）22例。比较手术时间、疤痕长度、美国骨科足踝学会（AOFAS）评分、跟腱断裂评分（ATRS）、小腿围、并发症。统计分析采用独立t检验、Mann-Whitney U检验和卡方检验（α = 0.05）。结果：MIR与OSR相比，手术时间（18.8±3.0 min vs. 55.2±6.5 min; p = 0.010）明显缩短，疤痕（2.02±0.39 cm vs. 10.2±1.9 cm; p = 0.005）较小。12个月时功能差异无统计学意义（AOFAS: 90.2±4.3比88.6±3.8,p = 0.558; ATRS: 90.9±3.3比89.7±2.6,p = 0.601）。MIR组无并发症，OSR组有1例浅表感染，3例腓肠神经损伤，2例瘢痕粘连。MIR患者在3个月时开始控制训练，在活动恢复方面表现出优越的趋势。结论：超声辅助MIR手术时间缩短69.9%，瘢痕减少80.2%，消除神经损伤风险，功能与OSR相同。长期生物力学性能和资源可及性值得进一步研究。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.