Limited-Incision Kager's Fascia Flap Coverage Versus Open Repair for Acute Achilles Tendon Rupture: A Retrospective Comparative Study.

Abstract

Purpose: There is ongoing debate within the medical community regarding the optimal surgical technique for repairing Achilles tendon ruptures. Therefore, this study aimed to compare a novel limited-incision Kager's fascia flap coverage technique with conventional open repair for acute Achilles tendon rupture.

Methods: Ninety patients surgically treated for acute closed Achilles tendon rupture between January 2017 and December 2021 were retrospectively followed, including 41 with limited-incision Kager's fascia flap coverage technique and 49 with traditional open surgical suture. Functional outcomes were evaluated at 12 months postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Achilles Tendon Total Rupture Score (ATRS). Color Doppler ultrasound examination of Achilles tendon blood supply was performed at 3 months postoperatively to assess hemodynamic parameters. To evaluate the influence of age on outcomes, patients were divided into ≥ 50 years and < 50 years subgroups.

Results: The limited-incision Kager's fascia flap coverage group demonstrated superior outcomes compared with the traditional open surgery group. At 12-month follow-up, the fascia flap group had significantly higher AOFAS scores (91.43 ± 2.74 vs. 84.80 ± 2.85) and ATRS scores (94.56 ± 2.45 vs. 86.26 ± 3.15) than the control group (both p < 0.001). At 3-month postoperative ultrasound assessment, the fascia flap group also showed better hemodynamic parameters, with higher peak systolic velocity (11.44 ± 2.06 cm/s vs. 10.39 ± 1.83 cm/s, p = 0.012), higher end-diastolic velocity (4.45 ± 0.64 cm/s vs. 3.36 ± 0.51 cm/s, p < 0.001), and lower resistance index (0.60 ± 0.06 vs. 0.67 ± 0.08, p < 0.001) compared with the control group. In age-stratified analyses, the functional and hemodynamic advantages of the fascia flap technique showed consistent trends across both age subgroups, suggesting potential benefits for older patients. All differences were statistically significant (p < 0.05).

Conclusion: The limited-incision Kager's fascia flap coverage technique for treating acute closed Achilles tendon ruptures shows certain efficacy, improving limb function, reducing surgery-related injuries, and potentially promoting Achilles tendon healing by enhancing local blood supply at the rupture site, thereby improving clinical outcomes and outperforming traditional open surgery. Simultaneously, the technology demonstrates good efficacy across different age groups.