Minimally Invasive Surgery Versus Traditional Open Surgery For Acute Closed Achilles Tendon Rupture

Objective:To compare the effectiveness of the 2 methods(traditional open Achilles tendon anastomosis,minimally invasive Achilles tendon anastomosis with small incision)for acute Achilles tendon rupture and to retrospective analysis of post-healing conditions,so as to provide a reference for the choice of clinical treatment plans.Methods:A retrospective study was conducted on patients with acute closed Achilles tendon rupture who were admitted to our department from January 2016 to December 2019.A total of 110 people met the criteria,109 were unilateral Achilles tendon rupture,and 1 was bilateral Achilles tendon rupture.According to different surgical methods,patients were divided into traditional open Achilles tendon surgery group andminimally invasive Achilles tendon surgery group.Traditional open surgery group:85 patients,86 feet,81 males and 4 females,42 cases on the left side and 44 cases on the right side;the age was 15 to 58 years,average age 34.87±8.39;the time from injury to surgery was 0 to 14 days,an average of 3.47±3.01 days.Minimally invasive Achilles tendon surgery group: 25 patients,25 feet,including 24 males and 1 female,14 cases on the left side and 11 cases on the right side;the age was 26 to 56 years,average age 35.32±7.16;time from injury to surgery ranges from 0 to 14 days,with an average of 4.04±3.49 days.All patients were followed up for 6 to 48 months,with an average of 23.3 months.Compare the incision length,operation time and blood loss,length of hospital stay,healing of the incision(with or without skin necrosis of the incision margin,incision infection,and exposed Achilles tendon),sural nerve injury and recurrent rupture between the twogroups.And to evaluate the effect of Arner-Lindholm and AOFAS using the standard for evaluation of ankle function score.Statistical analysis used SPSS22.0 statistical software in this study.Results :To compare the general situation of the two groups of patients,there was no significant difference in gender,age,mechanism of injury,and injury to surgery time(P >0.05).Patients in the minimally invasive group had significantly shorter incision length and bleeding volume than traditional group,and there was a statistically significant difference(p <0.05).There was no significant difference in the operation time and hospital stay(p> 0.05).The overall complication rate in the traditional group was 8.4%,including 4 cases of incision infection,2 cases of secondary rupture of the Achilles tendon,and 1 case of deep vein thrombosis;overall complications rate in the minimalincision group was4%,one patient had secondary rupture.There was no significant difference in the efficacy score of Arner-Lindholm between the two groups of patients;the average AOFAS score:traditional group was 92.05±4.54,and the minimally invasive group was 94.44±3.04,and the difference was statistically significant(p <0.05).Conclusion:The above 2 procedures can be used to treat acute Achilles tendon rupture.However,minimally invasive surgery have small incisions,low bleeding volume,high postoperative AOFAS scores,and better aesthetic results.Innovative use of a proximal Box suture and a distal Bunnell suture under a small incision to increase the strength of the Achilles tendon and reduce the incidence of sural nerve injury,with fewer complications and good clinical results.