A Clinical Comparative Study Of Three Different Surgical Techniques Repair Of Acute Achilles Tendon Rupture

purpose: Acute Achilles tendon rupture is a common foot and ankle sports injury.In recent years,with the development of a wide range of fitness exercises,the incidence rate has increased rapidly.The treatment of acute Achilles tendon rupture is mainly surgery,The clinical treatment methods and repair techniques for acute Achilles tendon rupture are constantly being developed and updated,but the optimal treatment strategy has not yet reached a consensus.This study was conducted to compare the efficacy and complications of mini-incision repair with double-Tsuge loop sutures,improved Krackow minimally invasive technique sutures and traditional Krackow suture open technique repair.It is expected to provide a theoretical basis for the selection of surgical treatment strategies for acute Achilles tendon rupture.Methods:A retrospective study was conducted by selecting 70 patients of which 66(94%)were male patients and 4(6%)were female patients(6%)with an average age of37.3±7.7 years with acute closed Achilles tendon rupture admitted to the First Affiliated Hospital of Dalian Medical University from August 1,2012 to August 1,2020,the clinical data and follow-up of these patients were retrospectively reviewed.Group A mini-incision repair with double-Tsuge loop sutures included 26(37%)patients,Group B improved Krackow minimally invasive technique sutures included 19(27%)patients,and Group C traditional Krackow suture open repair included 25(36%)patients.And focusing on comparing the operation time,Incision length,Duration of postoperative hospital stay,Incidence of postsurgical complications,the time to complete20 consecutive single heel lifts after surgery,The maximum mobility of the ankle joint,The American Orthopaedic Foot and Ankle Association(AOFAS)Ankle-Hindfoot Score,Achilles Tendon Rupture Score(ATRS)and Arner-Lindholm efficacy score.Result: By comparing the general statistical data of the three groups of injured patients,it was found that there was no significant difference in age(p=0.997),gender(p=0.711),duration from injury to surgery(p=0.064),and cause of injury(p=0.958).There was no difference in the time to complete 20 consecutive single heel lifts after surgery(p=0.082),The maximum mobility of the ankle joint(p=0.493),The American Orthopaedic Foot,Ankle Association(AOFAS)Ankle-Hindfoot Score(p=0.370),ATRS(p=0.816)and Arner-Lindholm efficacy score(p=0.520)among patients in the three groups,The average operation time,average incision length,and average length of duration of postoperative hospital stay in group C were larger than those in both groups A and B(p<0.05),And the average operation time,average incision length and average length of duration of postoperative hospital stay between groups A and B showed no significant difference(p=0.171;p=0.385;p=0.392).The overall complication rate in the group A patients was 4%,one patient had delayed wound healing after surgery;overall complications rate in the group B patients was 5%,one case had delayed wound healing;overall complications rate in the group C patients was 24%,including 4 cases of delayed wound healing after surgery,1 case of Infection with tendon necrosis,1 case of Stiffness of the ankle,1 case of reflex sympathetic dystrophy.Conclusion: The three surgical techniques can achieve the purpose of effectively repairing acute Achilles tendon rupture,and the clinical effect is satisfactory.Compared with the traditional Krackow suture open repair,the mini-incision repair with double-Tsuge loop sutures and the improved Krackow minimally invasive technique sutures have the advantages of significantly shortening the operation time and duration of postoperative hospital stay,reducing postoperative complications and improving the appearance of the incision.