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A comparison of characteristics and outcomes of operative treatment for Achilles tendon sleeve avulsion in older versus younger patients

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Achilles tendon sleeve avulsion (ATSA) is a rare injury that often results from pre-existing insertional Achilles tendinopathy and occurs when a tendon avulses from the insertion as a continuous sleeve. To date, outcomes of operative treatment for ATSA in older patients have not been reported. Therefore, this study aims to compare the characteristics and outcomes of Achilles tendon (AT) reattachment with or without tendon lengthening for ATSA between older and younger patients.

Materials and methods

This study enrolled 25 consecutive patients who underwent operative treatment following a diagnosis of ATSA between January 2006 and June 2020. The inclusion criterion was a minimum follow-up duration of one year. The enrolled patients were divided into two groups according to their age at operation: ≥ 65 years (group 1, 13 patients) and < 65 years (group 2, 12 patients). AT reattachment was performed in all patients using two 5.0-mm suture anchors after an inflamed distal stump resection in the 30° plantar-flexed ankle position.

Results

The degree of active dorsiflexion and plantar flexion, mean visual analog scale score, and Victorian Institute of Sports Assessment-Achilles scores at the final follow-up were not significantly different between the two groups (P > 0.05 each). The rate of satisfactory clinical outcomes (defined as fair or greater) was 84.6% and 91.7% in groups 1 and 2, respectively.

Conclusion

We observed that comparable clinical outcomes could be achieved after AT reattachment with or without lengthening for ATSA between older and younger patients.

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References

  1. Huttunen TT, Kannus P, Rolf C, Felländer-Tsai L, Mattila VM (2014) Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med 42(10):2419–2423

    Article  PubMed  Google Scholar 

  2. Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J (2015) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sport 25(1):e133-138

    Article  CAS  Google Scholar 

  3. Zellers JA, Carmont MR, Silbernagel KG (2016) Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of the rate and measures of return to play. Br J Sports Med 50(21):1325–1332

    Article  PubMed  Google Scholar 

  4. Kleiman M, Grose AE (1983) Achilles tendon rupture following steroid injection. Report of three cases. J Bone Joint Surg Am 65(9):1345–1347

    Article  Google Scholar 

  5. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HM, Rowlands S, Stricker BH (2003) Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med 163(15):1801–1807

    Article  PubMed  Google Scholar 

  6. Hess GW (2010) Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec 3(1):29–32

    Article  PubMed  Google Scholar 

  7. Bibbo C (2004) Technical tip; limited dual incision technique for repair of Achilles sleeve avulsion. Foot Ankle Int 25(7):513–515

    Article  PubMed  Google Scholar 

  8. Schipper ON, Anderson RB, Cohen BE (2018) Outcomes after primary repair of insertional ruptures of the Achilles tendon. Foot Ankle Int 39(6):664–668

    Article  PubMed  Google Scholar 

  9. Yang Y, Wang D, Wei L et al (2020) Repair of Achilles sleeve avulsion: a new transosseous suture technique. J Orthop Surg Res 15:224

    Article  PubMed  PubMed Central  Google Scholar 

  10. Huh J, Easley ME, Nunley JA (2016) Characterization and surgical management of Achilles tendon sleeve avulsions. Foot Ankle Int 37(6):596–604

    Article  PubMed  Google Scholar 

  11. Sabharwal S, Wilson H, Reilly P, Gupte CM (2015) Heterogeneity of the definition of elderly age in current orthopaedic research. Springerplus 17(4):516

    Article  Google Scholar 

  12. Delgado DA, Lambert BS, Boutris N et al (2018) Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2(3):e088

    PubMed  PubMed Central  Google Scholar 

  13. Robinson JM, Cook JL, Purdam C et al (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35(5):335–341

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ninomiya H, Watanabe M, Kamimura K (2021) Innovative fixation technique for avulsion fractures of the calcaneal tuberosity. J Foot Ankle Surg 60(1):218–220

    Article  PubMed  Google Scholar 

  15. Beavis RC, Rourke K, Court-Brown C (2008) Avulsion fracture of the calcaneal tuberosity: a case report and literature review. Foot Ankle Int 29(8):863–866

    Article  PubMed  Google Scholar 

  16. Huang J, Wang C, Ma X, Wang X, Zhang C, Chen L (2015) Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med 43(4):1008–1016

    Article  PubMed  Google Scholar 

  17. Bibbo C, Anderson RB, Davis WH, Agnone M (2003) Repair of the Achilles tendon sleeve avulsions: quantitative and functional evaluation of a transcalcaneal suture technique. Foot Ankle Int 24(7):539–544

    PubMed  Google Scholar 

  18. Pavlou G, Roach R, Salehi-Bird S (2009) Repair of the Achilles tendon sleeve avulsions: a transcalcaneal suture. Foot Ankle Int 30(1):65–67

    Article  PubMed  Google Scholar 

  19. Işık Ç, Tahta M (2017) Primary repair of Achilles tendon avulsions: presentation of a novel technique and its comparison with suture anchor repair. J Orthop Surg 25(3):1–6

    Article  Google Scholar 

  20. Maniscalco P, Bertone C, Bonci E, Donelli L, Pagliantini L (1998) Titanium anchors for the repair of distal Achilles tendon ruptures: preliminary report of a new surgical technique. J Foot Ankle Surg 37(2):96–100

    Article  CAS  PubMed  Google Scholar 

  21. Lui TH (2009) Fixation of tendo Achilles avulsion fracture. Foot Ankle Surg 15(2):58–61

    Article  CAS  PubMed  Google Scholar 

  22. Kiliçoğlu Ö, Türker M, Yildiz F, Akalan E, Temelli Y (2014) Suture anchor tenodesis in repair of distal Achilles tendon injuries. Eur J Orthop Surg Traumatol 24(1):117–122

    Article  PubMed  Google Scholar 

  23. Yamaguchi S, Endo J, Yamamoto Y, Sasho T (2015) Double-row bridging suture fixation augemented with double Krachow suture for the repair of avulsion of the ossified Achilles tendon: a technical tip. Foot Ankle Int 36(7):849–852

    Article  PubMed  Google Scholar 

  24. Longo UG, Candela V, Berton A et al (2020) Less invasive fixation of acute avulsions of the Achilles tendon: a technical note. Medicina (Kaunas) 56(12):715

    Article  PubMed  Google Scholar 

  25. Alhaug OK, Berdal G, Husebye EE, Hvaal K (2019) Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study. Foot Ankle Surg 25(5):630–635

    Article  PubMed  Google Scholar 

  26. Wegrzyn J, Luciani JF, Philippot R, Brunet-Guedj E, Moyen B, Besse JL (2010) Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop 34(8):1187–1192

    Article  PubMed  Google Scholar 

  27. Campillo-Recio D, Ibañez M, Hormigo-Garcia H, Jimeno-Torres E, Vilá-Rico J, Alberti-Fito G (2021) Arthroscopic flexor halluces longus transfer and percutaneous Achilles tendon repair for distal traumatic ruptures. Arthrosc Tech 10(11):e2435–e2442

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hong CC, Nag K, Tan KJ (2015) Arthroscopic flexor hallucis longus transfer for chronic Achilles tendon rupture. Tech Foot Ankle Surg 14(3):128–133

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea

    Jun Young Choi, Sung Sahn Lee, Tae Hun Song & Jin Soo Suh

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  1. Jun Young Choi
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  2. Sung Sahn Lee
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  3. Tae Hun Song
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  4. Jin Soo Suh
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Contributions

JYC wrote the article by organizing the data, participated in the design of the study and performed the statistical analysis. SSL helped with writing in English. THS sorted the involved patients with a review of the medial record. JSS conceived of the study and participated in its design and coordination and helped to draft the manuscript.

Corresponding author

Correspondence to Jin Soo Suh.

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Conflict of interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Data availability

All data generated or analyzed during this study are included in this published article.

Ethics approval

This study was approved by Inje University Ilsan Paik Hospital ethics review committee (2022–02-030) and performed according to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients prior to enrolment.

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Written informed consent was obtained from all enrolled patients.

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Choi, J.Y., Lee, S.S., Song, T.H. et al. A comparison of characteristics and outcomes of operative treatment for Achilles tendon sleeve avulsion in older versus younger patients. Arch Orthop Trauma Surg 143, 6513–6520 (2023). https://doi.org/10.1007/s00402-023-04945-4

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  • DOI: https://doi.org/10.1007/s00402-023-04945-4

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