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Endoscopic-assisted locking block modified Krackow technique combined with a V-Y flap for chronic Achilles tendon rupture

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the clinical outcomes of the endoscopic-assisted locking block modified Krackow technique with a V-Y flap. The hypothesis was that the minimally invasive technique can reduce wound complications and facilitate early recovery.

Methods

In total, 29 men with chronic Achilles tendon rupture who underwent either minimally invasive technique (n = 13) or open repair (n = 16) at our department between 2013 and 2019 were retrospectively analyzed. The rate of complications, time to return to moderate-intensity exercise, American Orthopedic Foot and Ankle Society ankle hindfoot score, Achilles tendon Total Rupture Score, heel-rise repetitions in 1 min, heel-rise height, and bilateral calf circumference at 6 months, 1 year, and 2 years postoperatively were recorded.

Results

All incisions healed primarily in the minimally invasive technique group; however, three patients in the open repair group experienced wound complications. The time to return to moderate-intensity exercise, American Orthopedic Foot and Ankle Society score, Achilles tendon Total Rupture Score, heel-rise repetition ratio, and heel-rise height ratio at 6 months postoperatively in the minimally invasive technique group were significantly better than those in the open repair group. However, it was not significantly different between both groups at 2 years postoperatively.

Conclusion

Endoscopy allowed scar tissue and adhesions to be removed, allowing the tendon ends to be mobilized out of the small proximal and distal incisions. Minimally invasive technique may result in a lower wound complication incidence and provide better early functional recovery and return to moderate-intensity exercise time than the conventional open procedure in treating chronic Achilles tendon ruptures.

Clinical trial registration

Wuxi Ninth People’s Hospital Medical Ethical Committee, LW2021026.

Level of evidence

III.

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Funding

Wuxi “Double Hundred” Young and Middle-aged Medical and Health Top-notch Talent Project.

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Author notes

  1. Tonglong Xu, Xuanzhe Liu are co-first authors; Jian Tian, Shen Liu are co-corresponding authors.

Authors and Affiliations

  1. Department of Orthopedics, Soochow University Affiliated Wuxi Ninth People’s Hospital, NO 999 Liangxi, Wuxi, 214062, Jiangsu, China

    Tonglong Xu, Jian Tian, Jingyi Mi, Yajun Xu, Xueming Chen & Yuxuan Zhang

  2. Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Xuanzhe Liu & Shen Liu

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  1. Tonglong Xu
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Correspondence to Jian Tian or Shen Liu.

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All authors certify that this investigation was performed in conformity with ethical principles of research. Written informed consent was obtained from each participant, and the institutional review board was approved by Wuxi Ninth People’s Hospital Medical Ethical Committee.

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Xu, T., Liu, X., Tian, J. et al. Endoscopic-assisted locking block modified Krackow technique combined with a V-Y flap for chronic Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 31, 86–93 (2023). https://doi.org/10.1007/s00167-022-07167-0

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