Abstract
Category:
Sports; Trauma
Introduction/Purpose:
Achilles Tendon (AT) rupture is one of the most prevalent adult tendon injuries, with the incidence rate estimated to range between 7 to 40 in 100,000 person-years. This study aimed to assess the clinical and functional outcomes of a modified “Gift box” open technique for AT rupture repair.
Methods:
After receiving IRB approval, in a single center study in Tehran, Iran, we conducted a consecutive case-series study including 36 patients with acute AT rupture who underwent modified gift box AT repair using two mini-incisions and gift box sutures by expert surgeons affiliated with the local hospitals (Figure 1). The postoperative protocol involved all patients discontinuing the use of crutches after 4 weeks and removing their boot after 8 weeks. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure scores were obtained from all patients at 6, 9, 18, and 36 months postoperatively with a complementary follow-up in an average of 24 months (range of 18 to 48 months) after the last follow-up. The study also included other variables such as visual analog scale (VAS) for pain, calf atrophy, and the range of sagittal ankle motion, wound complications, sural nerve injury, and re-rupture rate.
Results:
The patients treated with modified gift box technique yielded AOFAS scores of 85±3 and ATRS of 84.7±5.4 at 36 months postoperatively, further improving to 86±7 and 85.2±5.1 respectively during extended follow-up (up to 2 years). Approximately 82% of patients regained normal activities of daily living within 4 months, while 91.5% recovered preinjury vigorous activity levels by 6 months postoperatively. Mean VAS pain scores decreased from 7.9±0.9 at 2 months to < 4 after 3 months. Isokinetic testing demonstrated plantar flexion and dorsiflexion strength deficits of 84.9±5.3% and 89.8±4.7% respectively compared to the contralateral uninjured side at 3 months, resolving to equivalent strength by 42 months. Dorsiflexion range of motion reached 94% of normal at 5 years follow-up, though calf circumference remained < 95% of normal size.
Conclusion:
The modified gift box technique for AT rupture repair using two mini-incisions and gift box sutures, which we assume to be less invasive compared to the previously reported method, demonstrated favorable clinical outcomes with high patient satisfaction levels. Patients experienced significant improvements in functional scores, pain levels, strength, and range of motion over time, with most regaining their ability to perform activities of daily living and returning to preinjury levels of physical activity. While some residual deficits were observed, the procedure was well-tolerated with no significant complications, suggesting it is a safe and effective treatment option.
