Minimally Invasive Repair of Acute Achilles Tendon Rupture Using Gift Box Technique

Background: This study aimed to introduce a modified technique for minimally invasive Achilles tendon (AT) rupture repair using gift box sutures. The preliminary clinical and functional outcomes were investigated among a number of patients. Methods: In a consecutive case series study, 24 patients with acute AT rupture underwent modified minimally invasive AT repair using two mini-incisions and gift box sutures. The patients were followed up for 24 months. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure score were obtained from all patients. The other measured variables included pain intensity and satisfaction using a visual analog scale (VAS), calf atrophy, the range of sagittal ankle motion, development of wound complications, sural nerve injury, and re-rupture. Results: After two years, the mean scores of AOFAS and ATRS were obtained at 83±4 and 81.9±6.3, respectively. Approximately 87.5 % of the patients regained their previous level of activity. The mean VAS score was 7.7±0.9 regarding the satisfaction with the outcomes. Moreover, isokinetic testing of plantar flexion and dorsiflexion strength were 82.7±5.8 and 87.7±4.1%, respectively, compared to those of the normal side. The calf atrophy was not statistically significant. In total, five patients reported pain during their activities. The range of operated ankle motion decreased significantly, compared to that of the other side; however, the differences were not significant functionally. There was no patient with wound complications, nerve injury, or complaint about problem with footwear. Conclusion: Minimally invasive repair of acute AT rupture using two mini-incisions and gift box sutures offers good functional and clinical outcomes without wound complications which can be usually observed following open repair of AT ruptures. Level of evidence: III