Long Term Clinical-Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig

Abstract

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical-functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical-functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle-Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical-functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

Keywords: Achilles tendon; patient outcome assessment; return to sports; sports; surgery; ultrasonography.

Figure 1

Flowchart of patient selection. DM II: diabetes mellitus type II; M&G: Ma and Griffith technique; TT: Tenolig technique.

Figure 2

Ma and Griffith surgical technique. (a) During surgery, the site of the ruptured tendon is marked. (b) Six small incisions (5 mm) are performed at the sides of the proximal (4) and distal stump (2) of the tendon (2 cm apart from each other) to be able to direct and cross the wire suture (c) using nonabsorbable suture woven through the proximal and distal parts of the tendon. (d–f) The suture, with two semicurved needles at the ends, is transversely passed through the tendon followed by a (diagonal) cross-suture (at each end of the thread) in proximal to distal direction. (g,h) Maintaining the ankle in maximum equinus position, the suture is tied after arming the stumps and cutting the needles off, making the two segments of the tendon adhere. (i) Immediately after surgery, a brace in equinus position is applied.

Figure 3

The Tenolig surgical technique. (a) The Tenolig device and its components. (b) During surgery, the tendon rupture point is marked. (c) The first small skin incision (<1 cm) is performed approximately 6 cm above the rupture zone. (d) The first needle is inserted taking care to allow the anchor to penetrate perpendicularly into the proximal side of the tendon and then remove it from the distal portion of the tendon, 4 or 5 cm below the rupture point. (e) The second incision is made, and (f) the same procedure is repeated with the second needle. At the end, both needles are cut. (g) The plastic buttons are applied to protect the skin. The two straps are pulled tight simultaneously while the ankle is maintained in equinus position, (h) and the weights are threaded to fix the straps distally. (i) The sutures of the skin are left long to allow the removal of the implant 45 days after surgery.