The Reinforced Ma-Griffith Method Combined with Minimally Invasive Small-Incision Suture for Acute Achilles Tendon Rupture

Abstract

Objective: To evaluate the treatment effects of the reinforced Ma-Griffith method combined with a minimally invasive small incision(M-G/MISI) in the treatment of acute Achilles tendon rupture.

Methods: From January 2012 to January 2020, a retrospective study was carried out on thirty-one patients with acute Achilles tendon ruptures that were treated using the M-G/MISI. Patient with acute Achilles tendon rupture was operated on in the prone position. The M-G/MISI begin with making a small incision to debride the stumps of ruptured tendon. Then M-G/MISI was used to suture the distal and proximal Achilles tendons with the help of a epidural puncture needle and polydioxanone synthetic absorbable suture (PDS) Ⅱ line. Finally the stumps of ruptured tendon was reattached. After the surgery, the affected limb was fixed with either a plaster slab below the knee brace or a functional brace. Removal of plaster external fixation and partial weight-bearing with crutches five weeks after the operation; Complete weight-bearing nine weeks after the operation; jogging permitted 12 weeks after the operation; Patients were allowed to resume normal activities six months after the operation.

Results: All 31 patients in this study were male. Nineteen of these patients had Achilles tendon rupture on the right lower extremity, while 12 had ruptures on the left lower extremity. The patients had a mean age of 33.35 ± 7.13 years (range, 18-52 years). The mean operation time was 79.58 ± 22.67 minutes (range, 40-167 minutes). The mean time from injury to operation was 4.19 ± 2.01 days (range, 1-8 days), and the mean hospital stay was 9.87 ± 3.88 days (range, 5-22 days). The new technique had a small incision with a mean length of 3.94 ± 1.82 cm (range, 2-6 cm). The mean intraoperative blood loss was 16.77 ± 13.76 mL (range, 10-50 mL) and the mean follow-up time was 21.35 ± 10.18 months (range, 6-50 months). No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 97.00 (range, 93-100 points) AOFAS ankle-hindfoot score points and the mean ATRS was 97.39 (range, 91-100) points.

Conclusion: The reinforced Ma-Griffith method, combined with a minimally invasive small incision suture, is a simple, effective, minimally invasive technique and low-cost surgical method for the treatment of acute Achilles tendon rupture.

Keywords: Achilles tendon; Minimally invasive surgery; Reinforced Ma-Griffith method; Rupture; Small incision.

Fig. 1

Schematic diagram: The black dotted line indicates the suture track of the inside of the tendon. (A) Make an incision of about 2 cm on the medial side of the Achilles tendon; (B) cd is the two symmetrical points of the distal end of the Achilles tendon. The Kirschner needle is used to pass through the cd with the help of an electric drill, followed by an epidural puncture needle along the cd through the Achilles tendon, and the PDS II thread passes through it; (C) The epidural puncture needle passes through the Achilles tendon along the planned route before operation, and then the PDS II thread passes through the epidural puncture needle; (D) As mentioned above, the ruptured Achilles tendon is sutured according to the planned route.

Fig. 2

(A) Epidural puncture needle; (B) polydioxanone synthetic absorbable suture (PDS) II thread.

Fig. 3

A 29‐year‐old male with a ruptured Achilles tendon because of playing basketball. (A) Preoperative left lower limb MRI (magnetic resonance imaging, Siemens 3.0T) showed rupture of Achilles tendon; (B) before the operation, plan the suture route; (C) during the operation, with the help of epidural puncture needle, the PDS II thread passes through the Achilles tendon; (D) after the operation, the plaster was fixed; (E) the picture of the surgical incision when changing the dressing after the operation; (F) postoperative MRI picture.

Fig. 4

A 31‐year‐old male patient with ruptured Achilles tendon due to playing badminton. (A) Preoperative right lower limb MRI showed rupture of Achilles tendon; (B) before the operation, plan the suture route; (C) exposure of the broken end of the Achilles tendon during the operation; (D) before the incision is closed, a small incision can be seen; (E, F) postoperative MRI showed that the Achilles tendon had been repaired. During the follow‐up 6 months after operation, the incision was very small and the man returned to normal life.

Fig. 5

A 44‐year‐old middle‐aged man suffered a rupture of the Achilles tendon after a sprain. (A) Preoperative right lower limb MRI showed rupture of Achilles tendon; (B) draw the operation route before operation; (C) Suture Achilles tendon with the help of epidural puncture needle; (D) Close the incision and complete the operation; (E) On the second day after operation, the surgical incision was small and the patient was very satisfied; (F) Postoperative MRI showed that the Achilles tendon anastomosed well, and during the postoperative follow‐up, it was found that the patient returned to normal work and sports.