J Korean Foot Ankle Soc.  2021 Jun;25(2):89-94. 10.14193/jkfas.2021.25.2.89.

Management of Postoperative Complications Following Surgical Repair of Achilles Tendon Rupture

• Bae SY

• KMID: 2516646
• DOI: http://doi.org/10.14193/jkfas.2021.25.2.89

Abstract

The surgical repair of an Achilles tendon acute rupture is a proven, traditional treatment for optimal functional recovery. However, concerns regarding complications such as re-rupture, wound problems and infections are driving new techniques, including minimally invasive approaches and nonoperative treatments. If we understand the characteristics and contemplate treatment strategies for possible complications, the surgical repair of the Achilles tendon is an attractive option and can be expected to yield satisfactory functional recovery.

Keyword

Achilles tendon; Repair; Complications

Figure

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  Fig. 1 (A) A 58-year-old male patient who underwent surgical repair of Achilles tendon two months ago visited clinic due to persistent painful limping. T1-weighted sagittal magnetic resonance image showed high signal intensity and thinning of tendon suture site on Achilles lesion. (B) Turn-down flap from gastrocnemius was made after removing the remnant suture materials and the lesion. After removing the remnant suture materials and the lesion, we made turn-down flap from the gastrocnemius. (C) The gastrocnemius flap was pulled and sutured with the distal tendon in a plantarflexion position, and the remnant surrounding tissue was reconstructed on it.

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  Fig. 2 (A) The ultrasound image showed a gap (white bilateral arrows) caused by loss of continuity of Achilles tendon in the patients with re-rupture of Achilles tendon during hiking, who was a 71-year-old male and had a surgical history for a ruptured Achilles tendon 7 months ago. (B) The gap was narrowed after 2 months by conservative management including heel lifting and activity modification. (C) After three months of conservative treatment, the follow-up ultrasound image showed narrower gap and thicker surrounding tissue (small empty arrows), which replaced substantial continuity and the gait was improved.

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  Fig. 3 (A) A 39-year-old male patient visited clinic with an open wound and pus discharge that lasted six months after the open repair of Achilles tendon. (B) The enhanced T2-weighted sagittal magnetic resonance image showed infectious tissue accompanied by abscess but continuity of Achilles tendons was maintained. (C) The infectious tissue of tendon was extensively debrided and simple skin suture was performed after elliptic resection of sinus tract. Stiches were removed at 3 weeks after the surgery. The patient started normal gait at postoperative 10 weeks and returned to previous sports activity at postoperative 6 months.

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  Fig. 4 (A) Magnetic resonance image (MRI) of a 64-year-old male patient who visited clinic due to infected disruption of the surgical wound after the open repair of Achilles tendon rupture, shows continuity loss and infection. The T2-weighted sagittal MRI showed loss of continuity and infectious lesions in Achilles tendons for a 64-year-old male patient who visited our clinic due to claudication and infected surgical wound after the open repair of Achilles tendon rupture. (B) After complete resection of the infected Achilles tendon, he was treated with a 6-week short leg cast and then 6-week short leg brace, and the continuity of fibrous tissue was observed in ultrasound image 5 years after the surgery. His activity was recovered as same with the pre-injury level. Complete resection of infected Achilles tendon was performed and treated in the order of a 6-week short leg cast and then 6-week short leg brace. The ultrasound image at postoperative 5 year showed the continuity of fibrous tissue and the patients was recovered to previous injury activity level. (C) Ultrasound image for contralateral side.

Reference

1. Rensing N, Waterman BR, Frank RM, Heida KA, Orr JD. 2017; Low risk for local and systemic complications after primary repair of 1626 Achilles tendon ruptures. Foot Ankle Spec. 10:216–26. doi: 10.1177/1938640016676340. DOI: 10.1177/1938640016676340. PMID: 27837039.

2. Jildeh TR, Okoroha KR, Marshall NE, Abdul-Hak A, Zeni F, Moutzouros V. 2018; Infection and rerupture after surgical repair of Achilles tendons. Orthop J Sports Med. 6:2325967118774300. doi: 10.1177/2325967118774302. DOI: 10.1177/2325967118774302. PMID: 29854862. PMCID: PMC5971389.

3. Bruggeman NB, Turner NS, Dahm DL, Voll AE, Hoskin TL, Jacofsky DJ, et al. 2004; Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Relat Res. (427):63–6. doi: 10.1097/01.blo.0000144475.05543.e7. DOI: 10.1097/01.blo.0000144475.05543.e7. PMID: 15552138.

4. Hussien DG, Villarreal JV, Panchbhavi V, Jupiter DC. 2021; Predisposing factors for 30-day complications following Achilles tendon repair. J Foot Ankle Surg. 60:288–91. doi: 10.1053/j.jfas.2020.08.029. DOI: 10.1053/j.jfas.2020.08.029. PMID: 33461920.

5. Wu Y, Mu Y, Yin L, Wang Z, Liu W, Wan H. 2019; Complications in the management of acute Achilles tendon rupture: a systematic review and network meta-analysis of 2060 patients. Am J Sports Med. 47:2251–60. doi: 10.1177/0363546518824601. DOI: 10.1177/0363546518824601. PMID: 30781966.

6. Yang B, Liu Y, Kan S, Zhang D, Xu H, Liu F, et al. 2017; Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis. Int J Surg. 40:178–86. doi: 10.1016/j.ijsu.2017.03.021. DOI: 10.1016/j.ijsu.2017.03.021. PMID: 28288878.

7. Stavenuiter XJR, Lubberts B, Prince RM 3rd, Johnson AH, DiGiovanni CW, Guss D. 2019; Postoperative complications following repair of acute Achilles tendon rupture. Foot Ankle Int. 40:679–86. doi: 10.1177/1071100719831371. DOI: 10.1177/1071100719831371. PMID: 30808187.

8. Pean CA, Christiano A, Rubenstein WJ, Konda SR, Egol KA. 2018; Risk factors for complications after primary repair of Achilles tendon ruptures. J Orthop. 15:226–9. doi: 10.1016/j.jor.2018.01.017. DOI: 10.1016/j.jor.2018.01.017. PMID: 29657473. PMCID: PMC5895883.

9. Barber GR, Miransky J, Brown AE, Coit DG, Lewis FM, Thaler HT, et al. 1995; Direct observations of surgical wound infections at a comprehensive cancer center. Arch Surg. 130:1042–7. doi: 10.1001/archsurg.1995.01430100020005. DOI: 10.1001/archsurg.1995.01430100020005. PMID: 7575114.

10. Burrus MT, Werner BC, Park JS, Perumal V, Cooper MT. 2016; Achilles tendon repair in obese patients is associated with increased complication rates. Foot Ankle Spec. 9:208–14. doi: 10.1177/1938640015609983. DOI: 10.1177/1938640015609983. PMID: 26459362.

11. Liles J, Adams SB Jr. 2019; Management of complications of Achilles tendon surgery. Foot Ankle Clin. 24:447–57. doi: 10.1016/j.fcl.2019.04.008. DOI: 10.1016/j.fcl.2019.04.008. PMID: 31370996.

12. Deng S, Sun Z, Zhang C, Chen G, Li J. 2017; Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg. 56:1236–43. doi: 10.1053/j.jfas.2017.05.036. DOI: 10.1053/j.jfas.2017.05.036. PMID: 29079238.

13. Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, et al. 2008; Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial. Am J Sports Med. 36:1688–94. doi: 10.1177/0363546508319312. DOI: 10.1177/0363546508319312. PMID: 18645042.

14. Westin O, Nilsson Helander K, Grävare Silbernagel K, Samuelsson K, Brorsson A, Karlsson J. 2018; Patients with an Achilles tendon re-rupture have long-term functional deficits and worse patient-reported outcome than primary ruptures. Knee Surg Sports Traumatol Arthrosc. 26:3063–72. doi: 10.1007/s00167-018-4952-0. DOI: 10.1007/s00167-018-4952-0. PMID: 29691618. PMCID: PMC6154022.

15. van Maele M, Misselyn D, Metsemakers WJ, Sermon A, Nijs S, Hoekstra H. 2018; Is open acute Achilles tendon rupture repair still justified? A single center experience and critical appraisal of the literature. Injury. 49:1947–52. doi: 10.1016/j.injury.2018.08.012. DOI: 10.1016/j.injury.2018.08.012. PMID: 30144965.

16. Jones MP, Khan RJ, Carey Smith RL. 2012; Surgical interventions for treating acute Achilles tendon rupture: key findings from a recent Cochrane review. J Bone Joint Surg Am. 94:e88. doi: 10.2106/JBJS.J.01829. DOI: 10.2106/JBJS.J.01829. PMID: 22717840.

17. Majewski M, Rohrbach M, Czaja S, Ochsner P. 2006; Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med. 34:793–8. doi: 10.1177/0363546505283266. DOI: 10.1177/0363546505283266. PMID: 16627630.

18. Barfod KW, Sveen TM, Ganestam A, Ebskov LB, Troelsen A. 2017; Severe functional debilitations after complications associated with acute Achilles tendon rupture with 9 years of follow-up. J Foot Ankle Surg. 56:440–4. doi: 10.1053/j.jfas.2017.01.004. DOI: 10.1053/j.jfas.2017.01.004. PMID: 28216305.

19. Pajala A, Kangas J, Ohtonen P, Leppilahti J. 2002; Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 84:2016–21. doi: 10.2106/00004623-200211000-00017. DOI: 10.2106/00004623-200211000-00017. PMID: 12429764.

20. Bae SH, Lee HS, Seo SG, Kim SW, Gwak HC, Bae SY. 2016; Debridement and functional rehabilitation for Achilles tendon infection following tendon repair. J Bone Joint Surg Am. 98:1161–7. doi: 10.2106/JBJS.15.01117. DOI: 10.2106/JBJS.15.01117. PMID: 27440563.

21. Molloy A, Wood EV. 2009; Complications of the treatment of Achilles tendon ruptures. Foot Ankle Clin. 14:745–59. doi: 10.1016/j.fcl.2009.07.004. DOI: 10.1016/j.fcl.2009.07.004. PMID: 19857846.