Fixation Technique and Outcomes for Achilles Tendon Sleeve Avulsion Injury From the Calcaneus: A Case Series and Review of the Literatures
Chamnanni Rungprai MD1, Yantarat Sripanich MD1
Affiliation : 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Objective : Surgical treatment of Achilles tendon sleeve avulsion from its insertion is challenging. The purpose of this study
is to report a surgical technique for Achilles tendon sleeve avulsion injuries including outcomes and complication in four
patients.
Materials and Methods: A prospective case series of Achilles tendon sleeve avulsion injuries which underwent open
gastrocnemius lengthening, calcaneal exostectomy, debridement of the Achilles tendon, and reattachment of the Achilles
tendon to the calcaneus using double-row SutureBridgeTM technique was conducted. Patient self-reporting questionnaires and
outcome measures including general health (Short Form-36 [SF-36]), region-specific outcomes (Foot and Ankle Ability
Measure [FAAM]), and pain measure (Visual Analogue Scale [VAS]) were recorded at pre- and final post-operative visits.
Results : Four male patients, mean age of 52 years, were included in this study. An average follow-up time was 15 months
(range 12 to 18 months). There was significant improvement of SF-36 (25.4, 28.5, 24.1, and 28.7 which were improved to
50.5, 55.2, 51.7, and 52.8 for PCS and 42.4, 48.8, 45.2, and 46.2 which were improved to 55.9, 56.7, 54.3, and 59.8 for MCS);
FAAM (60, 67, 65, and 68 which decreased to 21, 30, 30, and 33 for ADL and 0, 0, 0, and 0 which improved to 72, 70, 69,
and 66 for sports); and VAS score (5, 7, 6, and 8 which decreased to 0, 0, 0, and 0) for the first, second, third, and fourth
patients, respectively. All patients returned to daily activities and work at 6 weeks and returned to sports activities
approximately 6 months post-operatively. There were no complications in this study.
Conclusion : The SutureBridgeTM technique appears to be an effective technique which has demonstrated promising results
with minimal complications for treatment of Achilles tendon sleeve avulsion injury.
Keywords : Achilles Tendon Sleeve Avulsion, Achilles Tendon Rupture, Achilles Tendinopathy, SutureBridge technique
