Outcomes of Limited Open Achilles Repair Using Modified Ring Forceps

Background: The optimal treatment of acute Achilles tendon ruptures remains controversial. When surgical repair is undertaken, the reported rate of infections and wound-healing complications ranges from 2% to 5%. Meta-analyses have demonstrated that minimally invasive approaches have equivalent rerupture rates, a significantly lower risk of superficial infections, and higher patient satisfaction rates compared with traditional open Achilles repair techniques. Purpose: To review the clinical outcomes of acute, limited open Achilles tendon repair using modified ring forceps and to analyze functional results using foot and ankle-specific outcome measures. Study Design: Case series; Level of evidence, 4. Methods: The clinical records of 32 consecutive patients (mean age, 44 years) with 33 acute Achilles tendon ruptures were retrospectively reviewed. All patients underwent limited open repair with modified ring forceps through a 2- to 3-cm midline incision. Suture placement into the tendon stumps was guided using a pair of ring forceps bent 30 degrees. Three No. 2 nonabsorbable sutures were placed in the proximal and distal segments, the tendon ends were reapproximated, and the sutures were tied to secure the tendon. Outcomes from a 10-cm visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sport Assessment-Achilles (VISA-A) were assessed. Results: At final follow-up (mean, 42.1 months [range, 6-90 months]), 31 of 32 patients (33 Achilles tendons) reported no pain in their Achilles, with amean Achilles VAS score of 0.7 +/- 4.2 of 100. The mean postoperative VISA-A score was 82.3 +/- 19.5 of 100. The mean FAAM activities of daily living and sports subscores were 96.5% +/- 5.2% and 85.1% +/- 21.2%, respectively. Regarding current functional level, 19 of 33 tendons (57.6%) were rated as "normal," 10 (30.3%) as "nearly normal," and 4 (12.1%) as "abnormal"; none were rated as "severely abnormal." There was 1 case (3.0%) of a superficial infection; there were no cases of deep infections, sural neuritis, or reruptures. The cost of the modified ring forceps technique is 5.3 to 12.1 times less than commercially available devices. Conclusion: Limited open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief, favorable functional outcomes, and a very low complication rate at midterm follow-up.