Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial.

INTRODUCTION: Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. It is important to evaluate whether early functional weight-bearing rehabilitation program after minimally invasive repair results in an earlier return to pre-injury activity but increases the risk of re-rupture. MATERIALS AND METHODS: This was a prospective randomized controlled trial involving 68 AATR patients undergoing minimally invasive surgery. 34 patients were enrolled in early weight­bearing mobilization accelerated rehabilitation group (AR group); 34 patients were enrolled in the traditional rehabilitation (TR) group. Outcomes measures included American Orthopaedic Foot and Ankle Society Score (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS) score before surgery and 3, 6, and 12 months after surgery, incidence rate of Achilles tendon re-rupture and total complications, length of hospital stay, time return to work and sports. RESULTS: There was no significant difference in preoperative basic data between the two groups. However, AOFAS score and ATRS score were better in AR group than TR group at 3 months postoperatively (92.4 ± 3.5 vs 88.3 ± 4.5, P < 0.01; 91.1 ± 4.4 vs 88.9 ± 3.4, P = 0.03, respectively), the mean length of hospital stay (4.7 ± 1.5 vs 7.6 ± 2.0 days, P < 0.01) and time return to work (4.5 ± 1.0 vs 7.5 ± 1.6 weeks, P < 0.01) were shorter in AR group than in TR group. No statistical significance was calculated in patient-reported outcomes during the rest of the follow-up time and complications. CONCLUSION: Early accelerated rehabilitation with weight-bearing in patients with AATR after minimally invasive surgery results in better early functional outcomes and shows similar security and feasibility. REGISTRATION NO: ChiCTR2100043398.

Biomechanical Comparison of Panda Rope Bridge Technique and Other Minimally Invasive Achilles Tendon Repair Techniques In Vitro.

BACKGROUND: Although nonoperative management of acute Achilles tendon rupture (ATR) is a reasonable option, surgical repair has attracted attention for young and active patients. More reliable Achilles tendon repair techniques are needed to enhance recovery after ATR in this population. PURPOSE/HYPOTHESIS: To biomechanically analyze the panda rope bridge technique (PRBT) and compare it with other minimally invasive repair techniques over a simulated, progressive rehabilitation program. It was hypothesized that PRBT would result in better biomechanical properties and enhanced recovery after ATR. STUDY DESIGN: Controlled laboratory study. METHODS: An Achilles tendon rupture was created 4 cm from the distal tendon insertion site in 40 bovine lower extremities, and specimens were then randomly allocated to 5 Achilles tendon repair techniques: (1) Achillon, (2) modified Achillon, (3) Percutaneous Achilles Repair System (PARS), (4) modified PARS, and (5) PRBT. Each group was subjected to a cyclic loading protocol that was representative of progressive postoperative rehabilitation for ATR (250 cycles at 1 Hz for each loading stage: 20-100 N, 20-200 N, 20-300 N, and 20-400 N). RESULTS: The PRBT technique demonstrated significantly less elongation (1.62 ± 0.25 mm) than the 4 other repair techniques after the first loading stage of 20 to 100 N (P < .05). All specimens in the 4 other groups developed a large gap (elongation ≥5 mm) at the 20- to 200-N loading stage. When overall biomechanical performance was examined, the PRBT group exhibited higher strength (20-400 N) and more mean loading cycles (984 ± 10) compared with the 4 other groups (P < .05). CONCLUSION: In this bovine model, PRBT biomechanically outperformed the other minimally invasive Achilles tendon repair techniques that were tested and could therefore meet the requirements of accelerated rehabilitation. CLINICAL RELEVANCE: The reduced tendency for premature rerupture and the overall improved biomechanical properties of PRBT suggest that ATR patients treated with PRBT may more readily complete early and aggressive postoperative rehabilitation protocols. In addition, they may have a lower risk of early irreversible suture failure.

[Biomechanical comparison study of two ultra-strong sutures in repair of Achilles tendon via panda rope bridge technique].

OBJECTIVE: To compare the biomechanical properties of two ultra-strong sutures and suturing methods in panda rope bridge technique (PRBT) application, and provide guidance for clinical selection of suture threads and suture methods. METHODS: Forty Achilles tendons from bulls were randomly divided into 4 groups ( n=10) and transected at the 4 cm proximal to the tendon insertion. Groups A and B used Ethibond sutures (USP 5), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed through a calcaneus canal. Groups A and B had 4 and 8 threads through the stump plane, respectively. Groups C and D used Ultrabraid sutures (USP 2), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed in the calcaneus with two anchors. Groups C and D had 4 and 8 threads through the stump plane, respectively. The dynamic tensile forces of 20-100, 20-200, 20-300, and 20-400 N were tested respectively by using a dynamic tensile testing machine at 0.5 Hz for 250 cycles. After each stage of testing, the gap between stumps was measured with a caliper and the type of suture failure was recorded. RESULTS: After dynamic tensile forces of 20-100 N and 20-200 N, the gaps of the four groups arranged from small to large were groups D, B, C, and A. The differences between groups A and B and groups C and D were significant ( P<0.05). But after dynamic tensile forces of 20-300 N and 20-400 N, the gaps were more than 5 mm in all groups. The suture retention rates of the four groups after dynamic tensile forces of 20-100 N and 20-200 N were all 100%. The suture retention rates of groups A, B, C, and D were 0, 80%, 60%, and 100%, respectively after dynamic tensile forces of 20-300 N. The differences of suture retention rates between group A and groups B and D were significant ( P<0.05). There was no significant difference between groups B, C, and D ( P>0.05). After dynamic tensile forces of 20-400 N, the suture retention rates of groups A, B, C, and D were 0, 50%, 0, and 70%, respectively. There were significant differences between groups A and B and groups C and D ( P<0.05). CONCLUSION: Repairing Achilles tendon rupture via PRBT with 8 ultra-strong sutures through the stump plane can meet the mechanical requirements for walking by using ankle boots and heel pads in the early accelerated rehabilitation after operation.

Biomechanical comparison study of two ultra-strong sutures in repair of Achilles tendon via panda rope bridge technique / 中国修复重建外科杂志

Objective: To compare the biomechanical properties of two ultra-strong sutures and suturing methods in panda rope bridge technique (PRBT) application, and provide guidance for clinical selection of suture threads and suture methods. Methods: Forty Achilles tendons from bulls were randomly divided into 4 groups ( n=10) and transected at the 4 cm proximal to the tendon insertion. Groups A and B used Ethibond sutures (USP 5), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed through a calcaneus canal. Groups A and B had 4 and 8 threads through the stump plane, respectively. Groups C and D used Ultrabraid sutures (USP 2), the proximal end was fixed at the myotendious junction with Krackow sutures and the distal end was fixed in the calcaneus with two anchors. Groups C and D had 4 and 8 threads through the stump plane, respectively. The dynamic tensile forces of 20-100, 20-200, 20-300, and 20-400 N were tested respectively by using a dynamic tensile testing machine at 0.5 Hz for 250 cycles. After each stage of testing, the gap between stumps was measured with a caliper and the type of suture failure was recorded. Results: After dynamic tensile forces of 20-100 N and 20-200 N, the gaps of the four groups arranged from small to large were groups D, B, C, and A. The differences between groups A and B and groups C and D were significant ( P0.05). After dynamic tensile forces of 20-400 N, the suture retention rates of groups A, B, C, and D were 0, 50%, 0, and 70%, respectively. There were significant differences between groups A and B and groups C and D ( P<0.05). Conclusion: Repairing Achilles tendon rupture via PRBT with 8 ultra-strong sutures through the stump plane can meet the mechanical requirements for walking by using ankle boots and heel pads in the early accelerated rehabilitation after operation.

Treatment of acute achilles tendon rupture with the panda rope bridge technique.

INTRODUCTION: Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. METHODS: Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. RESULTS: PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. 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 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. CONCLUSION: The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation.

Canopy bridges as road overpasses for wildlife in urban fragmented landscapes / Pontes de corda como passagens para animais silvestres em paisagens urbanas fragmentadas

The effects of habitat fragmentation and deforestation are exacerbated by some elements, such as roads and power lines, which may become filters or barriers to wildlife movements. In order to mitigate mortality and restore connectivity, wildlife passages are being constructed as linear corridors. The installation of these mitigation measures must be followed by systematic monitoring, in order to evaluate their use and effectiveness, to assist in their management, and to convince stakeholders of their value. In this paper we present the results of a monitoring study of the use of rope overpasses developed near a protected area in Porto Alegre, southern Brazil. The canopy bridges were installed by the Urban Monkeys Program in places where electric hazards and road-kills of brown howler monkeys (Alouatta guariba clamitans Cabrera, 1940) were recorded. Camera traps were installed at each bridge, and local people were selected and trained to monitor overpass use over 15 months, from August 2008 to October 2009. Three species were recorded using canopy bridges: brown howler monkey (Alouatta guariba clamitans Cabrera, 1940), white-eared opossum (Didelphis albiventris Lund, 1840) and porcupine (Sphiggurus villosus Cuvier, 1823). Rope bridges with the highest number of species recorded had more forest cover and lower urban area around them than overpasses little used. Our results indicate that overpasses, in Porto Alegre, work as a linear corridor between forest remnants, although the outcomes for individual survival, group persistence, population demography or gene flow have not been measured. Furthermore, canopy bridges may be important to mitigate the impact of roads and power lines on wildlife, but electric cables also need to be completely isolated when present, to warrant animals' physical integrity.

Os efeitos do desmatamento e da fragmentação de hábitats são exacerbados por elementos como rodovias e redes elétricas, que podem atuar como filtros ou barreiras aos movimentos da vida silvestre. Com o objetivo de mitigar a mortalidade e restaurar a conectividade, passagens de fauna têm sido construídas como corredores lineares. A instalação dessas estruturas deve ser seguida de monitoramento sistemático, visando à avaliação de seu uso e efetividade e a geração de informações para seu manejo e para convencer os tomadores de decisão sobre seu valor. Neste artigo, apresentamos os resultados do monitoramento do uso de seis pontes de corda, realizado durante 15 meses, entre agosto de 2008 e outubro de 2009, nas imediações da Reserva Biológica do Lami José Lutzenberger, em Porto Alegre, Brasil. As pontes de dossel foram instaladas pelo Núcleo de Extensão Macacos Urbanos em locais com registros de atropelamentos e choques elétricos de bugios-ruivos (Alouatta guariba clamitans Cabrera, 1940). Instalamos armadilhas fotográficas em cada ponte e selecionamos moradores locais para registrarem seu uso. Três espécies foram registradas usando as pontes de corda: o bugio-ruivo (Alouatta guariba clamitans Cabrera, 1940), o gambá-de-orelha-branca (Didelphis albiventris Lund, 1840) e o ouriço-cacheiro (Sphiggurus villosus Cuvier, 1823). As pontes de corda mais usadas por maior número de espécies são aquelas situadas nas áreas de maior cobertura florestal e menor área urbanizada, em relação às pontes menos usadas pelas espécies. Nossos resultados indicam que as pontes de corda funcionam como um corredor linear entre os remanescentes florestais, embora não tenhamos avaliado os efeitos das pontes sobre a sobrevivência dos indivíduos, persistência e demografia dos grupos e fluxo gênico na população. Além disso, as pontes podem ser usadas para mitigar o impacto de redes elétricas e rodovias sobre a mortalidade, mas os cabos elétricos também devem ser completamente isolados quando presentes.