Modified overlapping suture technique for the repair of horse-tail-like achilles tendon tears: technical description and clinical results

Objective To discuss the clinical efficacy of the modified overlapping suture technique to treat horse-tail-like Achilles tendon tears. Methods A retrospective analysis was conducted on data from 57 patients with horse-tail-like Achilles tendon tears treated with the overlapping suture technique from May 2020 to May 2024. Calculate the final Arner-Lindholm scores and compare the AOFAS scores, maximum plantar flexion angle, and dorsiflexion angle of the ankle joint before and after surgery, and record the muscle strength of the plantar flexor muscles of the ankle joint and compare it with that before the surgery. Results On average, 57 patients completed follow-up within 2 years. One patient experienced delayed wound healing after surgery, two patients re-ruptured their Achilles tendons three weeks post-surgery due to accidental falls, and one patient had a contralateral Achilles tendon rupture 2–4 years post-surgery. In addition, there were no symptoms of peroneal nerve injury after the surgery. The excellent and good rate of the Arner-Lindholm score after surgery was 98.2%; the postoperative AOFAS scores were (92.56 ± 6.71) points, (95% CI, 90.81–94.30), which showed a significant difference compared to the preoperative score of (64.92 ± 9.08) points, (95% CI, 62.56–67.27) ( p 0.00<0.01). The muscle strength of the plantar flexor group in the affected ankle joint post-surgery was (4.62 ± 1.7) grades (95% CI, 4.17–5.06), which showed no statistical significance compared to the healthy side (4.80 ± 1.3) grades (95% CI, 4.46–5.13) ( p 0.527 > 0.05); however, there was a significant difference compared to the pre-surgery muscle strength of the plantar flexor group on the affected side (3.2 ± 0.7) grades (95% CI, 3.01–3.8) ( p 0.00 < 0.01). In the final follow-up, the maximum plantar flexion angle of the affected ankle joint post-surgery was (37.1 ± 3.1)° (95% CI, 36.2–37.9)°, which showed no statistical significance compared to the maximum plantar flexion angle of the healthy side (38.3 ± 3.9)° (95% CI, 37.2–39.2)° ( p 0.072 > 0.05); the dorsiflexion angle of the ankle joint post-surgery was (18.3 ± 2.2)° (95% CI, 17.7–18.8)°, which showed no statistical significance compared to the dorsiflexion angle of the healthy side (18.2 ± 1.4)° (95% CI, 17.8–18.5)° ( p 0.773 > 0.05). Conclusions The modified overlapping suture technique can be used to treat patients with horse-tail-like Achilles tendon tears. After treatment, the motor function of their lower limbs can be restored. In addition, there are a few complications.