Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications | Revista Española de Cirugía Ortopédica y Traumatología

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"apellidos" => "Albertí-Fitó" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitari Quiron Dexeus, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reparación percutánea del tendón de Aquiles con sutura reabsorbible: resultados y complicaciones" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 388 "Ancho" => 1255 "Tamanyo" => 78243 ] ] "descripcion" => array:1 [ "en" => "The tendon is repaired with the modified repair Bunnell configuration (A–D), using Vicryl (polyglactin) No. 1 (Ethicon, Inc.) being the ends of the sutures harvested and tied medially and laterally at the height of the rupture, maintaining the ankle in 20 of plantar flexion." ] ] ] "textoCompleto" => "IntroductionThe Achilles tendon accounts for 20% of all large tendon injuries<a class="elsevierStyleCrossRef" href="#bib0130">1</a> with an estimated incidence ranging from 11 to 37 per 100,000.<a class="elsevierStyleCrossRefs" href="#bib0135">2,3</a> Controversy still surrounds what the optimal treatment for Achilles’ tendon ruptures is. Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0145">4</a> However, this argument has recently been questioned based on results obtained from accelerated functional rehabilitation protocols for conservative treatment.<a class="elsevierStyleCrossRef" href="#bib0150">5</a>Regarding surgical treatment, several techniques have been proposed being percutaneous Achilles tendon repair first described in 1977 by Ma and Griffith.<a class="elsevierStyleCrossRef" href="#bib0155">6</a> The main limitation of that technique is the potential risk of sural nerve injury secondary to entrapment with an incidence rate in clinical studies of around 13%.<a class="elsevierStyleCrossRef" href="#bib0160">7</a> Some authors have reported higher re-rupture rates with the percutaneous technique when compared to open, but it remains controversial.<a class="elsevierStyleCrossRef" href="#bib0165">8</a> Another important issue for the percutaneous technique is the use of non-absorbable vs. absorbable sutures. With the aim of reducing the incidence of complications related to non-absorbable suture intolerance, absorbable sutures have been used with no differences in re-rupture rates.<a class="elsevierStyleCrossRef" href="#bib0170">9</a>The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.Material and methodsA prospective cohort study including patients treated for an Achilles tendon rupture from January 2016 to March 2019 was conducted. This study was done in accordance with the principles of the Declaration of Helsinki, under the Ethics’ committee approval. Written informed consent was obtained from all participants.Inclusion criteria: ≥18 years of age, non-insertional (2–8cm proximal to insertion) Achilles tendon ruptures. Open or partial ruptures were excluded.The diagnosis was based on clinical criteria (palpable gap over the tendon, positive Thompson's test and functional impairment) and confirmed by ultrasonography in all patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Epidemiological data (age and sex), rupture and healing risk factors (smoke, hypertension, diabetes or chronic steroid treatment), previous diagnosis of tendinopathy (confirmed by MRI or ultrasound), pre-rupture sport activity (mild=once-twice per week; moderate=3–4 times per week; intensive=>4 times per week), job information (sedentary or physical), mechanism of rupture (sport, traumatic or casual) and the time in days between lesion and surgery were collected.Surgical techniqueThe surgery was performed within 7 days after rupture in all patients. Patients were positioned in the prone position with the injured foot hanging freely over the edge of the table. The rupture location had been previously marked.No tourniquet was used and local anaesthesia with 15–20mL of mepivacaine 2% was applied through the 10 puncture holes that were later used for needle entry.At each site of needle entrance, a small longitudinal incision was made with a number 11 blade so that the needle could pass without entrapment of subcutaneous tissue.The tendon was then repaired with the modified repair Bunnell configuration (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A–D), using Vicryl (polyglactin) No. 1 (Ethicon, Inc.) being the ends of the sutures harvested and tied medially and laterally at the height of the rupture, maintaining the ankle in 20 of plantar flexion. Afterwards, a clamp was used to ensure that subcutaneous tissue was not entrapped with the suture. Small incisions were closed with steri-strip or exceptionally fine sutures. A sterile dressing and cast were applied with the ankle in 20 of plantar flexion.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Postoperative careThe cast was removed 7–10 days after surgery. A functional orthosis with three heel wedges was put in place and partial weight-bearing allowed. Afterwards, one wedge was removed every week allowing weight-bearing with a functional orthosis at 90 angle 4 weeks after surgery. The functional orthosis was removed 6 weeks post-surgery.Functional rehabilitation initiated 2 weeks after surgery being careful with excessive dorsal flexion. A strengthening and proprioceptive exercise programme proceeded 6–8 weeks after surgery. Non-impact sport was introduced after the removal of the functional orthosis and impact sports was not permitted before 6 months after surgery.AssessmentPatients were assessed using Visual analogue scale (VAS) at the 1, 3, 6 and 12-month follow-up. The Achilles Tendon Rupture Score (ATRS) and AOFAS ankle-hindfoot score were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected.Statistical analysisThe baseline characteristics were summarized using standard descriptive statistics, and a descriptive analysis was carried out. Continuous variables are described as mean (SD) and categorical data are summarized as absolute frequency and percentages.ResultsFifty-two Achilles tendon ruptures of 52 patients were included. The mean (SD) age was 45.96 years (13.67) and there were 48 men (92.3%) and 4 women (7.7%).A previous diagnosis of Achilles tendinopathy was present in 7 patients (13.5%).Seven patients (13.5%) referred participation in no sports or mild sports, 35 patients (67.3%) in moderate sports and 10 patients (19.2%) in intensive sports.A total of 29 patients (55.8%) referred to perform sedentary work, 5 patients (9.6%) intensive physical work while 18 patients combined both sedentary and physical work.Aetiology of the rupture was a non-sportive mechanism in 27 patients (51.9%), a sport injury in 22 cases (42.3%) and a traumatic mechanism was identified in 3 patients (5.8%). The mean time (SD) between injury and surgical treatment was 4.11 days (2.18) with a maximum of 7 days and a minimum of 1 day (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The results of VAS scoring (SD) at 1, 3, 6 and 12 months follow-up were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months follow up (4.59). Mean (SD) AOFAS score was 91 points at 6 months (5.85) and 94.28 points at 12 months follow up (3.78).In ultrasound study at 6-month follow-up, good thickness and hypoechoic thickening without hypervascularization in the Doppler study was observed in all patients.The mean time (SD) to full-weight-bearing without pain was 81.25 days (35.14). At that time, basic daily activities (excluding sport and work activities) were restarted. The mean time (SD) to return to work and sport activities was 111.43 days (36.64) and 142.76 days (49.1), respectively. 47/52 patients (90.4%) confirmed having returned to their previous level of sports activity after surgery (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>There were 3 re-ruptures (5.77%) with a mean time between surgery and re-rupture of 108.75 days (SD 28.4) all of them within 4-month follow-up. The mechanism of re-rupture was a non-sports rupture in all patients. No rupture at the time to return to sports activity was reported.The 13 complications (25%) reported include 3 re-ruptures, previously described, 1 superficial wound infection and 9 transitory sural nerve injuries. All sural nerve injuries were transitory and had a mean (SD) time until their resolution of 73.3 days (37.1). The symptoms related to the sural nerve injury were resolved within 150 days in all patients (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe present study shows good functional outcomes for percutaneous Achilles tendon repair with absorbable suture in patients with an acute Achilles tendon rupture, but not exempt of minor complications.<a class="elsevierStyleCrossRefs" href="#bib0140">3–5</a>As for the epidemiological data, the mean age is 45.96 years old, 92.3% men, being most ruptures related to sport injuries (42.3%), according to the previously reported.<a class="elsevierStyleCrossRefs" href="#bib0135">2,10,11</a>According to the literature, the Achilles tendon rupture affected the area between 2 and 8cm proximal to the calcaneal insertion in all of our patients, corresponding to hypovascularized zone.<a class="elsevierStyleCrossRef" href="#bib0185">12</a>We use a double Bunnell crossed type suture according to the results observed in biomechanical studies<a class="elsevierStyleCrossRef" href="#bib0190">13</a> and absorbable Vicryl #1 suture instead of Polydioxanone, Johnson & Johnson® (PDS) for many reasons. First, PDS is smoother. It has a greater risk of cutting the tendon during knot-pulling.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> Moreover, absorbable sutures are associated with a lower incidence of suture reaction and have shown no difference in regard to the functional results.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> Furthermore, the Vicryl material suffers greater degradation, which contributes to relief from the complications associated with sural nerve injuries when they happen.Progressive improvement in the VAS score was achieved, with a mean score of 2.63 at the 1-month follow-up and 0.08 at the 12-month follow-up. The percentage of patients with no pain at 3, 6 and 12 months was 17%, 69% and 96%, respectively, with the greatest improvement in the VAS score between the 3 and 6-month follow-up, similar to previously reported.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> ATRS scores at 6 and 12 months were 92.45 and 94.04, respectively with better results achieved at the 6-month follow-up comparing to previously reported.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> An explanation for the difference in functional scores at 6 months follow-up might be the mean age of our patients, with only 7 (13.5%) patients older than 60 in this series.The 90% of our patients reported having returned to their pre-injury level, increasing to 98% when we exclude re-rupture patients. One of the 3 patients with a postoperative tendon re-rupture, recovered the previous level of activity.One of the most important aspects regarding Achilles tendon rupture treatment is the re-rupture incidence. In this study a re-rupture rate of 5.77% (N=3) was observed, which is similar to the previously reported (2%–8% re-rupture rates) for percutaneous Achilles tendon repair.<a class="elsevierStyleCrossRef" href="#bib0210">17</a> Classically, the percutaneous repair re-rupture rate was seen to be lower when compared to the initial conservative treatment.<a class="elsevierStyleCrossRefs" href="#bib0145">4,6</a> The main problem associated with this classical conservative treatment was the prolonged time of immobilization, which entailed important secondary muscle atrophy.<a class="elsevierStyleCrossRef" href="#bib0215">18</a> After the early weight-bearing and controlled rehabilitation protocol, the re-rupture rate with conservative treatment decreased drastically.<a class="elsevierStyleCrossRefs" href="#bib0150">5,19,21–23</a> Due to the favourable results in some recent studies with conservative treatment and because of the bimodal age distribution of Achilles tendon ruptures, some authors advocate for conservative treatment for young patients.<a class="elsevierStyleCrossRefs" href="#bib0140">3–5,21–23</a> This is because there is the potential for tendon healing in this younger age-range.<a class="elsevierStyleCrossRefs" href="#bib0130">1,2</a> It might be worthwhile to reserve surgical treatment for patients in the second-peak group.<a class="elsevierStyleCrossRefs" href="#bib0140">3–5,24,25</a> For that purpose, prospective studies between conservative and surgical treatment comparing the incidence between the two peaks are necessary.It is important to empathize that in this series 1 in 4 patients (25%) suffered some type of complication. This rate is higher than those previously reported for percutaneous Achilles tendon repair, which has been established between 4 and 15%.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> A reason which would explain this fact is that we have observed a high rate of complications due to transitory sural nerve injuries’ symptoms (17.3%), complication which, if is transitory, is not considered as a surgical complication in most previous studies. These sural nerve injuries were completely resolved in all cases within 4 months after surgery. One of the main causes of sural nerve injuries is the entrapment during the percutaneous suture.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> The use of the absorbable suture, which has the same biomechanical properties as the non-absorbable suture and with fewer reported side effects, could explain the disappearance of symptoms in these patients.<a class="elsevierStyleCrossRef" href="#bib0220">19</a>Finally, related to complications, one case of superficial wound infection was observed and completely resolved with oral antibiotic treatment.Our study has some limitations. First, it is a prospective cohort study and there is no control group with conservative treatment. Moreover, despite Achilles tendon ruptures have a bimodal age distribution with different aetiologies described, all patients were included in a single group due to the small number of patients over 60 years of age.ConclusionsIn conclusion, in our experience, percutaneous Achilles tendon repair with absorbable sutures in patients with an acute Achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively.<a class="elsevierStyleCrossRefs" href="#bib0140">3–5,20</a> For this reason, conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles Tendon Ruptures, mainly in cooperative young patients.<a class="elsevierStyleCrossRefs" href="#bib0140">3–5</a>Level of evidenceLevel of evidence II.FundingThe authors declare that they have not received financial funding to carry out the research and/or the preparation of the article.Conflict of interestsThe authors declare no conflicts of interest regarding the search, authorship and/or publication of this article. All authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2130339" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1809200" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2130340" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1809199" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Postoperative care" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Assessment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Level of evidence" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-16" "fechaAceptado" => "2022-06-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1809200" "palabras" => array:6 [ 0 => "Achilles tendon rupture" 1 => "Repair" 2 => "Absorbable suture" 3 => "Ultrasound" 4 => "Functional outcomes" 5 => "Conservative treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1809199" "palabras" => array:6 [ 0 => "Rotura del tendón de Aquiles" 1 => "Reparación" 2 => "Sutura reabsorbible" 3 => "Ultrasonido" 4 => "Resultados funcionales" 5 => "Tratamiento conservador" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveThe purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures. Material and methodsProspective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019).Inclusion criteria: ≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography.Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected. ResultsVAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries). ConclusionsPercutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEl propósito es evaluar los resultados clínicos y complicaciones de la reparación percutánea del tendón de Aquiles con suturas reabsorbibles. Material y métodosEstudio de cohorte prospectivo incluyendo 52 pacientes tratados por rotura del tendón de Aquiles (enero 2016-marzo 2019).Criterios de inclusión: ≥18 años de edad, roturas no insercionales del tendón de Aquiles. Diagnóstico clínico y confirmado por ecografía. Evaluación mediante Escala Analógica Visual (EVA), puntuación de rotura del tendón de Aquiles (ATRS) y ecografía. Recopilación de tasas de re-rotura y complicaciones postoperatorias. ResultadosPuntuación EVA (DE) al mes, 3, 6 y 12 meses de seguimiento: 2,63 (0,83), 1,79 (1,25), 0,69 (1,09) y 0,08 (0,39). Media (DE) de la puntuación ATRS: 92,45 puntos a los 6 meses (6,27) y 94,04 puntos a los 12 meses (4,59). 3 re-roturas (5,77%) con tiempo medio entre cirugía y re-rotura de 108,75 días (DE 28,4), todas durante los 4 meses de seguimiento. No roturas a la reincorporación a la actividad deportiva. 13 complicaciones (25%) (3 re-roturas, 1 infección de herida superficial y 9 lesiones transitorias del nervio sural). ConclusionesLa reparación percutánea del tendón de Aquiles con suturas reabsorbibles en pacientes con rotura aguda del tendón de Aquiles muestra buenos resultados funcionales; con alta incidencia de complicaciones. La mayoría de complicaciones fueron síntomas transitorios del nervio sural, que se evitarían en pacientes tratados conservadoramente. Asociado a un protocolo temprano de rehabilitación con carga, debe considerarse una opción, especialmente en pacientes jóvenes cooperadores." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 235 "Ancho" => 1005 "Tamanyo" => 30924 ] ] "descripcion" => array:1 [ "en" => "Diagnosis is confirmed by ultrasonography in all patients (A: Longitudinal section of Achilles tendon rupture, B: cross section of Achilles tendon rupture)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 388 "Ancho" => 1255 "Tamanyo" => 78243 ] ] "descripcion" => array:1 [ "en" => "The tendon is repaired with the modified repair Bunnell configuration (A–D), using Vicryl (polyglactin) No. 1 (Ethicon, Inc.) being the ends of the sutures harvested and tied medially and laterally at the height of the rupture, maintaining the ankle in 20 of plantar flexion." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.96 (13.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 (92.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous Achilles tendinopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (13.46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sport activities</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (13.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (67.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intensive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (19.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Work activities</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sedentary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (55.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (34.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Injury mechanism</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non sport \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (51.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sport \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (42.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Traumatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Injury-to-surgery time (days)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.11 (2.18) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3511762.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient baseline characteristics (n=52)." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ATRS: Achilles Tendon Rupture Score." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visual Analogue Scale (SD)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.63 (0.83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.79 (1.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 (1.09) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.08 (0.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AOFAS ankle-hindfoot score (6 and 12 months)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 (5.85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.28 (3.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ATRS (6 and 12 months)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.45 (6.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.04 (4.59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Painless complete weight-bearing (days)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.25 (35.14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Return to Work (days)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111.43 (36.64) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Return to Sports (days)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142.76 (49.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3511760.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Outcomes of the percutaneous Achilles tendon repairs." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Re-ruptures, N (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.77%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean time from surgery (days) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">108.75 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minor complications, N (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (19%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transitory sural nerve lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean time to resolution (days) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.3 (37.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Superficial wound infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3511761.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Complications." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The management of fresh ruptures of the tendo achillis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. 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Nilsson-Helander" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546513503282" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2867" "paginaFinal" => "2876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24013347" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0155" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous repair of acute closed ruptured achilles tendon: a new technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.W. Ma" 1 => "T.G. 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Saleh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chir Organi Mov" "fecha" => "1991" "volumen" => "76" "paginaInicial" => "223" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1816983" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0165" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Yang" 1 => "Y. Liu" 2 => "S. Kan" 3 => "D. Zhang" 4 => "H. Xu" 5 => "F. 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Original Paper

Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications

Reparación percutánea del tendón de Aquiles con sutura reabsorbible: resultados y complicaciones

D. Campillo-Recio, M. Comas-Aguilar

Corresponding author

marta.comas.aguilar@gmail.com

Corresponding author.

, M. Ibáñez, Y. Maldonado-Sotoca, G. Albertí-Fitó

Hospital Universitari Quiron Dexeus, Barcelona, Spain

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              "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El tend&#243;n se repara con la configuraci&#243;n de Bunnell modificada &#40;A&#8211;D&#41;&#44; utilizando Vicryl&#8482; &#40;poliglactina&#41; del n&#176; 1 &#40;Ethicon&#44; Inc&#46;&#41;&#44; recogi&#233;ndose las suturas y at&#225;ndose medial y lateralmente a la altura de la ruptura&#44; manteniendo un &#225;ngulo de 20&#176; de flexi&#243;n plantar&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The tendon is repaired with the modified repair Bunnell configuration &#40;A&#8211;D&#41;&#44; using Vicryl &#40;polyglactin&#41; No&#46; 1 &#40;Ethicon&#44; Inc&#46;&#41; being the ends of the sutures harvested and tied medially and laterally at the height of the rupture&#44; maintaining the ankle in 20 of plantar flexion&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Achilles tendon accounts for 20&#37; of all large tendon injuries<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> with an estimated incidence ranging from 11 to 37 per 100&#44;000&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;3</span></a> Controversy still surrounds what the optimal treatment for Achilles&#8217; tendon ruptures is&#46; Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> However&#44; this argument has recently been questioned based on results obtained from accelerated functional rehabilitation protocols for conservative treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Regarding surgical treatment&#44; several techniques have been proposed being percutaneous Achilles tendon repair first described in 1977 by Ma and Griffith&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> The main limitation of that technique is the potential risk of sural nerve injury secondary to entrapment with an incidence rate in clinical studies of around 13&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Some authors have reported higher re-rupture rates with the percutaneous technique when compared to open&#44; but it remains controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> Another important issue for the percutaneous technique is the use of non-absorbable vs&#46; absorbable sutures&#46; With the aim of reducing the incidence of complications related to non-absorbable suture intolerance&#44; absorbable sutures have been used with no differences in re-rupture rates&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A prospective cohort study including patients treated for an Achilles tendon rupture from January 2016 to March 2019 was conducted&#46; This study was done in accordance with the principles of the Declaration of Helsinki&#44; under the Ethics&#8217; committee approval&#46; Written informed consent was obtained from all participants&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria&#58; &#8805;18 years of age&#44; non-insertional &#40;2&#8211;8<span class="elsevierStyleHsp" style=""></span>cm proximal to insertion&#41; Achilles tendon ruptures&#46; Open or partial ruptures were excluded&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis was based on clinical criteria &#40;palpable gap over the tendon&#44; positive Thompson&#39;s test and functional impairment&#41; and confirmed by ultrasonography in all patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Epidemiological data &#40;age and sex&#41;&#44; rupture and healing risk factors &#40;smoke&#44; hypertension&#44; diabetes or chronic steroid treatment&#41;&#44; previous diagnosis of tendinopathy &#40;confirmed by MRI or ultrasound&#41;&#44; pre-rupture sport activity &#40;mild<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>once-twice per week&#59; moderate<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#8211;4 times per week&#59; intensive<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#62;4 times per week&#41;&#44; job information &#40;sedentary or physical&#41;&#44; mechanism of rupture &#40;sport&#44; traumatic or casual&#41; and the time in days between lesion and surgery were collected&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">The surgery was performed within 7 days after rupture in all patients&#46; Patients were positioned in the prone position with the injured foot hanging freely over the edge of the table&#46; The rupture location had been previously marked&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">No tourniquet was used and local anaesthesia with 15&#8211;20<span class="elsevierStyleHsp" style=""></span>mL of mepivacaine 2&#37; was applied through the 10 puncture holes that were later used for needle entry&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">At each site of needle entrance&#44; a small longitudinal incision was made with a number 11 blade so that the needle could pass without entrapment of subcutaneous tissue&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The tendon was then repaired with the modified repair Bunnell configuration &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#8211;D&#41;&#44; using Vicryl &#40;polyglactin&#41; No&#46; 1 &#40;Ethicon&#44; Inc&#46;&#41; being the ends of the sutures harvested and tied medially and laterally at the height of the rupture&#44; maintaining the ankle in 20 of plantar flexion&#46; Afterwards&#44; a clamp was used to ensure that subcutaneous tissue was not entrapped with the suture&#46; Small incisions were closed with steri-strip or exceptionally fine sutures&#46; A sterile dressing and cast were applied with the ankle in 20 of plantar flexion&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Postoperative care</span><p id="par0060" class="elsevierStylePara elsevierViewall">The cast was removed 7&#8211;10 days after surgery&#46; A functional orthosis with three heel wedges was put in place and partial weight-bearing allowed&#46; Afterwards&#44; one wedge was removed every week allowing weight-bearing with a functional orthosis at 90 angle 4 weeks after surgery&#46; The functional orthosis was removed 6 weeks post-surgery&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Functional rehabilitation initiated 2 weeks after surgery being careful with excessive dorsal flexion&#46; A strengthening and proprioceptive exercise programme proceeded 6&#8211;8 weeks after surgery&#46; Non-impact sport was introduced after the removal of the functional orthosis and impact sports was not permitted before 6 months after surgery&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment</span><p id="par0070" class="elsevierStylePara elsevierViewall">Patients were assessed using Visual analogue scale &#40;VAS&#41; at the 1&#44; 3&#44; 6 and 12-month follow-up&#46; The Achilles Tendon Rupture Score &#40;ATRS&#41; and AOFAS ankle-hindfoot score were assessed at the 6 and 12 month follow-up&#46; Ultrasound was performed at the 6-month follow-up&#46; The re-rupture rate and postoperative complications were also collected&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The baseline characteristics were summarized using standard descriptive statistics&#44; and a descriptive analysis was carried out&#46; Continuous variables are described as mean &#40;SD&#41; and categorical data are summarized as absolute frequency and percentages&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Fifty-two Achilles tendon ruptures of 52 patients were included&#46; The mean &#40;SD&#41; age was 45&#46;96 years &#40;13&#46;67&#41; and there were 48 men &#40;92&#46;3&#37;&#41; and 4 women &#40;7&#46;7&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A previous diagnosis of Achilles tendinopathy was present in 7 patients &#40;13&#46;5&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seven patients &#40;13&#46;5&#37;&#41; referred participation in no sports or mild sports&#44; 35 patients &#40;67&#46;3&#37;&#41; in moderate sports and 10 patients &#40;19&#46;2&#37;&#41; in intensive sports&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 29 patients &#40;55&#46;8&#37;&#41; referred to perform sedentary work&#44; 5 patients &#40;9&#46;6&#37;&#41; intensive physical work while 18 patients combined both sedentary and physical work&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aetiology of the rupture was a non-sportive mechanism in 27 patients &#40;51&#46;9&#37;&#41;&#44; a sport injury in 22 cases &#40;42&#46;3&#37;&#41; and a traumatic mechanism was identified in 3 patients &#40;5&#46;8&#37;&#41;&#46; The mean time &#40;SD&#41; between injury and surgical treatment was 4&#46;11 days &#40;2&#46;18&#41; with a maximum of 7 days and a minimum of 1 day &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The results of VAS scoring &#40;SD&#41; at 1&#44; 3&#44; 6 and 12 months follow-up were 2&#46;63 &#40;0&#46;83&#41;&#44; 1&#46;79 &#40;1&#46;25&#41;&#44; 0&#46;69 &#40;1&#46;09&#41; and 0&#46;08 &#40;0&#46;39&#41;&#44; respectively&#46; Mean &#40;SD&#41; ATRS score was 92&#46;45 points at 6 months &#40;6&#46;27&#41; and 94&#46;04 points at 12 months follow up &#40;4&#46;59&#41;&#46; Mean &#40;SD&#41; AOFAS score was 91 points at 6 months &#40;5&#46;85&#41; and 94&#46;28 points at 12 months follow up &#40;3&#46;78&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In ultrasound study at 6-month follow-up&#44; good thickness and hypoechoic thickening without hypervascularization in the Doppler study was observed in all patients&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The mean time &#40;SD&#41; to full-weight-bearing without pain was 81&#46;25 days &#40;35&#46;14&#41;&#46; At that time&#44; basic daily activities &#40;excluding sport and work activities&#41; were restarted&#46; The mean time &#40;SD&#41; to return to work and sport activities was 111&#46;43 days &#40;36&#46;64&#41; and 142&#46;76 days &#40;49&#46;1&#41;&#44; respectively&#46; 47&#47;52 patients &#40;90&#46;4&#37;&#41; confirmed having returned to their previous level of sports activity after surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">There were 3 re-ruptures &#40;5&#46;77&#37;&#41; with a mean time between surgery and re-rupture of 108&#46;75 days &#40;SD 28&#46;4&#41; all of them within 4-month follow-up&#46; The mechanism of re-rupture was a non-sports rupture in all patients&#46; No rupture at the time to return to sports activity was reported&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The 13 complications &#40;25&#37;&#41; reported include 3 re-ruptures&#44; previously described&#44; 1 superficial wound infection and 9 transitory sural nerve injuries&#46; All sural nerve injuries were transitory and had a mean &#40;SD&#41; time until their resolution of 73&#46;3 days &#40;37&#46;1&#41;&#46; The symptoms related to the sural nerve injury were resolved within 150 days in all patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The present study shows good functional outcomes for percutaneous Achilles tendon repair with absorbable suture in patients with an acute Achilles tendon rupture&#44; but not exempt of minor complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As for the epidemiological data&#44; the mean age is 45&#46;96 years old&#44; 92&#46;3&#37; men&#44; being most ruptures related to sport injuries &#40;42&#46;3&#37;&#41;&#44; according to the previously reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;10&#44;11</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">According to the literature&#44; the Achilles tendon rupture affected the area between 2 and 8<span class="elsevierStyleHsp" style=""></span>cm proximal to the calcaneal insertion in all of our patients&#44; corresponding to hypovascularized zone&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">We use a double Bunnell crossed type suture according to the results observed in biomechanical studies<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> and absorbable Vicryl &#35;1 suture instead of Polydioxanone&#44; Johnson &#38; Johnson&#174; &#40;PDS&#41; for many reasons&#46; First&#44; PDS is smoother&#46; It has a greater risk of cutting the tendon during knot-pulling&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Moreover&#44; absorbable sutures are associated with a lower incidence of suture reaction and have shown no difference in regard to the functional results&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; the Vicryl material suffers greater degradation&#44; which contributes to relief from the complications associated with sural nerve injuries when they happen&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Progressive improvement in the VAS score was achieved&#44; with a mean score of 2&#46;63 at the 1-month follow-up and 0&#46;08 at the 12-month follow-up&#46; The percentage of patients with no pain at 3&#44; 6 and 12 months was 17&#37;&#44; 69&#37; and 96&#37;&#44; respectively&#44; with the greatest improvement in the VAS score between the 3 and 6-month follow-up&#44; similar to previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> ATRS scores at 6 and 12 months were 92&#46;45 and 94&#46;04&#44; respectively with better results achieved at the 6-month follow-up comparing to previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> An explanation for the difference in functional scores at 6 months follow-up might be the mean age of our patients&#44; with only 7 &#40;13&#46;5&#37;&#41; patients older than 60 in this series&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The 90&#37; of our patients reported having returned to their pre-injury level&#44; increasing to 98&#37; when we exclude re-rupture patients&#46; One of the 3 patients with a postoperative tendon re-rupture&#44; recovered the previous level of activity&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">One of the most important aspects regarding Achilles tendon rupture treatment is the re-rupture incidence&#46; In this study a re-rupture rate of 5&#46;77&#37; &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; was observed&#44; which is similar to the previously reported &#40;2&#37;&#8211;8&#37; re-rupture rates&#41; for percutaneous Achilles tendon repair&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> Classically&#44; the percutaneous repair re-rupture rate was seen to be lower when compared to the initial conservative treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#44;6</span></a> The main problem associated with this classical conservative treatment was the prolonged time of immobilization&#44; which entailed important secondary muscle atrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> After the early weight-bearing and controlled rehabilitation protocol&#44; the re-rupture rate with conservative treatment decreased drastically&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;19&#44;21&#8211;23</span></a> Due to the favourable results in some recent studies with conservative treatment and because of the bimodal age distribution of Achilles tendon ruptures&#44; some authors advocate for conservative treatment for young patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#8211;5&#44;21&#8211;23</span></a> This is because there is the potential for tendon healing in this younger age-range&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1&#44;2</span></a> It might be worthwhile to reserve surgical treatment for patients in the second-peak group&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#8211;5&#44;24&#44;25</span></a> For that purpose&#44; prospective studies between conservative and surgical treatment comparing the incidence between the two peaks are necessary&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">It is important to empathize that in this series 1 in 4 patients &#40;25&#37;&#41; suffered some type of complication&#46; This rate is higher than those previously reported for percutaneous Achilles tendon repair&#44; which has been established between 4 and 15&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> A reason which would explain this fact is that we have observed a high rate of complications due to transitory sural nerve injuries&#8217; symptoms &#40;17&#46;3&#37;&#41;&#44; complication which&#44; if is transitory&#44; is not considered as a surgical complication in most previous studies&#46; These sural nerve injuries were completely resolved in all cases within 4 months after surgery&#46; One of the main causes of sural nerve injuries is the entrapment during the percutaneous suture&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> The use of the absorbable suture&#44; which has the same biomechanical properties as the non-absorbable suture and with fewer reported side effects&#44; could explain the disappearance of symptoms in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Finally&#44; related to complications&#44; one case of superficial wound infection was observed and completely resolved with oral antibiotic treatment&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Our study has some limitations&#46; First&#44; it is a prospective cohort study and there is no control group with conservative treatment&#46; Moreover&#44; despite Achilles tendon ruptures have a bimodal age distribution with different aetiologies described&#44; all patients were included in a single group due to the small number of patients over 60 years of age&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">In conclusion&#44; in our experience&#44; percutaneous Achilles tendon repair with absorbable sutures in patients with an acute Achilles tendon rupture has shown good functional results but with a high incidence of complications&#46; Although most complications were transitory sural nerve symptoms&#44; this complication would be avoided in patients treated conservatively&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#8211;5&#44;20</span></a> For this reason&#44; conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles Tendon Ruptures&#44; mainly in cooperative young patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Level of evidence</span><p id="par0185" class="elsevierStylePara elsevierViewall">Level of evidence II&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that they have not received financial funding to carry out the research and&#47;or the preparation of the article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest regarding the search&#44; authorship and&#47;or publication of this article&#46; All authors declare no conflicts of interest&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2022-03-16"
    "fechaAceptado" => "2022-06-30"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1809200"
          "palabras" => array:6 [
            0 => "Achilles tendon rupture"
            1 => "Repair"
            2 => "Absorbable suture"
            3 => "Ultrasound"
            4 => "Functional outcomes"
            5 => "Conservative treatment"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Rotura del tend&#243;n de Aquiles"
            1 => "Reparaci&#243;n"
            2 => "Sutura reabsorbible"
            3 => "Ultrasonido"
            4 => "Resultados funcionales"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study including 52 patients treated for Achilles tendon ruptures &#40;January 2016 to March 2019&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Inclusion criteria&#58; &#8805;18 years of age&#44; non-insertional Achilles tendon ruptures&#46; Diagnosis based on clinical criteria&#44; confirmed by ultrasonography&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Assessment using Visual Analogue Scale &#40;VAS&#41;&#44; Achilles Tendon Rupture Score &#40;ATRS&#41; and ultrasound&#46; Re-rupture rate and postoperative complications were collected&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VAS scoring &#40;SD&#41; at 1&#44; 3&#44; 6 and 12 months follow-up &#40;FU&#41; were 2&#46;63 &#40;0&#46;83&#41;&#44; 1&#46;79 &#40;1&#46;25&#41;&#44; 0&#46;69 &#40;1&#46;09&#41; and 0&#46;08 &#40;0&#46;39&#41;&#44; respectively&#46; Mean &#40;SD&#41; ATRS score was 92&#46;45 points at 6 months &#40;6&#46;27&#41; and 94&#46;04 points at 12 months FU &#40;4&#46;59&#41;&#46; Three re-ruptures &#40;5&#46;77&#37;&#41; occurred with a mean time between surgery and re-rupture of 108&#46;75 days &#40;SD 28&#46;4&#41;&#44; all of them within 4-month FU&#46; No ruptures at the time to return to sports activity&#46; Thirteen complications &#40;25&#37;&#41; &#40;3 re-ruptures&#44; 1 superficial wound infection and 9 transitory sural nerve injuries&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications&#46; Although most complications were transitory sural nerve symptoms&#44; these would be avoided with conservative treatment&#46; Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures&#44; specially in cooperative young patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito es evaluar los resultados cl&#237;nicos y complicaciones de la reparaci&#243;n percut&#225;nea del tend&#243;n de Aquiles con suturas reabsorbibles&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte prospectivo incluyendo 52 pacientes tratados por rotura del tend&#243;n de Aquiles &#40;enero 2016-marzo 2019&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Criterios de inclusi&#243;n&#58; &#8805;18 a&#241;os de edad&#44; roturas no insercionales del tend&#243;n de Aquiles&#46; Diagn&#243;stico cl&#237;nico y confirmado por ecograf&#237;a&#46; Evaluaci&#243;n mediante Escala Anal&#243;gica Visual &#40;EVA&#41;&#44; puntuaci&#243;n de rotura del tend&#243;n de Aquiles &#40;ATRS&#41; y ecograf&#237;a&#46; Recopilaci&#243;n de tasas de re-rotura y complicaciones postoperatorias&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Puntuaci&#243;n EVA &#40;DE&#41; al mes&#44; 3&#44; 6 y 12 meses de seguimiento&#58; 2&#44;63 &#40;0&#44;83&#41;&#44; 1&#44;79 &#40;1&#44;25&#41;&#44; 0&#44;69 &#40;1&#44;09&#41; y 0&#44;08 &#40;0&#44;39&#41;&#46; Media &#40;DE&#41; de la puntuaci&#243;n ATRS&#58; 92&#44;45 puntos a los 6 meses &#40;6&#44;27&#41; y 94&#44;04 puntos a los 12 meses &#40;4&#44;59&#41;&#46; 3 re-roturas &#40;5&#44;77&#37;&#41; con tiempo medio entre cirug&#237;a y re-rotura de 108&#44;75 d&#237;as &#40;DE 28&#44;4&#41;&#44; todas durante los 4 meses de seguimiento&#46; No roturas a la reincorporaci&#243;n a la actividad deportiva&#46; 13 complicaciones &#40;25&#37;&#41; &#40;3 re-roturas&#44; 1 infecci&#243;n de herida superficial y 9 lesiones transitorias del nervio sural&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La reparaci&#243;n percut&#225;nea del tend&#243;n de Aquiles con suturas reabsorbibles en pacientes con rotura aguda del tend&#243;n de Aquiles muestra buenos resultados funcionales&#59; con alta incidencia de complicaciones&#46; La mayor&#237;a de complicaciones fueron s&#237;ntomas transitorios del nervio sural&#44; que se evitar&#237;an en pacientes tratados conservadoramente&#46; Asociado a un protocolo temprano de rehabilitaci&#243;n con carga&#44; debe considerarse una opci&#243;n&#44; especialmente en pacientes j&#243;venes cooperadores&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagnosis is confirmed by ultrasonography in all patients &#40;A&#58; Longitudinal section of Achilles tendon rupture&#44; B&#58; cross section of Achilles tendon rupture&#41;&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The tendon is repaired with the modified repair Bunnell configuration &#40;A&#8211;D&#41;&#44; using Vicryl &#40;polyglactin&#41; No&#46; 1 &#40;Ethicon&#44; Inc&#46;&#41; being the ends of the sutures harvested and tied medially and laterally at the height of the rupture&#44; maintaining the ankle in 20 of plantar flexion&#46;</p>"
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                  \t\t\t\t">45&#46;96 &#40;13&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">48 &#40;92&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Work activities</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sedentary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;55&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;9&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Combined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;34&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Injury mechanism</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non sport&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;51&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sport&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;42&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traumatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Injury-to-surgery time &#40;days&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;11 &#40;2&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3511762.png"
              ]
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient baseline characteristics &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;&#46;</p>"
        ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
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          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ATRS&#58; Achilles Tendon Rupture Score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual Analogue Scale &#40;SD&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;63 &#40;0&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;79 &#40;1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69 &#40;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08 &#40;0&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AOFAS ankle-hindfoot score &#40;6 and 12 months&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91 &#40;5&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;28 &#40;3&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ATRS &#40;6 and 12 months&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;45 &#40;6&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;04 &#40;4&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painless complete weight-bearing &#40;days&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;25 &#40;35&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Return to Work &#40;days&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#46;43 &#40;36&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Return to Sports &#40;days&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;76 &#40;49&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Outcomes of the percutaneous Achilles tendon repairs&#46;</p>"
        ]
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Re-ruptures&#44; <span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean time from surgery &#40;days&#41; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#46;75 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Minor complications&#44; <span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transitory sural nerve lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information

ISSN: 18884415
Original language: English

DOI:10.1016/j.recot.2022.06.008

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Year/Month	Html	Pdf	Total

2024 October	43	2	45
2024 September	80	5	85
2024 August	77	4	81
2024 July	62	3	65
2024 June	54	7	61
2024 May	41	5	46
2024 April	60	11	71
2024 March	76	4	80
2024 February	120	8	128
2024 January	137	11	148
2023 December	140	19	159
2023 November	187	13	200
2023 October	208	17	225
2023 September	111	16	127
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2023 July	145	10	155
2023 June	117	9	126
2023 May	111	12	123
2023 April	100	8	108
2023 March	28	9	37
2023 February	28	10	38
2023 January	72	23	95
2022 December	0	5	5
2022 November	0	6	6
2022 October	0	5	5
2022 September	0	12	12
2022 August	0	6	6

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