[Aseptic drainage associated with polyglactine sutures used for repair of Achilles tendon ruptures]

Imaging of Foreign Body Reactions to Non-absorbable Sutures in Achilles Tendon Repair: Radiologic and Histopathologic Correlation in Two Cases

Achilles tendon ruptures are commonly managed with surgical repair, often using non-absorbable sutures for their tensile strength. However, foreign body reactions have been increasingly reported, accounting for up to 2% of complications in some studies, compared to approximately 3% for wound dehiscence. We present two cases of biopsy-proven foreign body reactions following percutaneous Achilles tendon repair with FiberWire® (Arthrex, Naples, Florida) sutures. Both patients developed localized swelling and erythema months after surgery, without any systemic signs of infection. Ultrasound and MRI revealed cystic-like lesions along the suture path, accompanied by inflammatory changes. Surgical debridement and suture removal led to complete resolution of symptoms, with corresponding normalization on follow-up imaging. Histopathology confirmed a foreign body reaction with giant cells and reactive fibroblast deposition. These cases emphasize the importance of recognizing foreign body reactions as a potential mimic of infection or rerupture, guiding appropriate management.

Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study

We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4-72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.

Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture

Background

To reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture.

Methods

From January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated.

Results

The mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000).

Conclusions

Acute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy.

Study design

Case-control studies, Level of evidence, 3.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04802-8.

A delayed foreign body granuloma associated with polypropylene sutures used in tendon transfer. A case report

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Delayed suture reactions are rare.

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We present an unusual case of foreign body granuloma to polypropylene.

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Differential diagnosis and management are discussed.

Introduction

A delayed foreign body reaction to polypropylene sutures has not been previously reported following tendon repair.

Presentation of case

A 12-year old boy underwent tendon transfer. Tendon repair was done using polypropylene sutures. Five months later, a slowly growing granuloma was seen at the tendon repair site. Skin testing did not show an allergic reaction to the suture. Excision of the granuloma and removal of sutures were curative. Histology confirmed a foreign body granuloma.

Discussion

A mass developing several months at the site of tendon repair indicates either an allergic or foreign body reaction to the suture. Skin testing (for allergy) and histological examination of the mass differentiate allergic from foreign body reactions.

Conclusion

We report on a rare case of a giant granuloma caused by a delayed foreign body reaction to polypropylene sutures used in tendon repair.

Granuloma formation secondary to Achilles tendon repair with nonabsorbable suture

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Achilles tendon ruptures are generally observed after sport traumas and results of primary repair are good.

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Several complications after surgery were reported.

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In tendon repairs generally nonabsorbable sutures are used.

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Ethibond suture is a strong and safe material for Achilles tendon repairs it may cause soft tissue problems such as granuloma.

INTRODUCTION

Several complications can be observed after Achilles tendon repairs. In this study we aimed to report granuloma formation secondary to Achilles tendon repair with Ethibond (Ethicon INC, Somerville, New Jersey) suture.

PRESENTATION OF CASE

A 31 year-old man operated for Achilles tendon rupture. The Ethibond suture was used for primary repair. The patient attended to polyclinic with the complaints of swelling and discharge around the operation site four months after operation. A mass around distal portion of the Achilles tendon was detected. The granulomatous tissue was excised. Inside the mass Ethibond suture was detected. On histopathologic examination, typical findings of the foreign body reaction were observed. No microorganism was cultivated in the tissue culture. The patient has no complaint on the twelfth month control after surgery.

DISCUSSION

The results of primary repair of Achilles tendon are good but several complications were reported. In tendon repairs generally nonabsorbable sutures are used. The Ethibond is nonabsorbable, braided suture. In the literature, granuloma formations secondary to the suture materials such as polygylactine and braided polyethylen–polyester after Achilles tendon repair were reported but granuloma secondary to the Ethibond is very rare.

CONCLUSION

Although Ethibond suture is a strong and safe material for Achilles tendon repairs it may cause soft tissue problems such as granuloma.