The Functional Outcomes of a Novel Modified Giftbox Technique for Primary Achilles Tendon Repairs

Research Type: Level 4 – Case series Introduction/Purpose: Primary Achilles tendon ruptures are common injuries and typically result from acute loading associated with sudden and forceful contraction of the gastrocnemius. Various surgical techniques exist that allow decreased re-rupture rates and faster return to play. The giftbox technique demonstrates improvement in the biomechanical properties of acute Achilles tendon repairs and decreased re-rupture rates compared to prior techniques (Labib et al. 2009; Labib et al. 2016). However, re-ruptures still occur. For this reason, this project explores a modification to the giftbox technique, where the proximal and distal free suture ends are passed anteriorly to the tendon and tied at lateral struts. Specifically, the purpose is to evaluate the functional outcomes observed with this novel technique. Methods: An institution-based registry with foot and ankle patient data that was prospectively collected was queried. Consecutive patients who underwent surgical repair of acute Achilles tendon ruptures between June 2017 and March 2023 with the senior author’s modified giftbox technique were evaluated. The inclusion criteria were patients who had an acute primary Achilles tendon rupture within six weeks prior to surgery, clinical diagnosis, and underwent surgical repair. Patients with ipsilateral ankle pathology and revision surgeries were excluded from the study. Patient reported outcome measures (PROMs) were obtained preoperatively and at 6 month, and ≥1-year postoperative clinic visit with the validated Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL) subscale, PROMIS Mental Health, and PROMIS Physical Health. PROMs were compared to the preoperative scores with a paired t-test and 95% confidence intervals were reported. Results: 56 patients were identified who had undergone acute Achilles tendon rupture repair with the modified giftbox technique and were included in this study (14 females). All patients completed a preoperative survey, 46 (82%) patients completed a 1-month postoperative PROM survey, 51 (91%) completed a 3-month postoperative PROM, 50 (89.3%) completed a 6-month postoperative PROM, and 54 (96%) patients completed a final postoperative PROM, with a minimum of 1-year. Mean follow-up was 2.85 years. The PROM results are summarized in Table 1. Notably, a significant improvement in all scores except PROMIS-MH was observed starting at the 3-month visit. Patients continued to progress with each visit. Overall complication rate was 10.7% consisting of 1 re-rupture, 1 infection, 1 neuropathy, and 3 delayed wound healing. Conclusion: This study clinically assesses a novel modified giftbox technique for treating acute Achilles tendon ruptures, revealing improved functional outcomes based on FAAM (ADL and Sport), PROMIS-PH, and VAS in both mid-term and long-term follow-ups. The novel modified giftbox technique is suitable for surgical repair of acute Achilles tendon ruptures, and results compare well to historical reports of re-rupture, infection, and wound complication rates. Furthermore, this provides a comprehensive overview of patient standards at each interval.