C A S E
S T U D Y
BIOFIBER™
Absorbable Biologic Scaffold for Surgical Repair and Reinforcement of Soft Tissue
Achilles Tendon Repair
Case Overview:
A 63-year-old male presented to our clinic with right heel pain that had progressed
over three years. The patient reported the pain originated in the back of his heel, ran
up the back of his leg and was aggravated by activity. The patient is a former smoker,
has no history of trauma, and no significant medical history.
David Yeager, DPM
Katherine Shaw Bethea Hospital
Dixon, IL
Physical examination revealed an erythematous, posterior prominence at the area
of the insertion of the right Achilles tendon. Edema was also noted at the posterior
bony prominence of the heel. There was limited dorsiflexion at the ankle joint. Pain
was elicited on palpation of the posterior calcaneal prominence. Surprisingly, pain
on palpation along with a positive Tinel’s sign was noted at the right tarsal tunnel.
Radiographs revealed a large, superior calcaneal spur, which had worsened significantly when compared to radiographs taken two years prior. (Figure 1) Tarsal tunnel
syndrome was ruled out with diagnostic injections and nerve conduction studies. The
patient reported no relief after treatment with orthotics and change in shoe gear.
Surgical Technique:
Due to the location of the large calcaneal extosis, the insertion of the Achilles tendon
would need to be reflected from the calcaneus. BIOFIBER™ scaffold was selected to
provide a transition area of the Achilles tendon to its insertion into the calcaneus.
BIOFIBER™ is a biocompatible polymer, woven into a scaffold, that is engineered to
facilitate tissue in-growth and reinforce soft tissue repairs. It augments the tendonto-bone interface by reinforcing the repair. Reinforcing and promoting healing of
this crucial area may return a patient to activities faster. The BIOFIBER™ scaffold
design provides strong, yet flexible added support and protection and its high tensile
strength allows for it to be sutured, creating a stable construct for tendon-to-bone
repairs.
KEY POINTS:
Reinforcement of soft
tissue repairs
High tensile and suture
retention strength
Elasticity to share the load
with ingrowing tissue
The patient was placed on the operating table in the prone position for surgery and
the foot and ankle were prepped and draped in the usual aseptic manner. A Lazy-S
incision was made over the posterior aspect of the insertion of the Achilles tendon.
Full thickness flaps were created and carried through to the level of the Achilles
tendon. Subsequently, a direct midline incision was made at the Achilles tendon and
carried distally to its insertion into the calcaneus.
The Achilles tendon was reflected medially and laterally to present the large, posterior calcaneal exostosis into the surgical field. Care was taken to preserve the medial
and lateral most attachments of the Achilles tendon. A significant amount of tendinopathy from the inner substance was debrided. The tendon was also cut in an
inverted T-type orientation.
The calcaneal exostosis was resected using a sagittal saw, osteotome, and rasped
smooth with a Maltz rasp. Due to the
meshed characteristic of the BIOFIBER™
the surgeon drilled the bone with a .062
Kirchner wire to provide a further bleeding bone scaffold. Next, two corkscrew
suture anchors were inserted approximately 1 cm proximal to the insertion of
the Achilles tendon and central to each
Figure 1
half of the tendon.
The BIOFIBER™ was placed on the posterior surface of the calcaneus and was incorporated into the Achilles tendon repair by suturing its four corners with sutures from the
suture anchors. (Figures 2 and 3)
The Achilles tendon was tensioned proximally and approximated into its native position. The longitudinal incision in the midline of the Achilles tendon was repaired using
suture. The interface between the tendon and the bone was flush. A layered closure
was performed using absorbable suture and nylon suture. The patient was discharged
in a posterior splint with non-weightbearing status.
Figure 2
Figure 3
Discussion:
On subsequent post-operative visits, the patient had decreased pain with no inflammatory reaction. The incision healed uneventfully and with full range of motion at
the ankle joint. Radiographs reveal the resection of the hypertrophied navicular and
the bone flush in relation to the other bones on the medial side of the foot. (Figure 4)
The patient progressed to post-operative physical therapy in a CAM walker boot from
partial weightbearing to full weightbearing, and regular shoe gear as tolerated. The
patient appreciated the lack of tendon bulkiness which helped decrease the chance
of painful shoe irritation.
Figure 4
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www.tornier.com
Proper surgical procedures and techniques are the responsibility of the medical professional. This material is furnished for
information purposes only. Each surgeon must evaluate the appropriateness of the material based on his or her personal
medical training and experience. Prior to use of any Tornier implant system, the surgeon should refer to the product package insert for complete warnings, precautions, indications, contraindications and adverse effects. Package inserts are also
available by contacting Wright. Contact information can be found in this document and the package insert.
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©2016 Wright Medical Group N.V. or its affiliates. All Rights Reserved.
CAW-4197 REV B ECN 160796 28-Jun-2016