Summary
Purpose
To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best short-term functional results.
Methods
In the retrospective analysis of the results of 3 surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5—83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Čretnik and Kosanović) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruščić) included 61 (23.3%) patients. The rehabilitation protocol for group C included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2 weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6 months.
Results
Patients from group C achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in group B, one in group C, and none in group A.
Conclusions
Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruščić.
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References
Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010; doi:10.1002/14651858.
Mafulli M. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81A:1019–36.
Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg. 2008;97(3):275–275.
Unger F. Zdravje je blagostanje – vodilna vloga Evrope pri skrbi za zdravje. Acta Medico Biotech. 2008;1:11–8.
Čretnik A, Frank A. Incidence and outcome of rupture of the Achilles tendon. Wien Klin Wochenschr. 2004;116(Suppl 2):33–8.
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94:2136–43.
Čretnik A, Kosanović M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon. A comparative study. Am J Sports Med. 2005;33:1369–79.
Amendola A. Outcomes of open surgery versus nonoperative management of acute Achilles tendon rupture. Clin J Sport Med. 2014;24(1):90–1. doi:10.1097/JSM.0000000000000064.2202-10.
Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture: a prospective randomised study and review of the literature. Am J Sports Med. 1993;21:791–9.
Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–90.
Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achillles tedon. Clin Orthop. 1977;128:247–55.
Čretnik A, Kosanović M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg. 2004;43:72–81.
Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment vs. early immobilization of Achilles tendon in tension. Foot Ankle Int. 2002;23:60–5.
Suchak AA, Spooner C, Reid DC, Jomha NM. Postoperative rehabilitation protocols for Achilles tendon ruptures. A meta-analysis. Clin Orthop Relat Res. 2006;445:216–21.
Suchak AA, Bostick GF, Beaupré LA, Durand DC, Jomha NM. The influence of early weight-bearing compared to non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008;90(9):1876–83.
Müller ME, Allgöwer M, Shnaeider R, Willenegger H. Udžbenik osteosinteze AO – metoda. Zagreb: Jumena; 1981.
Pauwels F. (editor) Gesamte Abhandlungen zur funktionellen Anatomie des Bewegungsapparates. Berlin: Springer; 1965.
Nikolić V, Hudec M. Biomehanika potpornog sustava. Principi i elementi biomehanike. Zagreb: Školska knjiga; 1988.
Wong J, Barras V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–75.
Khan RJK, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials 2005. http://www.udel.edu/bioms/seminararchives/09_10/Khan%20RJ%20Treatment%20of%20acute%20achilles%20tendon%20rupture%20metananlysis.pdf. Accessed 15 Jan 2014.
Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo Achillis repair. Foot Ankle Int. 2004;25:215–8.
Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle Int. 1990;11:67–72.
Webb JM, Banister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–80.
Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon: a prospective randomized controlled study. Foot Ankle Int. 2001;22:559–68.
Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007;35:2033–8.
Van der Eng DM, Schepers T, Goslings JC, Schep NWL. Rerupture rate after early weightbearing in operative versus conservative treatments of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013;52(5):622–8.
Jomha NM, Suchak A, Beaupre L. et al. A prospective, randomized trial comparing early weight bearing vs. non-weight bearing after Achilles tendon rupture. Presented at the American Orthopaedic Foot and Ankle Society 23rd Annual Summer Meeting. July 13–15, 2007. Toronto 2007. http://www.orthosupersite.com/view.asp?rID=22850. Accessed 15 Jan 2014.
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D. Lonzarić, A. Kruščić, D. Dinevski, P. Povalej Bržan and B. Jesenšek Papež declare that they have no competing interests.
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Lonzarić, D., Kruščić, A., Dinevski, D. et al. Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques. Wien Klin Wochenschr 129, 176–185 (2017). https://doi.org/10.1007/s00508-016-1158-7
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DOI: https://doi.org/10.1007/s00508-016-1158-7