Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 16, Issue 2, pp 204–209 | Cite as

Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study

  • A. Gigante
  • A. Moschini
  • A. Verdenelli
  • M. Del Torto
  • S. Ulisse
  • L. de Palma
Sports Medicine

Abstract

There is no agreement on the ideal type of surgical management for Achilles tendon rupture. The present randomized prospective study was performed to compare outcome data of open and percutaneous repair in the treatment of Achilles tendon rupture. Forty consecutive patients with acute rupture of Achilles tendon were recruited. Patients were randomized to receive open (group A) or percutaneous repair with Tenolig® (group B). All patients followed the same rehabilitation protocol except for slight differences in the duration of immobilization. Follow-up included objective evaluation (at 4 and 12 months), subjective evaluation using the SF-12® questionnaire (at 24 months), and bilateral ultrasound scanning and isokinetic testing (at 12 months). The differences in the parameters evaluated clinically were not significant except for ankle circumference, which was significantly greater in group B. There were two minor complications in the open repair group and one case of failed repair in the percutaneous group. SF-12® questionnaire, ultrasound and isokinetic test data did not show significant differences between the groups. The present study demonstrates that the open and the percutaneous technique are both safe and effective in repairing the ruptured Achilles tendon and that both afford the same degree of restoration of clinical, ultrasound and isokinetic patterns. Medium-term results were substantially comparable. Percutaneous repair is performed on a day-surgery basis, it reduces cutaneous complications and operation times, and enables faster recovery, enhancing overall patient compliance. To us, these characteristics make it preferable to open repair in managing subcutaneous ruptures of Achilles tendon in non-professional sports practicing adults.

Keywords

Achilles tendon Tendon rupture Tendon repair Percutaneous repair Percutaneous treatment 

Notes

Acknowledgments

The authors are grateful Dr S. Modena for reviewing the English. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The experiments comply with the current laws of the country in which they were performed.

References

  1. 1.
    Aracil J, Pina A, Lozano J et al (1992) Percutaneous suture of Achilles tendon ruptures. Foot Ankle 13:350–351PubMedGoogle Scholar
  2. 2.
    Arner O, Lindholm A, Orell SR (1959) Subcutaneous rupture of the Achilles tendon. A study of 92 cases. Acta Chir Scand Suppl 239:1–51Google Scholar
  3. 3.
    Bradley JP, Tibone JE (1990) Percutaneous and open surgical repairs of Achilles tendon ruptures. A comparative study. Am J Sport Med 18:188–195CrossRefGoogle Scholar
  4. 4.
    Carden D, Noble J, Chalmers J et al (1987) Rupture of the calcaneus tendon: the early and late management. J Bone Joint Surg Br 69-B:416–420Google Scholar
  5. 5.
    Cetti R, Andresen I (1993) Roentgenographic diagnosis of ruptured Achilles tendon. Clin Orthop 286:215–221PubMedGoogle Scholar
  6. 6.
    Cetti R, Christensen S, Ejsted R et al (1993) Operative versus nonoperative treatment of Achilles tendon rupture. Am J Sports Med 21:791–799PubMedCrossRefGoogle Scholar
  7. 7.
    Chillemi C, Gigante A, Verdenelli A, Marinelli M, Ulisse S, Morgantini A, De Palma L (2002) Percutaneous repair of Achilles tendon ruptures: ultrasonographic and isokinetic evaluation. Foot Ankle Surg 8:267–276CrossRefGoogle Scholar
  8. 8.
    Coughlin MJ, Mann RA (2001) Patologie dei tendini. In: Verduci (ed) Chirurgia del piede e della caviglia, Roma, vol 218, pp 801–816Google Scholar
  9. 9.
    Del Ponte P, Potier L, de Poulpiquet P et al (1992) Treatment of subcutaneous rupture of the Achilles tendon with percutaneous tenorraphy. Rev Chir Orthop Repar Appar Mot 78:404–407Google Scholar
  10. 10.
    Fierro N, Sallis R (1995) Achilles tendon rupture: is casting enough? Postgrad Med 98:145–151PubMedGoogle Scholar
  11. 11.
    FitzGibbons RE, Hefferon J, Hill J (1993) Percutaneous Achilles tendon repair. Am J Sports Med 21:724–727PubMedCrossRefGoogle Scholar
  12. 12.
    Fruensgaard S, Helmig P, Riis J, Stovring J (1992) Conservative treatment for acute rupture of the Achilles tendon. Intern Orthop 16:33–35CrossRefGoogle Scholar
  13. 13.
    Hattrup S, Johonson K (1985) A review of ruptures of the Achilles tendon. Foot Ankle 6:34–38PubMedGoogle Scholar
  14. 14.
    Haertsch PA (1981) The blood supply to the skin of the leg: a post-mortem investigation. British J Plast Surg 34:470–477CrossRefGoogle Scholar
  15. 15.
    Haggmark T, Liedberg H, Eriksson E, Wredmark T (1986) Calf muscle atrophy and muscle function after non-operative vs operative treatment of Achilles tendon ruptures. Orthopaedics 9:160–164Google Scholar
  16. 16.
    Hockenbury RT, Johns JC (1990) A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle 11:67–72PubMedGoogle Scholar
  17. 17.
    Jacobs D, Martens M, Van Audekercke R et al (1978) Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med 6:107–111PubMedCrossRefGoogle Scholar
  18. 18.
    Jozsa L, Kvist M, Balint BJ, Reffy A (1989) The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical and sociological study of 292 cases. Am J Sports Med 17:338PubMedCrossRefGoogle Scholar
  19. 19.
    Lea R, Smith L (1972) Non-surgical treatment of tendo Achilles rupture. J Bone Joint Surg Am 54-A:1398–1406Google Scholar
  20. 20.
    Ma G, Griffith T (1977) Percutaneous repair of acute closed ruptured Achilles tendon. Clin Orthop 128:247–255PubMedGoogle Scholar
  21. 21.
    Maffulli N (1999) Rupture of the Achilles tendon. Current concepts review. J Bone Joint Surg Am 81-A:1019–1036Google Scholar
  22. 22.
    Möller M, Kälebo P, Tidebrant G, Movin T, Karlsson J (2002) The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment, with comparisons to MRI appearance. Knee Surg Sports Traumatol Arthrosc 10(1):49–56PubMedCrossRefGoogle Scholar
  23. 23.
    Möller M, Movin T, Granhed H, Lind K, Faxén E, Karlsson J (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–8PubMedCrossRefGoogle Scholar
  24. 24.
    Nistor L (1976) Conservative treatment of fresh subcutaneous rupture of the Achilles tendon. Acta Orthop Scand 47:459–462PubMedCrossRefGoogle Scholar
  25. 25.
    Nistor L (1981) Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am 63-A:394–399Google Scholar
  26. 26.
    Riedl S, Sandberger L, Nitschmann K, Meeder PJ (2002) Suture of fresh Achilles tendon rupture. Comparison of open with percutaneous suture technique. Chirurg 73(6):607–14PubMedCrossRefGoogle Scholar
  27. 27.
    Rook MD (1996) Lesione dei tendini, dei vasi, dei nervi e della cute. In: Verduci (ed) Chirurgia del Piede, Roma, vol. 32, pp 497–501Google Scholar
  28. 28.
    Rowley DI, Scotland TR (1982) Rupture of Achilles tendon treated by a simple operative procedure. Injury 14:252–254PubMedCrossRefGoogle Scholar
  29. 29.
    Soldatis JJ, Goodfellow DB, Wilber JH (1997) End-to-end operative repair of Achilles tendon rupture. Am J Sports Med 25:90–95PubMedCrossRefGoogle Scholar
  30. 30.
    Soma CA, Mandelbaum BR (1995) Repair of acute Achilles tendon ruptures. Orthop Clin North Am 26:239–247PubMedGoogle Scholar
  31. 31.
    Wicks NH, Harbison JS, Paterson DC (1980) Tendon injuries about the foot and ankle in children. Aust N J Z Surg 50:158CrossRefGoogle Scholar
  32. 32.
    Willis C, Washburn S, Caiozzo V, Prietto C (1986) Achilles tendon rupture: a review of literature comparing surgical versus non-surgical treatment. Clin Orthop 207:156–163Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • A. Gigante
    • 1
  • A. Moschini
    • 1
  • A. Verdenelli
    • 1
  • M. Del Torto
    • 1
  • S. Ulisse
    • 1
  • L. de Palma
    • 1
  1. 1.Clinica OrtopedicaUniversità di AnconaAnconaItaly

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