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Operative Behandlung der Achillessehnenruptur

Surgical treatment of Achilles tendon rupture

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Zusammenfassung

Die offene Sehnennaht ist in Deutschland die am häufigsten eingesetzte Behandlungsmethode der Achillessehnenruptur. In den letzten 10 Jahren hat sich durch die Entwicklung neuer, minimalinvasiver Operationstechniken das therapeutische Spektrum der operativen Methoden weiter vergrößert. Wichtige Kriterien zur Therapieplanung sind Rupturlokalisation, -alter und Begleitkrankheiten. Bei der frischen Achillessehnenruptur kann die Indikation zur minimalinvasiven Naht gestellt werden. Eine veraltete Achillessehnenruptur sollte offen rekonstruiert werden.

Der entscheidende Nachteil der offenen Sehnennaht ist das relativ hohe Infektionsrisiko. Durch minimalinvasive Operationstechniken konnte die Häufigkeit postoperativer Infektionen deutlich gesenkt werden. Die Nahtmethoden ohne Eröffnung der Rupturregion können unter dem Begriff „perkutane Nahttechniken“ zusammengefasst und die minimalinvasiven Methoden mit Eröffnung der Rupturregion als „kombinierte offen-perkutane Techniken“ bezeichnet werden. Bekannte Probleme der Ma-Griffith-Technik wie Läsion des N. suralis, geringe Festigkeit der Naht und ungenügende Adaption der Sehnenstümpfe wurden durch neue, minimalinvasive Operationstechniken minimiert.

Gerade für sportlich aktive Menschen kann eine Achillessehnenruptur, die fast immer ohne Unfall durch Fremdeinwirkung entsteht, eine erhebliche psychische Verunsicherung hinsichtlich der Integrität des eigenen Körpers bewirken. Dies sollte gerade bei der postoperativen Behandlung beachtet und akzeptiert werden.

Abstract

The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities. For recent Achilles tendon ruptures minimally invasive suturing is indicated but for older ruptures a reconstruction often has to be carried out. The decisive disadvantage of an open tendon suture is the relatively high risk of infection. Using minimally invasive surgical techniques the frequency of postoperative infection could be significantly reduced. The suture methods without opening the ruptured region can be collectively grouped under the term percutaneous suture techniques and the minimally invasive methods with opening of the rupture region as combined open percutaneous techniques. Documented problems with the Ma-Griffith technique, such as injury of the sural nerve, low stability of the suture and insufficient adaption of the tendon stumps have been minimized by new minimally invasive operation techniques. Achilles tendon ruptures which nearly always arise without any external influence or accidents can have substantial psychological consequences regarding the integrity of one’s own body especially for people actively engaged in sport. This aspect should be considered and accepted in particular during postoperative treatment.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum „Carl Gustav Carus“, Technische Universität Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland

    M.H. Amlang

  2. Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England

    N. Maffuli

  3. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italien

    G. Longo

  4. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    T. Stübig, J. Imrecke & T. Hüfner

Authors
  1. M.H. Amlang
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  2. N. Maffuli
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  3. G. Longo
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  4. T. Stübig
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  5. J. Imrecke
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  6. T. Hüfner
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Correspondence to M.H. Amlang.

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Amlang, M., Maffuli, N., Longo, G. et al. Operative Behandlung der Achillessehnenruptur. Unfallchirurg 113, 712–720 (2010). https://doi.org/10.1007/s00113-010-1809-5

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