Skip to main content

Advertisement

SpringerLink
Log in

Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Open fibrin gluing is reported to enable anatomical reconstruction with less soft tissue compromise than suture repair. Our main objective was to compare the complication rate, function, pain and disability of the two operative approaches of percutaneous suture using the Paessler technique and open fibrin gluing.

Methods

Sixty-four patients (two centres, retrospective cohort study, 2000–2009) who had undergone acute Achilles tendon repair with either percutaneous suture (n = 27; 44 years) or open fibrin glue (n = 37; 45 years) took part in a follow-up examination after a median of 63 months (range, six to 180). Ankle range of motion, calf and ankle circumferences and return to work and sports activities were evaluated. Isokinetic und sonographic evaluation results were retrieved.

Results

Complications were noted in 22 patients (34 %). Delayed wound healing without evidence of surgical site infection was found in three patients in the fibrin group and two patients in the suture group. Postoperative scar tenderness described as pain at the rim of the shoe was significantly more frequent in the suture group (p = 0.03). Re-rupture requiring re-operation occurred in one patient. Transient paresthesia of the heel occurred in 12 patients. No sural nerve lesions were reported. There was no significant difference between groups regarding lower leg circumference, disability, or function. Ultrasound and isokinetic measurements did not reveal a significant difference between the two methods.

Conclusions

The present study suggests that open fibrin gluing is a reasonable alternative to percutaneous repair of acute ruptures of the Achilles tendon and both techniques can yield reliably good results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ames PR, Longo UG, Denaro V, Maffulli N (2008) Achilles tendon problems: not just an orthopaedic issue. Disabil Rehabil 30(20–22):1646–1650

    Article  PubMed  Google Scholar 

  2. Metzl JA, Ahmad CS, Levine WN (2008) The ruptured Achilles tendon: operative and non-operative treatment options. Curr Rev Musculoskelet Med 1(2):161–164

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ufberg J, Harrigan RA, Cruz T, Perron AD (2004) Orthopedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med 22(7):596–600

    Article  PubMed  Google Scholar 

  4. Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 8(9):CD003674

    Google Scholar 

  5. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87(10):2202–2210

    Article  PubMed  Google Scholar 

  6. Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ (2002) Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med 30(6):783–790

    PubMed  Google Scholar 

  7. Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 36(4):765–773

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hohendorff B, Siepen W, Spiering L, Staub L, Schmuck T, Boss A (2008) Long-term results after operatively treated Achilles tendon rupture: fibrin glue versus suture. J Foot Ankle Surg 47(5):392–399

    Article  PubMed  Google Scholar 

  9. Redaelli C, Niederhäuser U, Carrel T, Meier U, Trentz O (1992) Rupture of the Achilles tendon–fibrin gluing or suture? Chirurg 63(7):572–576

    CAS  PubMed  Google Scholar 

  10. Buchgraber A, Pässler HH (1997) Percutaneous repair of Achilles tendon rupture. Immobilization versus functional postoperative treatment. Clin Orthop Relat Res 341:113–122

    Article  PubMed  Google Scholar 

  11. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  CAS  PubMed  Google Scholar 

  12. Thermann H, Zwipp H, Tscherne H (1995) Functional treatment concept of acute rupture of the Achilles tendon. 2 years results of a prospective randomized study. Unfallchirurg 98(1):21–32

    CAS  PubMed  Google Scholar 

  13. Grechenig W, Clement H, Bratschitsch G, Fankhauser F, Peicha G (2002) Ultrasound diagnosis of the Achilles tendon. Orthopade 31(3):319–325

    Article  CAS  PubMed  Google Scholar 

  14. 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):49–56

    Article  PubMed  Google Scholar 

  15. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (2012) Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am 94(23):2136–2143

    Article  PubMed Central  PubMed  Google Scholar 

  16. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92(17):2767–2775

    Article  PubMed  Google Scholar 

  17. Maes R, Copin G, Averous C (2006) Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 72(2):179–183

    PubMed  Google Scholar 

  18. Majewski M, Rohrbach M, Czaja S, Ochsner P (2006) Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med 34(5):793–798

    Article  PubMed  Google Scholar 

  19. Lenth RV (2007) Statistical power calculations. J Anim Sci 85(13 Suppl):E24–E29

    Article  CAS  PubMed  Google Scholar 

  20. Pajala A, Kangas J, Ohtonen P, Leppilahti J (2002) Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am 84-A(11):2016–2021

    PubMed  Google Scholar 

  21. Kołodziej L, Bohatyrewicz A, Kromuszczyńska J, Jezierski J, Biedroń M (2013) Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study–preliminary report. Int Orthop 37(4):625–629

    Article  PubMed Central  PubMed  Google Scholar 

  22. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U (1993) Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 21(6):791–799

    Article  CAS  PubMed  Google Scholar 

  23. Nyyssönen T, Saarikoski H, Kaukonen JP, Lüthje P, Hakovirta H (2003) Simple end-to-end suture versus augmented repair in acute Achilles tendon ruptures: a retrospective comparison in 98 patients. Acta Orthop Scand 74(2):206–208

    Article  PubMed  Google Scholar 

  24. Bhattacharyya M, Gerber B (2009) Mini-invasive surgical repair of the Achilles tendon–does it reduce post-operative morbidity? Int Orthop 33(1):151–156

    Article  PubMed Central  PubMed  Google Scholar 

  25. Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L (2008) Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc 16(2):204–209

    Article  CAS  PubMed  Google Scholar 

  26. Henríquez H, Muñoz R, Carcuro G, Bastías C (2012) Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 470(4):998–1003

    Article  PubMed Central  PubMed  Google Scholar 

  27. McMahon SE, Smith TO, Hing CB (2011) A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg 17(4):211–217

    Article  PubMed  Google Scholar 

  28. Lim J, Dalal R, Waseem M (2001) Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int 22(7):559–568

    CAS  PubMed  Google Scholar 

  29. Haji A, Sahai A, Symes A, Vyas JK (2004) Percutaneous versus open tendo Achillis repair. Foot Ankle Int 25(4):215–218

    PubMed  Google Scholar 

  30. Nilsson-Helander K, Thurin A, Karlsson J, Eriksson BI (2009) High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc 17(10):1234–1238

    Article  PubMed  Google Scholar 

  31. Schneppendahl J, Thelen S, Schek A, Bala I, Hakimi M, Grassmann JP, Eichler C, Windolf J, Wild M (2012) Initial stability of two different adhesives compared to suture repair for acute Achilles tendon rupture—a biomechanical evaluation. Int Orthop 36(3):627–632

    Article  PubMed Central  PubMed  Google Scholar 

  32. Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P (2012) Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs. Int Orthop 36(9):1947–1951

    Article  PubMed Central  PubMed  Google Scholar 

  33. Maffulli N, Spiezia F, Longo UG, Denaro V (2012) Z-shortening of healed, elongated Achilles tendon rupture. Int Orthop 36(10):2087–2093

    Article  PubMed Central  PubMed  Google Scholar 

  34. Kangas J, Pajala A, Ohtonen P, Leppilahti J (2007) Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med 35(1):59–64

    Article  PubMed  Google Scholar 

  35. Ambacher T, Kühn P, Schmidt R, Disselhorst-Klug C, Paar O (2001) Muscle strength and functional results after surgical repair of Achilles tendon rupture with fibrin gluing. Zentralbl Chir 126(12):989–994

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Source of funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany

    Matthias Knobe, Gertraud Gradl, Johannes Corsten, Thomas Dienstknecht & Hans-Christoph Pape

  2. Department of Orthopaedic Trauma, St. Vincenz and Elisabeth Hospital Mainz, Mainz, Germany

    Kajetan Klos

  3. Department of Orthopaedics, University of Aachen Medical Center, Aachen, Germany

    Bjoern Rath

  4. Department of Oral and Maxillofacial and Plastic Facial Surgery, University of Aachen Medical Center, Aachen, Germany

    Tolga Taha Sönmez

  5. Department of Orthopaedic Trauma, Marien-Hospital Aachen, Aachen, Germany

    Christian Hoeckle

  6. Department of Orthopaedic Trauma, Harald Tscherne Lab for Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstr., 52074, Aachen, Germany

    Matthias Knobe & Gertraud Gradl

Authors
  1. Matthias Knobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gertraud Gradl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kajetan Klos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johannes Corsten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Dienstknecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bjoern Rath
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tolga Taha Sönmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christian Hoeckle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hans-Christoph Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Knobe.

Additional information

Matthias Knobe and Gertraud Gradl contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Knobe, M., Gradl, G., Klos, K. et al. Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture?. International Orthopaedics (SICOT) 39, 535–542 (2015). https://doi.org/10.1007/s00264-014-2615-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2615-4

Keywords

Search

Navigation