Elsevier

Injury

Volume 38, Issue 7, July 2007, Pages 839-844
Injury

The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment

https://doi.org/10.1016/j.injury.2006.12.010Get rights and content

Summary

Background

There is still controversy regarding the optimal surgical technique and post-operative treatment of acute Achilles tendon ruptures. We evaluated a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight bearing.

Methods

A consecutive group of 163 patients was prospectively followed during a 6 year period (1998–2004) in one university hospital and five teaching hospitals. Data were collected during the outpatient department visits at 1, 3, 5, and 7 weeks, 4 months and 12 months after the intervention. Outcome parameters were the incidence of re-rupture, other complications, the functional outcome and the period of sick leave concerning work and sport.

Results

The patient group consisted of 128 men (79%) and 35 women (21%). The mean operating time was 41 min. In 9 patients (5.5%) a major complication occurred, necessitating 5 surgical re-interventions (2 for re-ruptures, 2 for infections and 1 for tendon necrosis). Fifteen patients (9.2%) suffered from dysfunction of the sural nerve. The median time of returning to work was 28 days (range 1–368) and the median time of returning to sport was 167 days (range 31–489). The majority of patients (150; 92%) were satisfied with the results.

Conclusion

Minimally invasive Achilles tendon repair in combination with a functional rehabilitation program is a safe and quick procedure with a low rate of re-rupture and a high level of patient satisfaction.

Introduction

In the treatment of acute Achilles tendon rupture (ATR) many authors advocate a surgical approach, especially in the young and physically active patient.4, 8, 11, 17, 30, 31 Since the first description of a minimally invasive operative technique for treatment of acute Achilles tendon rupture by Ma and Griffith in 1977, minimally invasive surgery for ATR has gained popularity and various modifications of the technique have followed.1, 4, 6, 15 Regardless of the surgical technique, cast immobilisation has been the most popular method of post-operative treatment until now. However, there is a tendency towards mobilisation and full weight bearing soon after operative treatment of Achilles tendon rupture, with various authors reporting good results.3, 6, 7, 9, 11, 16, 18, 23, 24

Theoretically, a treatment strategy consisting of both a minimally invasive procedure while allowing a liberal post-operative regime would represent the ‘best of both worlds’. Although minimally invasive surgery for Achilles tendon rupture has gained popularity, little evidence is available on the safety of the technique, especially in combination with a functional aftertreatment. We present the results of a combination of minimally invasive surgical repair combined with a functional post-operative regime allowing full weight bearing. The minimally invasive technique applied in this study was a modification of the technique described by Ma and Griffith: instead of 6 stab incisions, a small horizontal incision was used, and the suture was guided through the calcaneus.

The aim of this study was to evaluate a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight bearing.

Section snippets

Design

The study was designed as a prospective multi-centre clinical trial. Primary end point was the incidence of re-rupture, the functional outcome and the duration of sick leave concerning work and sports.

Secondary end points were the incidence of other complications after minimally invasive Achilles tendon repair, such as wound-infection and sural nerve neuralgia, and the subjective evaluation by the patient.

Patients

The data were collected prospectively in one university hospital and five teaching

Results

Between May 1998 and February 2004, 163 consecutive patients were included, 128 men (79%) and 35 women (21%). Three patients (1.8%) were lost to follow-up, one died and two patients moved to other countries. The age was between 22 and 76 years (mean 38 years) and in 83% of the cases the injury was sports-related. We tried to operate on all patients within 24 h of rupture (mean 1 day, range: 1–4 days) and were able to leave the hospital within 0 (same day admission) to 17 days (median: 2). The

Discussion

There is still controversy about the management of subcutaneous Achilles tendon ruptures. Although most authors prefer surgical repair because of the high re-rupture rate after conservative management.8, 11, 17, 30, 31 Some authors prefer the conservative management concept because of the prevention of the typical complications associated with open surgery.19

Khan et al. showed that complications typically associated with open repair can be avoided by percutaneous tendon sutures without an

Conclusion

The minimally invasive Achilles tendon repair combined with a functional rehabilitation program has been shown to be a safe and quick procedure with a low rate of re-ruptures, quick return to work and sports and a high level of patient satisfaction. We consider the outcome as a support for this procedure and its post-operative mobilisation regimen.

Conflict of interest

The authors of this manuscript have no financial or proprietary interest in the subject matter discussed in the manuscript in one way or another. The completion of this manuscript has been achieved in order to contribute to the knowledge of the surgical management of trauma.

Acknowledgements

The authors would like to kindly thank all participating surgeons and surgical residents of the following hospitals: Academic Medical Centre, Amsterdam, The Netherlands; Dr. R.M.J.M. Butzelaar, St. Lucas–Andreas Ziekenhuis, Amsterdam; Drs. A.K.F. Tanka, Spaarne Ziekenhuis, Haarlem; Dr. M.P. Simons, Onze Lieve Vrouwe Gasthuis, Amsterdam; Drs. P.P. Bor, Ziekenhuis Gooi Noord, Blaricum; Dr. J.G. van Baal, Twenteborg Ziekenhuis, Almelo; Drs. R.P. Strating, Ziekenhuis De Heel, Zaandam.

The authors

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