Treatment of Acute Achilles Tendon Rupture: Fibrin Glue versus Fibrin Glue Augmented with the Plantaris Longus Tendon

doi:10.1053/j.jfas.2009.04.005

The Journal of Foot and Ankle Surgery

Volume 48, Issue 4, July–August 2009, Pages 439-446

https://doi.org/10.1053/j.jfas.2009.04.005 Get rights and content

In the surgical repair of Achilles tendon ruptures, suturing is standard, although fibrin glue also has been used for repair since the 1980s. Augmentation with the plantaris longus tendon is also a popular technique; however, no study has yet compared the outcome of augmented versus only glued repair of ruptured Achilles tendons. This study compares the long-term results of surgical repair of Achilles tendon rupture with fibrin glue versus fibrin glue augmented with the plantaris longus tendon. Forty patients who had undergone Achilles tendon repair with fibrin glue took part in a follow-up examination after an average of 11.5 years. The fibrin group consisted of 16 patients and the fibrin glue augmented with plantaris longus tendon group consisted of 15 patients. The modified Thermann score (adapted from Weber) and results of an isokinetic force measurement were the same in both groups, whereas complications in the 2 groups also did not differ. We conclude that augmentation with the plantaris longus tendon is not necessary when operatively treating acute ruptured Achilles tendons with fibrin glue. Level of Clinical Evidence: 2

Section snippets

Study Cohort

Patients were selected for participation in this study based on the following 3 inclusion criteria: (1) the patient was unable to plantarflex the ankle on the injured side at the time of the initial presentation, (2) the presence of a positive Thompson-Dougherty test on initial examination, and (3) surgical repair of the ruptured Achilles tendon took place within 7 days of the initial traumatic event. Patients were excluded if the initial evaluation and treatment of the rupture was delayed

Demographic Characteristics of the Cohort

A total of 44 Achilles tendon ruptures were treated operatively with fibrin glue between October 1987 and December 1999. Of these, 40 patients (33 men, 7 women) met our criteria for inclusion in this investigation. The remaining 4 were excluded because of delayed presentation after trauma, or degenerative or chronic Achilles tendon rupture. The median age of the patients at the time of operation was 38 years (range 25–67) in the fibrin group and 39 (range 16–80) in the augmented group (P =

Discussion

The treatment of acute Achilles tendon ruptures is widely discussed in the literature 4, 18, 20, 28, 29, 30, 31, 32, 33. It has been argued that an anatomical reconstruction of ruptured Achilles tendons with fibrin glue is efficacious 11, 12, 34, 35, 36, and since the 1980s gluing with fibrin has been used as an alternative to the more common suture technique for treating Achilles tendon ruptures. The positive influence of fibrin glue on tendon tissue healing has been demonstrated in

Acknowledgment

We would like to thank Christopher Ritter, PhD for assistance and preparation of the manuscript.

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Citation Excerpt :
Sealing of solid organ injuries and hemostasis [75]. Healing of skin graft, tendon and nerve repair [79–95]. Tisseel is described by its manufacturer as a ‘fibrin sealant indicated for use as an adjunct to hemostasis in adult and pediatric patients (>1mo of age) undergoing surgery when control of bleeding by conventional surgical techniques (such as suture, ligature, and cautery) is ineffective or impractical.
Foreign body ingestion is common in the pediatric population and the mainstay of treatment is typically endoscopic removal. Complications such as tracheoesophageal fistula may occur due to foreign body ingestion. The treatment of tracheoesophageal fistula following foreign body ingestion is controversial. We report the case of a 33 month-old former 25 week-old triplet who developed a tracheoesophageal fistula following her foreign body ingestion. Following initial foreign body removal, subsequent treatment with electrocautery and fibrin sealant facilitated closure of the fistula as seen on repeat esophagram performed six weeks post-operatively. We report this case as a reminder of this complication and its association with foreign body ingestion as well as its insidious presentation and to encourage consideration of this modality as a primary treatment for acquired tracheoesophageal fistulae secondary to foreign body ingestion.
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Operative treatment carries the risk of complications but significantly reduces the risk of repeat rupture (2). However, the optimum operative technique (open, mini-open versus percutaneous) remains controversial (16,17), and a wide range of surgical options exist, including augmentation of the repair with adjacent autogenous tendon (18–20), reapproximation with fibrin glue (21,22), and the use of acellular dermal grafts (23,24). Classically the postoperative regimens consisted of complete cast immobilization for periods of 6 to 9 weeks (3–5).
The management of Achilles tendon rupture is a much-debated subject. In recent years, there has been much interest in early postoperative mobilization. We present the results of our Achilles tendon repair technique and accelerated rehabilitation program. The technique we propose uses the strength of a 1-loop polydioxanone “suture frame” to enable restoration of the tendon length, immediate positioning of the foot in a near-plantigrade position, and an accelerated rehabilitation program. We followed up 15 cases of Achilles tendon rupture treated with this technique. The initial follow-up was a review of case notes and a telephone questionnaire. All patients were subsequently invited for a clinical follow-up visit, and 11 patients (68.75%) attended. No cases of infection or repeat rupture occurred. The return to work (mean 5.6 weeks) and return to sport (mean 4.8 months) were relatively rapid. Regarding overall satisfaction on a scale of 0 to 10, the median was 9 (range 8 to 10). Of the 11 patients who attended the clinical follow-up visit, the mean American Orthopaedic Foot and Ankle Surgery ankle-hindfoot score was 94.5 points (range 83 to 100). The Achilles rupture repair scores (including isokinetic muscle strength) were good or excellent in all but 1 patient, whose result was fair. Of the 11 patients, 10 reported complete satisfaction with their outcome. Our technique with accelerated rehabilitation is safe and effective in the management of acute Achilles tendon rupture. It facilitates an early return to work and recreational sports, with excellent overall patient satisfaction.
Comparison of Augmentation Method for Achilles Tendon Repair: Using Thoracolumbar Fascia and the Polypropylene Mesh
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Secondary reconstruction of chronic Achilles tendon rupture: flexor hallucis longus transfer versus plantaris longus augmentation
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View all citing articles on Scopus

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: Conflict of Interest: None reported.

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Original ResearchTreatment of Acute Achilles Tendon Rupture: Fibrin Glue versus Fibrin Glue Augmented with the Plantaris Longus Tendon

Section snippets

Study Cohort

Demographic Characteristics of the Cohort

Discussion

Acknowledgment

Lancet

J Foot Ankle Surg

J Foot Ankle Surg

Ambrose Paré conseiller, et premier chirurgien du Roy avec les figures & portraicts tant de l'Anatomie que des instruments de Chirurgie, & de plusieurs Monstres

A Paris, Chez Gabriel Buon

Der Achillessehnenriss als Sport- und Arbeitsunfall, Analyse von 198 Verletzungen

Unfallheilkunde

Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials

J Bone Joint Surg Am

Die Behandlung der Achillessehnenruptur

Unfallchirurg

Les ruptures du tendon d'Achille

Rev Chir

Über die Wirkung des Fibrins

Dtsch Med Wochenschr

Zur nahtlosen interfaszikulären Nerventransplantation im Tierexperiment

Wien Med Wochenschr

Isolation from beef pancreas of crystalline trypsinogen, trypsin, a trypsin inhibitor, and an inhibitor trypsin compound

J Gen Physiol

Achillessehnenruptur – Fibrinklebung oder Naht?

Chirurg

Achillessehnenrupturen Ursachen – Operationstechnik – Ergebnisse – Begutachtungsprobleme

Unfallchirurg

Results of surgical treatment of rupture of the Achilles tendon with use of the plantaris tendon

Arch Chir Neerl

Die Achillessehnenruptur und ihre Naht mit Hilfe der Plantarissehne

Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed

A new method of operation in subcutaneous rupture of Achilles tendon

Acta Chir Scand

Endoscopic-assisted Achilles tendon repair with plantaris tendon augmentation

Arthroscopy

Current concepts review: rupture of the Achilles tendon

J Bone Joint Surg Am

Die operative Behandlung der frischen subkutanen Achillessehnenruptur und deren Behandlungsergebnisse

Akt Traumatol

Simple end-to-end suture versus augmented repair in acute Achilles tendon ruptures

Acta Orthop Scand

Versorgung der Achillessehnenruptur. Vergleichsstudie zwischen Adaptationsnaht und Plantarissehnendurchflechtung

Unfallchirurg

Achilles tendon repair with the plantaris tendon compared with repair using polyglycol threads

J Trauma

Über die subkutane totale Achillessehnenruptur und deren Behandlung

Acta Chir Scand

Achillessehnennaht mit der Plantaris-longus-Sehne

Wien med Wochenschr

Achillessehnennaht mit der Plantarissehne

Klin Med

Original Research
Treatment of Acute Achilles Tendon Rupture: Fibrin Glue versus Fibrin Glue Augmented with the Plantaris Longus Tendon