PERCUTANEOUS AND OPEN SURGICAL REPAIRS OF ACHILLES TENDON RUPTURES: COMPARISON OF SURGICAL TECHNIQUES.

Abstract

BACKGROUND and AIM: There is no consensus on the best treatment for acute Achilles tendon ruptures. There is no single, uniformly accepted surgical technique, and the surgical options include open repair with or without augmentation and percutaneous techniques. A retrospective analysis was conducted to compare different surgical procedures for the treatment of the rupture of the achilles tendon.

PATIENTS and METHODS: from october 2002 to september 2006, 176 patients (male 155 and female 21) underwent surgical procedures: 105 open repair (Kessler, Barbed wire) and 71 percutaneous repair (Ma Griffith, Tenolig, Bio-tex).132 patients were evaluated, including criteria was a minimal follow-up of six months;; all patients were interwieved, 81 were assesed with physical examination using Kitaoka rating score and 44 also with isokinetic dynamometer test (Kintrex) measuring strenght, power and endurance.

RESULTS: The mean surgical time was 53.5 minutes with the open repair and 28,6 minutes in closed procedure. All the closed procedures were performed in regional anesthesia and did not required hospitalization. Objective and functional assessement and the isokinetic test showed no statistically significant difference between the two groups (p< 0.05). All patients return to pre-injury working and recreational sport activities. At the physical examination 47 patients showed an important (more than 2 cm) reduction of calf circumference. In the open group there were no rerupture, one deep infection, 10 painful or ipertrophic scars. Complication in the percutaneous repair included 3 reruptures (2 patients fell few days after surgery), no wound infections, 3 disturbances in sensitivity of the sural nerve.

CONCLUSION: On the basis of these results, the percutaneous repair as suitable alternative to open techniques may be recommended. This is a simple and safe surgical procedure which allows to achieve an high rate of excellent functional outcomes with minimal morbidity. Furthermore the time for surgery is shorther and the procedure can be performed without hospitalization.