AUGMENTED VS NON-AUGMENTED SURGICAL REPAIR OF A FRESH TOTAL ACHILLES TENDON RUPTURE: A PROSPECTIVE, RANDOMIZED STUDY

Abstract

Background: The aim of our prospective, randomized study was to compare two operative techniques for the treatment of acute Achilles tendon rupture and question the necessity of augmented repair. Null hypothesis: Augmentation with a down-turned gastrocnemius fascia flap does not give any better result than end-to-end suturation by the Krackow locking loop surgical technique.

Study Design: A prospective, randomized clinical trial.

Methods: Sixty patients with acute Achilles tendon rupture were randomized preoperatively to receive end-to-end suturation by the Krackow locking loop technique either without augmentation (Group I) or with one down-turned gastrocnemius fascia flap, as described by Silfverskiöld (Group II). A dorsal brace allowed free active plantar flexion of the ankle postoperatively, whereas dorsiflexion was restricted to neutral for the first three weeks. Weight bearing was limited for six weeks. The follow-up period was one year, and evaluation was performed in terms of clinical measurements, an outcome score, isokinetic calf muscle performance tests and tendon elongation measurements.

Results: The mean operation time was 25 minutes longer in the augmentation group and the incision 7 cm longer (p< 0.001 both). The overall ankle scores were excellent in 70% of cases and good in 30% in both groups. The isokinetic calf muscle strength scores were excellent in 41% of cases, good in 52%, and fair in 7% in group I, whereas those in the group II were excellent in 45% of cases, good in 35%, fair in 15% and poor in 5%. Achilles tendon elongation occurred in both groups and elongation correlated significantly with previous AT problems (ρ= 0.47, p=0.040), isokinetic peak torque deficits (ρ= 0.64, p=0.001) and isometric strength deficits (ρ= 0.48, p=0.026) in the nonaugmentation group. No significant differences were seen between the two groups at the 3-month and 12-month check-ups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, overall outcome, iso-kinetic calf muscle strength, mean peak work-displacement relationships or tendon elongation. Six re-ruptures (three in each group) and two deep infections in group II were regarded as treatment failures and were excluded. The final results in all the rerupture cases were good.

Conclusions: Routine use of augmentation does not seem to be necessary in surgery for fresh total Achilles tendon ruptures.