INSTRUMENT GUIDED REPAIR OF ACHILLES TENDON: DOES IT REDUCE POST-OPERATIVE MORBIDITY?

Abstract

Introduction: We studied prospectively two groups of patients treated operatively for acute achilles tendon rupture admitted in our institution in order to compare post operative morbidity, usage of hospital resources and immobilisation regimen involving immediate weight-bearing with traditional non-weight-bearing. The aim was to assess the benefit of instrument guided surgical method, which reduces hospitalisation cost, post operative wound care cost and reduce requirement of post-operative analgesics together with improved rehabilitation and return to normal activity for young patients [age below 45] with a rupture of the Achilles tendon.

Material and methods: 34 patients had repair of the tendon with an open method as an inpatient under instruction of the admitting consultant. Second group of 25 patients had repair as limited open technique with an Achillon instrument and immediate weight bearing.

Result: Opiates or opiate-based analgesia were used in the open repair group and in the minimally invasive group, patients reported no pain with paracetamol or ibuprofen. Two cases of severe wound infection leading to dehiscence requiring further surgery and 5 cases of minor surgical site infection leading to delayed wound healing were reported as wound complications in the open group. All the patients in the mini invasive group reported their satisfaction with wound healing and minimal scar at the incision site. Based on self-reports, the time taken to return to normal walking was median of 11 weeks in the achillon treatment group and 17 weeks for the open group. There was also an earlier return to normal stair climbing, with a median of 13 weeks [9–21 weeks] in the achillon treatment group and 19 weeks [13–27 weeks] for the opens technique.

Conclusion: This study has shown that mini invasive repair with Achillon instrument may allow us to perform surgery with less bed usage, less consumption of post operative analgesics and other associated indirect cost to the healthcare provider. It also allows faster rehabilitation. It provides further evidence that minimally invasive repair with early weight bearing rehabilitation has advantages over traditional open repair with delayed mobilisation for patients who have undergone surgery for ruptured Achilles tendon. The practical advantages for patients in early weight-bearing mobilisation were earlier return to normal walking and stair climbing than their open group counterparts. We would, therefore, advocate the use of minimally invasive procedure with early weight-bearing mobilisation for the rehabilitation of all patients with acute ruptures of the Achilles tendon.