ACHILLES TENDON RUPTURE: OPEN VERSUS PERCUTANEOUS TECHNIQUE – COMPARATIVE STUDY OF 81 CASES

Abstract

Introduction: Acute Achilles tendon rupture is very much associated with sports practice and it’s a common lesion between young people. Despite of much Discussion: in the literature, the correct treatment of the complete ruptures of this tendon in the acute phase remains controversial.

The objective of this work is to accomplish a comparative analysis between the results obtained with both techniques: open versus percutaneous.

Materials and Methods: This work included 81 patients (6 women e 75 men) with acute rupture of the Achilles tendon between January of 1999 and December of 2008 and that were submitted 51 to surgical treatment with open technique and 30 with the percutaneous with the technique of Ma and Griffith modified. This patients had medium age of 35,6 years with a greater incidence between 30 and 39 years and with medium time follow-up of 1,9 years.

The diagnostic of the lesion was based in clinic criteria and when there was a doubt an ecography was realized.

In both Methods: was used posteoperative cast immobilization with 20° of plantar flexion during 6 weeks. The patients were analysed according to clinical e functional evaluations and the American Orthopaedic Foot and Ankle Society scale and the Holtz score.

Results: The patients included in the percutaneous group had better functional results with more precocious weight bearing, better ankle range of movement e more earlier return to sports practice (p< 0,001). In the open technique there were more complications in comparison with the percutaneous one (15,7% vs 6,7%). In the open technique there were no rerupture and in the percutaneous technique there were 6.

The results in both scales were better in the percutaneous group but it wasn’t statistically significative.

Discussion: Good functional results and a low percentage of complications recommend the use of surgical techniques in the treatment of this disease. Better functional and aesthetic results were obtained in the percutaneous group but at expense of a more percentage of reruptures. Open surgery is indicated in the reruptures after the utilisation of the percutaneous technique.