Abstract
The Achilles tendon is formed by the fusion of gastrocnemius and soleus muscle, and is one of the strongest of the human body. Acute ruptures occur mostly in men between 30 and 50 years of age, with irregular sports activity. Rupture generally occurs in a low perfusion area, between 2 and 6 cm above the calcaneal tuberosity.
We reviewed and examined 45 patients with Achilles tendon rupture submitted to surgical correction, between January 2004 and December 2008 (5 years), in our Hospital.
For each patient was determined the injury type, time until diagnosis, time between diagnosis and surgery, surgical technique employed, immobilization period, rehabilitation program, occurrence of complications and rerupture, follow-up period and clinical outcome (AOFAS score).
The most frequent cause of rupture was professional activity (46%), followed by soccer practice (38%). The diagnosis was made in the first medical observation in 71% of patients. The mean surgical period until surgery was of 0.7 days, and the mean time of admission was of 3.56 days. The used surgical techniques were open surgery (25 cases), open surgery augmented with gastrocnemius fascia (5 cases), and percutaneous surgery with the Achillon system (15 cases).
The mean AOFAS score was of 92.42 (84–100), was of 100 in the Achillon group, 92 in the open surgery group and 91 in the augmented surgery group.
The complications all occurred in the open surgery group, with one infection, one surgical incision healing delay and one case of sural nerve injury.
The mean follow-up was of 4.4 months and the main complain was of local tenderness in the surgical wound, with all patients having returned to their normal level of activity.
This series complications rate is low, and the AOFAS score and satisfaction rate is higher in the percutaneous group, following the tendency expressed in the international literature. Reflecting the growing tendency for information in our patients, one important cause of dissatisfaction in the open surgery group is not to have had the opportunity of a percutaneous surgery.
The results of percutaneous surgery are excellent, with a lower rate of complications, less surgical wound complaints. The possibility raised by other studies of a higher rerupture rate in the percutaneous group was not confirmed in this group.
Currently all Achilles ruptures are treated percutaneously in our Hospital, if the rupture meets the indications criteria for this type of surgery.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Tel: +41 44 448 44 00; Email: office@efort.org
Author: Rui Martins, Portugal
E-mail: mouramartins@sapo.pt
