Abstract
The percutanous repair of the Achilles tendon is a cost efficient method of restoring early limb function and may offer reduced risk of re-rupture and wound infection. This technique has been described in the elderly population and elite athletes; we present an evaluation of this technique in a District General Hospital setting. We have prospectively audited the outcome of 56 patients who have elected to have percutaneous repair for Achilles tendon rupture from 2009–2011. The majority were males (44) with mean age of 46 years (range 27–80). Twenty nine patients ruptured the right tendon and 27 the left. 82% (46) of injuries were sustained whilst exercising: e.g. football (22), badminton (7), running (5). All but 2 patients were managed on a Day Case basis and 4 requested general anaesthesia. Patients were immediately weight bearing in a brace following surgery and commenced physiotherapy at 2 weeks.
Functional outcome was measured using a modified Achilles Tendon Rupture Score (ATRS) at 3, 6, 9 and 12 months: 100 score equals maximal limitation. The mean ATRS scores a 3, 6, 9 and 12 months were 53 (7–82), 31 (0–74), 30 (0–67) and 15 (1–52) respectively. We have had 4 complications: 2 sural nerve injuries, 1 poor wound healing and 1 re-rupture at 8 weeks.
Overall complication rate was 7.1%, comparable to other studies. We have shown a good outcome following percutaneous Achilles tendon repair. The majority of patients show good restoration of function by 3 months and a minor limitation at 6 months. The majority of the improvement in function occurred between 3 and 6 months following surgery. Two patients reported ongoing tendinopathic pain following repair increasing mean scores.
We believe this technique can be introduced in District General Hospitals to give good outcome on a cost effective basis.
