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Erschienen in: Wiener klinische Wochenschrift 5-6/2017

01.03.2017 | original article

Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques

verfasst von: Dragan Lonzarić, Aleksandar Kruščić, Dejan Dinevski, Petra Povalej Bržan, Breda Jesenšek Papež

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2017

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Summary

Purpose

To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best short-term functional results.

Methods

In the retrospective analysis of the results of 3 surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5—83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Čretnik and Kosanović) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruščić) included 61 (23.3%) patients. The rehabilitation protocol for group C included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2 weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6 months.

Results

Patients from group C achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in group B, one in group C, and none in group A.

Conclusions

Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruščić.
Literatur
1.
Zurück zum Zitat Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010; doi: 10.​1002/​14651858. Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010; doi: 10.​1002/​14651858.
2.
Zurück zum Zitat Mafulli M. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81A:1019–36. CrossRef Mafulli M. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81A:1019–36. CrossRef
3.
Zurück zum Zitat Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg. 2008;97(3):275–275. CrossRef Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg. 2008;97(3):275–275. CrossRef
4.
Zurück zum Zitat Unger F. Zdravje je blagostanje – vodilna vloga Evrope pri skrbi za zdravje. Acta Medico Biotech. 2008;1:11–8. Unger F. Zdravje je blagostanje – vodilna vloga Evrope pri skrbi za zdravje. Acta Medico Biotech. 2008;1:11–8.
5.
Zurück zum Zitat Čretnik A, Frank A. Incidence and outcome of rupture of the Achilles tendon. Wien Klin Wochenschr. 2004;116(Suppl 2):33–8. PubMed Čretnik A, Frank A. Incidence and outcome of rupture of the Achilles tendon. Wien Klin Wochenschr. 2004;116(Suppl 2):33–8. PubMed
6.
Zurück zum Zitat Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94:2136–43. CrossRefPubMedPubMedCentral Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94:2136–43. CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Čretnik A, Kosanović M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon. A comparative study. Am J Sports Med. 2005;33:1369–79. CrossRefPubMed Čretnik A, Kosanović M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon. A comparative study. Am J Sports Med. 2005;33:1369–79. CrossRefPubMed
9.
Zurück zum Zitat Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture: a prospective randomised study and review of the literature. Am J Sports Med. 1993;21:791–9. CrossRefPubMed Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture: a prospective randomised study and review of the literature. Am J Sports Med. 1993;21:791–9. CrossRefPubMed
10.
Zurück zum Zitat Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–90. PubMed Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–90. PubMed
11.
Zurück zum Zitat Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achillles tedon. Clin Orthop. 1977;128:247–55. Ma GWC, Griffith TG. Percutaneous repair of acute closed ruptured Achillles tedon. Clin Orthop. 1977;128:247–55.
12.
Zurück zum Zitat Čretnik A, Kosanović M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg. 2004;43:72–81. CrossRefPubMed Čretnik A, Kosanović M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg. 2004;43:72–81. CrossRefPubMed
13.
Zurück zum Zitat Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment vs. early immobilization of Achilles tendon in tension. Foot Ankle Int. 2002;23:60–5. CrossRef Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment vs. early immobilization of Achilles tendon in tension. Foot Ankle Int. 2002;23:60–5. CrossRef
14.
Zurück zum Zitat Suchak AA, Spooner C, Reid DC, Jomha NM. Postoperative rehabilitation protocols for Achilles tendon ruptures. A meta-analysis. Clin Orthop Relat Res. 2006;445:216–21. PubMed Suchak AA, Spooner C, Reid DC, Jomha NM. Postoperative rehabilitation protocols for Achilles tendon ruptures. A meta-analysis. Clin Orthop Relat Res. 2006;445:216–21. PubMed
15.
Zurück zum Zitat Suchak AA, Bostick GF, Beaupré LA, Durand DC, Jomha NM. The influence of early weight-bearing compared to non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008;90(9):1876–83. CrossRefPubMed Suchak AA, Bostick GF, Beaupré LA, Durand DC, Jomha NM. The influence of early weight-bearing compared to non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008;90(9):1876–83. CrossRefPubMed
16.
Zurück zum Zitat Müller ME, Allgöwer M, Shnaeider R, Willenegger H. Udžbenik osteosinteze AO – metoda. Zagreb: Jumena; 1981. Müller ME, Allgöwer M, Shnaeider R, Willenegger H. Udžbenik osteosinteze AO – metoda. Zagreb: Jumena; 1981.
17.
Zurück zum Zitat Pauwels F. (editor) Gesamte Abhandlungen zur funktionellen Anatomie des Bewegungsapparates. Berlin: Springer; 1965. Pauwels F. (editor) Gesamte Abhandlungen zur funktionellen Anatomie des Bewegungsapparates. Berlin: Springer; 1965.
18.
Zurück zum Zitat Nikolić V, Hudec M. Biomehanika potpornog sustava. Principi i elementi biomehanike. Zagreb: Školska knjiga; 1988. Nikolić V, Hudec M. Biomehanika potpornog sustava. Principi i elementi biomehanike. Zagreb: Školska knjiga; 1988.
19.
Zurück zum Zitat Wong J, Barras V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–75. PubMed Wong J, Barras V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–75. PubMed
21.
Zurück zum Zitat Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo Achillis repair. Foot Ankle Int. 2004;25:215–8. CrossRefPubMed Haji A, Sahai A, Symes A, et al. Percutaneous versus open tendo Achillis repair. Foot Ankle Int. 2004;25:215–8. CrossRefPubMed
22.
Zurück zum Zitat Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle Int. 1990;11:67–72. CrossRef Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle Int. 1990;11:67–72. CrossRef
23.
Zurück zum Zitat Webb JM, Banister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–80. CrossRefPubMed Webb JM, Banister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–80. CrossRefPubMed
24.
Zurück zum Zitat Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon: a prospective randomized controlled study. Foot Ankle Int. 2001;22:559–68. CrossRefPubMed Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon: a prospective randomized controlled study. Foot Ankle Int. 2001;22:559–68. CrossRefPubMed
25.
Zurück zum Zitat Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007;35:2033–8. CrossRefPubMed Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007;35:2033–8. CrossRefPubMed
26.
Zurück zum Zitat Van der Eng DM, Schepers T, Goslings JC, Schep NWL. Rerupture rate after early weightbearing in operative versus conservative treatments of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013;52(5):622–8. CrossRefPubMed Van der Eng DM, Schepers T, Goslings JC, Schep NWL. Rerupture rate after early weightbearing in operative versus conservative treatments of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013;52(5):622–8. CrossRefPubMed
27.
Metadaten
Titel
Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques
verfasst von
Dragan Lonzarić
Aleksandar Kruščić
Dejan Dinevski
Petra Povalej Bržan
Breda Jesenšek Papež
Publikationsdatum
01.03.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 5-6/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-1158-7