Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up

Year 2015, Volume: 49 Issue: 6, 661 - , 28.10.2015

Alexandros Mavrodontidis Marios Lykissas , Panayiotis Koulouvaris Vasilios Kontogeorgakos Dionysios Giannoulis Charalampos Zalavras

Abstract

Objective: The purpose of this study was to present the functional outcomes of percutaneous tenorrhaphy of the Achilles tendon with a minimum follow-up of 10 years.
Methods: The medical records of patients who underwent percutaneous surgery for acute unilateral Achilles tendon rupture between 2000 and 2004 were retrospectively reviewed.
Results: A total of 11 male patients met the inclusion criteria and were followed for a mean of 12.6 years (range: 10–13 years). The average age at the time of surgery was 39.3 years (range: 29–53 years). Patients returned to work at an average of 2.7 months (range: 1–4 months) after surgery and to normal daily activities (NDA) at an average of 4.1 months (range: 3–6 months) postoperatively. The mean strength ratio between the injured and normal sides was 90%. Compared with the contralateral normal side, the thickness of the operated tendon increased by a mean of 0.7 cm, while the circumference of the affected calf diminished by a mean of 1.1 cm. No difference in active and passive range of motion (ROM) was recorded between the affected and the contralateral normal ankle joints. Isometric plantar flexion was 87% of normal. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after surgery. The sensory defect had completely resolved by 6 months postoperatively.
Conclusion: Long-term outcomes of our series support the effectiveness of percutaneous tenorrhaphy in Achilles function rehabilitation of patients with acute ruptures.

DOI: 10.3944/AOTT.2015.14.0196

Keywords

Achilles tendon; long-term outcomes; percutaneous repair; rupture; sural nerve.

References

• Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Can- ada. Foot Ankle Int 2005;26:932–6.
• Józsa L, Kvist M, Bálint BJ, Reffy A, Järvinen M, Lehto M, Barzo M. The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociologi- cal study of 292 cases. Am J Sports Med 1989;17:338–43.
• Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoff- meyer P. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a pro- spective multicenter study. J Bone Joint Surg Am 2002;84- A:161–70.
• Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am 1999;81:1019–36.
• Möller A, Astron M, Westlin N. Increasing inci- dence of Achilles tendon rupture. Acta Orthop Scand 1996;67:479–81.
• Arİen A, Helgİ D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a pre- vious Achilles tendon rupture. Scand J Med Sci Sports 2004;14:30–3.
• Pa¨ssler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol 1998;14:93– 95.
• Rippstein PF, Jung M, Assal M. Surgical repair of acute Achilles tendon rupture using a “mini-open” technique. Foot Ankle Clin 2002;7:611–9.
• Rowley DI, Scotland TR. Rupture of the Achilles ten- don treated by a simple operative procedure. Injury 1982;14:252–4.
• Wong J, Barrass V, Maffulli N. Quantitative review of op- erative and nonoperative management of achilles tendon ruptures. Am J Sports Med 2002;30:565–75.
• Zwipp H, Südkamp N, Thermann H, Samek N. Rupture of the Achilles tendon. Results of 10 years’ follow-up after surgical treatment. A retrospective study. [Article in Ger- man] Unfallchirurg 1989;92:554–9. [Abstract]
• Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med 1978;6:107–11.
• Krüger-Franke M, Scherzer S. Long-term results of sur- gically treated Achilles tendon ruptures. [Article in Ger- man] Unfallchirurg 1993;96:524–8. [Abstract]
• Quigley TB, Scheller AD. Surgical repair of the ruptured Achilles tendon. Analysis of 40 patients treated by the same surgeon. Am J Sports Med 1980;8:244–50.
• Sölveborn SA, Moberg A. Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures. Am J Sports Med 1994;22:607–10.
• Winter E, Weise K, Weller S, Ambacher T. Surgical re- pair of Achilles tendon rupture. Comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998;117:364,7.
• Gillies H, Chalmers J. The management of fresh ruptures of the tendo achillis. J Bone Joint Surg Am 1970;52:337– 43.
• Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Intervention for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 2004;3:CD003674.
• Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov 1991;76:223–8.
• Webb JM, Bannister GC. Percutaneous repair of the rup- tured tendo Achillis. J Bone Joint Surg Br 1999;81:877– 80.
• Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 2005;15:133–5.
• Kerkhoffs GM, Struijs PA, Raaymakers EL, Marti RK. Functional treatment after surgical repair of acute Achil- les tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 2002;122:102–5.
• Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon--a prospective random- ized controlled study. Foot Ankle Int 2001;22:559–68.
• Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med 2003;31:692–700.
• Cretnik A, Zlajpah L, Smrkolj V, Kosanović M. The strength of percutaneous methods of repair of the Achil- les tendon: a biomechanical study. Med Sci Sports Exerc 2000;32:16,20.
• Hockenbury RT, Johns JC. A biomechanical in vitro com- parison of open versus percutaneous repair of tendon Achilles. Foot Ankle 1990;11:67–72.
• Kakiuchi M. A combined open and percutaneous tech- nique for repair of tendo Achillis. Comparison with open repair. J Bone Joint Surg Br 1995;77:60–3.
• Park HG, Moon DH, Yoon JM. Limited open repair of ruptured Achilles tendons with Bunnel-type sutures. Foot Ankle Int 2001;22:985–7.
• Ceccarelli F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and minimally invasive techniques of Achil- les tendon repair. Clin Orthop Relat Res 2007;458:188– 93.
• Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture. Immobilization versus func- tional postoperative treatment. Clin Orthop Relat Res 1997;341:113–22.
• Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo achillis repair. Foot Ankle Int 2004;25:215–8.
• Aktan Ikiz ZA, Uçerler H, Bilge O. The anatomic features of the sural nerve with an emphasis on its clinical impor- tance. Foot Ankle Int 2005;26:560–7.
• Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 2006;72:179–83.
• Henríquez H, Muñoz R, Carcuro G, Bastías C. Is percu- taneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 2012;470:998– 1003.