Repair of acute Achilles tendon ruptures using Lynn method

Year 2013, Volume: 40 Issue: 3, 474 - 479, 01.09.2013

Tolga Tolunay Ahmet Onur Akpolat Arslan Kağan Arslan Rahmi Yavuz Önem Erkan Akgün İbrahim Azboy Abdullah Demirtaş

https://doi.org/10.5798/diclemedj.0921.2013.03.0313

Abstract

Objectives: Efficiency assessment of Lynn method on open primary repair of acute Achilles tendon ruptures. Methods: Data were evaluated from 19 patients who treated with the Lynne method due to acute Achilles tendon rupture. Average follow-up length was 12.3 months (range 8-15 months). Dominant side was the right side by all patients and all patients were males. Plantaris tendon augmentation was applied after end-to-end repair by modified Kessler suture technique. Results: The mean postoperative AOFAS score (The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores) was 93.5 (range 82-100). The average of Achilles tendon postoperative assessment score, as developed by Thermann and colleagues, was 93.3. Both assessment scores were between 90-100 and were evaluated as very good. None of the patients developed post-operative wound infection. The Thompson test was negative on all patients and bilateral motor strength was 5/5. Conclusion: Lynn method, especially in young and active patients with acute Achilles tendon rupture is a method that should be considered in treatment protocols.

Keywords

Achilles tendon, Lynn method, AOFAS score

Akut Aşil tendon yırtıklarının Lynn yöntemi ile tamiri

Abstract

Amaç: Akut Aşil tendon yırtıklarının açık primer tamirinde Lynn yönteminin etkinliğinin değerlendirilmesi. Yöntemler: Akut Aşil tendon yırtığı nedeniyle Lynn yöntemi ile tedavi edilen 19 hastanın verileri değerlendirildi. Hastaların ortalama takip süreleri 12,3 ay (8 – 15 ay) idi. Tüm hastaların dominant tarafları sağ taraf olup, çalışmaya katılan bütün hastalar erkekti. Tüm hastalara modifiye Kessler dikiş tekniği kullanılarak uç-uca tamir yapıldıktan sonra plantaris tendonu ile güçlendirme uygulandı. Bulgular: Postoperatif AOFAS skoru (The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores) ortalama 93,5 (dağılım 82-100) olarak hesaplandı. Thermann ve arkadaşlarının geliştirdiği Aşil tendon cerrahi sonrası değerlendirme skorunda ortalama puan 93,3 olarak saptandı. Her iki değerlendirme 90-100 puan arasında çıkmış olup sonuçlar çok iyi olarak değerlendirildi. Operasyon sonrasında hiçbir hastada yara yeri enfeksiyonu gelişmedi. Yapılan son kontrollerinde tüm hastaların Thompson testi negatif olup, bilateral motor kuvvet 5/5 olarak saptandı. Sonuç: Lynn yöntemi, özellikle aktif ve genç yaştaki akut Aşil tendon yırtığı olan hastaların tedavi protokolleri arasında göz önünde bulundurulması gereken bir yöntemdir.

Keywords

Aşil tendon, Lynn yöntemi, AOFAS skoru

References

• O’Brien M. The Anatomy of Achilles Tendon. Foot Ankle Clin 2005;10:225-38.
• Lesic A, Bumbasirevic M. Disorders of the Achills tendon. Current Orthop 2004;18:63-75.
• Kvist M, Hurme T, Kannus P, et al. Vascular density at the myotendinous junction of the rat gastrocnemius muscle af- ter immobilization and remobilization. Am J Sports Med 1995;23:359-364.
• Lui TH. Fixation of tendo Achilles avulsion fracture. Foot Ankle Surg 2009;15:58-61.
• Maffuli N. Rupture of the Achilles Tendon. J Bone Joint Surg 1999; 81A:1019-1035.
• Couglinn MJ, Mann R. Achilles tendon rupture. Surgery of the Foot And Ankle, Seventh Edition, London. Tokyo, Mosby, 1999; 835-850.
• Campbell P, Lawton JO. Spontaneous rupture of the Achil- les tendon: Pathology and management. Bri J Hosp Med 1993;50:321-325.
• Maffuli N. Current concepts of management of subcutaneous tears of the Achilles tendon. Bull Hosp Jt Dis 1998;57:152- 158.
• Maffuli N, Kader D. Tendinopathy of tendon Achilles. J Bone Joint Surg 2002; 84B:1-8.
• Lui TH. Surgical tip: Repair of acute Achille rupture with Krackow suture through a 1.5 cm medial wound. Foot An- kle Surg 2009;371:1-4.
• Azar FM. Travmatik bozukluklar, Campbell’s Opera- tive Orthopaedics 3. Cilt10. Baskı. Hayat Tıp Kitapçılık 2007;2449-2493.
• Bradley JP, Tibone JE. Percutaneous and open surgical re- pairs of Achilles tendon ruptures. A comperative study. Am J Sports Med 1990;18:188-195.
• Öçgüder DA, Doğan M, Bektaşer SB, et al. Comparison of the open primary repair with augmentation and without augmentation in acute achilles tendon ruptur. Turk J Med Sci 2011;41:639-646.
• Gerdes MH, Brown TD, Bell AL, et al. A flap augmenta- tion technique for Achilles tendon repair. Postoperative strength and functional outcome. Clin Orthop Relat Res 1992;280:241-246.
• Wolman, R., Singh, D. Achilles Tendon Rupture, Sports In- juries. Foot Ankle&Lower Leg, Primal Pictures 2001.
• Bhandari. M. Guyatt. H. Treatment of Acute Achilles Ten- don Ruptures. A Systematic overview and metanalysis. Clin Orthop 2002;400:190-200.
• Kocher MS, Bishop J. Nonoperative Management of the Achilles Tendon Ruptures. Am J Sports Med 2002;30:783- 788.
• DeCarbo WT, Hyer CF. Interference screw fixation for Flexor Hallucis Longus tendon transfer for chronic Achilles tendonopathy. J Foot Ankle Surg 2008;47:69-72.
• Mann RA, Holmes GB, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg [Am]1991;73:214-219.
• Lynn TA. Repair of the torn Achilles tendon, using the plan- taris tendon as a reinforcing membrane. J Bone Joint Surg [Am] 1966;48:268-272.
• Webb. JM., Bannister, GC. Percutaneous repair of the rup- tured tendon Achilles. J Bone Joint Surg 1990;81B:877-880.
• Winter E, Weise K, Weller S, Ambusher T. Surgical Re- pair of Achilles tendon rupture comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998;117:364-367.
• Wong J. Quantitative review of operative and nonoperative management of Achilles tendon ruptures, Am J Sports Med 2002;30:565-575.
• TOTBİD Dergisi, 2004, cilt 3, sayı 1-2.
• Kitaoka HB, Alexander IJ, Adellaar RS, et al. Clinical rat- ing systems for the ankle-hind foot, mid foot, hallux and lesser toes. Foot Ankle Int 1994;15:349-353.
• Thermann H, Zwipp H, Tscherne H. Functional treatment concept of acute rupture of the Achilles tendon. 2 years results of a prospective randomized study. Unfallchirurg 1995;98:21-32.
• Luthje P, Nurmi I, Nyyssonen T. Missed Achilles tendon rupture due to oral levofloxacin: surgical treatment and re- sult. Arch Orthop Trauma Surg 2005;125:124-126.
• Myerson M, Mc garvey W. Disorders of the insertion of the achilles tendon and achilles tendinitis. J. Bone Joint Surg 1998;80:1814-1824.
• Inglis AE, Smith L. Nonsurgical treatment of the tendo achilles rupture. J Bone Surg 1972;54A:1398.
• Moller M, Movin T, Granhed H, et al. Acute rupture of ten- don Achilles. A prospective randomised study of compari- son between surgical and non-surgical treatment. J Bone Joint surg [BR] 2001;83:843-848.
• Lea RB, Smith L. Non-surgical treatment of tendon Achil- les rupture. J Bone Joint Surg 1972;54-A:1398-1407.
• Garden DG, Noble J, Chalmers J. Rupture of the calcaneal tendon: the early and late management, J Bone Joint Surg 1987;69-B:416-423.
• Kakiuchi M. A combined open and percutaneus technique for repair of tendo Achillis; comparrison wıth open repair. J Bone Joint Surg [Br] 1995;77:60-63.
• Buchgraber A,Passler HH. Percutaneus repair of Achilles tendon ruptıre: Immobilization versus functional postoper- ative treatment. Clin Orthop Relat Res 1997;341:113-122.
• Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendon Achilles. Chir Organi Mov 1991;76:223-228.
• Dalton GP, Wapner KL, Hecht PJ. Complications of Achil- les and posterior tibial tendon surgeries. Clin orthop Relat Res 2001;391:133-139.