COMPARISON OF MINI-OPEN AND PERCUTANEOUS REPAIR METHODS IN TREATMENT OF ACUT ACHILLES TENDON RUPTURE

Year 2022, Volume: 29 Issue: 1, 101 - 110, 01.03.2022

Fatih İnci İbrahim Alper Yavuz

https://doi.org/10.17343/sdutfd.1008494

Abstract

Objective
Treatment of acute Achilles tendon rupture (ATR) is
still a controversial issue. Treatment of acute ATR
with mini-open and percutaneously applied minimally
invasive techniques has become a better option
because of lower re-rupture rates and less wound site
problems than traditional open surgical treatment.
Although successful results have been obtained
with these techniques, sural nerve injury is the most
important complication of these techniques. In this
study, it was aimed to compare the clinical results and
complication rates of minimally invasive techniques
(mini-open and percutaneous repair) used in the
treatment of acute ATR.
Material and Methods
A total of 42 patients whose acute ATR was repaired
with minimally invasive methods between 2016
and 2019 were included in the study. The patients
were divided into two groups: the mini-open repair
group in which the tendon ends could be observed
from the surgical incision (Group A, n=22) and the
percutaneous repair group in which they could not
be observed (Group B, n=20). AOFAS score, ankle
plantar flexion and dorsiflexion angles, return to
work and sports were used for clinical evaluation.
Post-surgical complications were divided into two
categories: minor (not requiring re-surgery) and major
(requiring re-surgery) complications. The groups
were compared in terms of functional outcomes and
complications.
Results
The mean age of the patients was 40.30±5.56 (23-
50). No statistically significant difference was found
between the groups in terms of demographic data
(p>0.05 for all). There was no statistically significant
difference between the groups in terms of the
functional results of the patients in the second year
after surgery and the time to return to work and sports
(p>0.05 for all). Minor complications in 2 patients in the
mini-open group and in 3 patients in the percutaneous
repair group observed. While sural neuropathy was
seen in 3 (15%) patients after percutaneous repair,
it was not seen in any patient after mini-open repair.
Major complication requiring reoperation was seen in
one patient of each group. There was no statistically
significant difference between the groups in terms of
both minor and major complications. (p=0.566 and
p=0.947, respectively).
Conclusion
The functional outcomes and complication rates of the
treatment of acute Achilles tendon rupture with miniopen
or percutaneous repair are similar. Because
of the lower risk of sural nerve injury, the mini-open
repair method may be more advantageous.

Keywords

Achilles tendon rupture, Mini-open, Percutaneous, Repair, Sural nerve

AKUT AŞİL TENDON RÜPTÜR TEDAVİSİNDE MİNİ-AÇIK VE PERKÜTAN TAMİR YÖNTEMLERİNİN KARŞILAŞTIRILMASI

Abstract

Amaç
Akut aşil tendon rüptürü (ATR) tedavisi halen tartışmalı
bir konudur. Geleneksel açık cerrahi tedaviye
göre daha düşük re-rüptür oranları ve daha az yara
yeri sorunları gözlenmesi nedeniyle akut ATR’nin mini-
açık ve perkütan olarak uygulanan minimal invaziv
tekniklerle tedavisi daha iyi bir seçenektir. Bu teknikler
ile başarılı sonuçlar alınmasına rağmen, sural sinir
yaralanması bu tekniklerin en önemli komplikasyonudur.
Bu çalışmada, akut ATR tedavisinde kullanılan
minimal invaziv tekniklerin (mini-açık ve perkütan
tamir) klinik sonuçlarının ve komplikasyon oranlarının
karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem
016-2019 yılları arasında akut ATR’si minimal invaziv
yöntemler ile tamir edilen toplam 42 hasta çalışmaya
alınmıştır. Hastalar, cerrahi kesiden tendon uçlarının
gözlenebildiği mini-açık tamir grubu (Grup 1, n=22) ve
gözlenemediği perkütan tamir grubu (Grup 2, n=20)
olmak üzere 2 gruba ayrıldı. Klinik değerlendirme için
AOFAS skoru, ayak bileği plantar fleksiyon ve dorsifleksiyon
açıları, işe ve spora geri dönüş süreleri
kullanıldı. Cerrahi sonrası komplikasyonlar ise minör
(tekrar cerrahi gerektirmeyen) ve majör (tekrar cerrahi
gerektiren) komplikasyonlar olmak üzere iki kategoriye
ayrıldı. Gruplar fonksiyonel sonuçlar ve komplikasyonlar
açısından karşılaştırıldı.
Bulgular
Hastaların ortalama yaşı 40,30±5,56 (23-50) olarak
bulundu. Gruplar arasında yaş, cinsiyet, ameliyata
kadar geçen süre, ameliyat süresi, takip süresi açısından
istatistiksel olarak anlamlı bir fark bulunamadı
(hepsi için p>0.05). Hastaların ameliyat sonrası ikinci
yıl fonksiyonel sonuçları ile işe ve spora dönüş süreleri
açısından gruplar arasında istatistiksel olarak anlamlı
bir fark bulunamadı (hepsi için p>0.05). Mini-açık
grupta 2 hastada ve perkütan tamir grubunda 3
hastada minör komplikasyon gözlendi. Sural nöropati
perkütan tamir sonrası 3 (%15) hastada görülürken,
mini-açık tamir sonrası hiçbir hastada görülmedi. Her
iki grubun birer hastasında tekrar ameliyat gerektiren
major komplikasyon görüldü. Gruplar arasında hem
minör hem majör komplikasyonlar açısından istatistiksel
anlamlı fark bulunamadı (sırasıyla p=0,566 ve
p=0,947).
Sonuç
Akut ATR’nin mini-açık veya perkütan tamirle tedavisinin
fonksiyonel sonuçları ve komplikasyonları benzerdir.
Daha düşük sural sinir yaralanma riski olması
nedeniyle mini-açık tamir yöntemi daha avantajlı olabilmektedir.

Keywords

Aşil tendon rüptürü, Mini-açık, Perkütan, Tamir, Sural sinir

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