Biyolojik açık cerrahi yöntem ile Aşil tendonu onarımının fonksiyonel sonuçları

Yıl 2014, , 563 - 569, 12.11.2014

Armagan Arslan Serdar Kamil Cepni Turker Sahinkaya Cuneyt May Harun Mutlu Atilla Sancar Parmaksizoglu

https://doi.org/10.3944/AOTT.2014.14.0132

Öz

Amaç: Çalışmanın amacı biyolojik açık cerrahi yöntem ile Aşil tendon onarımı ve erken postoperatif mobilizasyon uygulanan hastaların orta dönem fonksiyonel sonuçlarını değerlendirmekti.

Çalışma planı: Biyolojik açık cerrahi yöntemle Aşil tendon onarımı yapılan 22 erkek hasta retrospektif olarak değerlendirildi. Hastaların her iki ayak bilekleri Amerikan Ayak ve Ayak Bileği Derneği’nin (AOFAS) art ayak skoru, izokinetik kas kuvveti ve dayanıklılığı, 15° dorsifleksiyon ve 20° plantarfleksiyonda aktif açı reprodüksiyon testleri ile ölçülerek karşılaştırıldı.

Bulgular: Hastaların ortalama yaşı 38.6 yıl, ortalama takip süreleri 33.7 ay olarak saptandı. Bir hastada künt travma nedeniyle postoperatif 1. aydaki rerüptür dışında ek bir komplikasyon izlenmedi. Hastaların ortalama AOFAS art ayak skoru 97.9 idi. Her iki ayak bileğinin 30°/sn’deki zirve tork (izokinetik kas kuvveti) ve 120°/sn’deki toplam iş (izokinetik kas dayanıklılığı) değerleri karşılaştırıldığında bilekler arasında anlamlı fark görülmedi. 15° dorsifleksiyon ve 20° plantarfleksiyon açılarında aktif açı reprodüksiyon testi ile yapılan propriosepsiyon değerlendirmesinde her iki tarafın da benzer olduğu saptandı.

Çıkarımlar: Biyolojik açık Aşil tendon onarımı ve sonrasında uygulanan erken mobilizasyon programının aktif genç hastalarda oluşan akut Aşil tendon yırtıkları için uygun bir girişim olduğu düşüncesindeyiz. Tedavi ile düşük komplikasyon oranları elde edilmiş, ayak bileği kas gücü ve dayanıklılığının yanı sıra pozisyon hissi de geri kazanılmıştır.

Anahtar Kelimeler

Biyolojik açık Aşil tendon onarımı; izokinetik kas gücü ve dayanıklılığı; pozisyon hissi ölçümü

Functional outcomes of repair of Achilles tendon using a biological open surgical method

Öz

Objective: The aim of this study was to evaluate the mid-term functional outcomes of ankles following biological open Achilles tendon repair and early postoperative mobilization.

Methods: The study retrospectively evaluated 22 male patients who underwent one-sided biological open Achilles tendon repair. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, isokinetic muscle strength and endurance tests and active angle reproduction test at 15° of dorsiflexion and 20° of plantarflexion of the injured and uninjured sides were measured and compared.

Results: Mean age was 38.6 years and mean follow-up was 33.7 months. One patient had rerupture following a blunt trauma 1 month after operation. No other complication was seen. Mean AOFAS hindfoot score was 97.9 (range: 90 to 100). Peak isokinetic torque at 30°/sec (isokinetic muscle strength) and total work at 120°/sec (isokinetic muscle endurance) did not significantly differ between the operated and uninjured ankles. Proprioceptive evaluation with active angle reproduction test at 15°of dorsiflexion and 20° of plantarflexion was similar between the two sides.

Conclusion: Biological open Achilles tendon repair with early postoperative mobilization appears to be a convenient intervention for acute Achilles tendon rupture in active young patients. Treatment results in low complication rates and restores ankle strength, endurance and position sense.

Anahtar Kelimeler

Biological open Achilles tendon repair, isokinetic muscle strength and endurance, position sense measurement

Kaynakça

• Akgün U, Erol B, Karahan M. Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures. [Article in Turkish] Acta Orthop Trau- matol Turc 2006;40:228-33.
• Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a compara- tive study. Am J Sports Med 2005;33:1369-79. CrossRef
• Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo achillis repair. Foot Ankle Int 2004;25:215-8.
• 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.
• 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.
• Elliott AJ, Kennedy JG, O’Malley M. Minimally invasive Achilles tendon repair using the Achillon repair system. Tech Foot Ankle Surg 2006;5:171-4. CrossRef
• 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. CrossRef
• Ozkaya U, Parmaksizoglu AS, Kabukcuoglu Y, Sokucu S, Basilgan S. Open minimally invasive Achilles tendon repair with early rehabilitation: functional results of 25 consecutive patients. Injury 2009;40:669-72. CrossRef
• Mortensen HM, Skov O, Jensen PE. Early motion of the ankle after operative treatment of a rupture of the Achil- les tendon. A prospective, randomized clinical and radio- graphic study. J Bone Joint Surg Am 1999;81:983-90.
• Moorman CT, Kaseta MK. Formal open repair of the Achilles tendon. In: Nunley JA, editor. The Achilles ten- don, treatment and rehabilitation. New York: Springer Science & Business Media, LLC; 2009. p. 83-92.
• Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myer- son MS, Sanders M. Clinical rating systems for the ankle- hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53. CrossRef
• Chan AP, Chan YY, Fong DT, Wong PY, Lam HY, Lo CK, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol 2011;3:32. CrossRef
• Tenenbaum S, Dreiangel N, Segal A, Herman A, Is- raeli A, Chechik A. The percutaneous surgical approach for repairing acute Achilles tendon rupture: a compre- hensive outcome assessment. J Am Podiatr Med Assoc 2010;100:270-5. CrossRef
• Leppilahti J, Siira P, Vanharanta H, Orava S. Isokinetic evaluation of calf muscle performance after Achilles rup- ture repair. Int J Sports Med 1996;17:619-23. CrossRef
• Goren D, Ayalon M, Nyska M. Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures. Foot Ankle Int 2005;26:286-90.
• Heit EJ, Lephart SM, Rozzi SL. The effect of ankle brac- ing and taping on joint position sense in the stable ankle. J Sport Rehabil 1996;5:206-13.
• Lentell G, Baas B, Lopez D, McGuire L, Sarrels M, Sny- der P. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther 1995;21:206-15.
• 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.
• Gelberman RH, Woo SL, Lothringer K, Akeson WH, Amiel D. Effects of early intermittent passive mobiliza- tion on healing canine flexor tendons. J Hand Surg Am 1982;7:170-5. CrossRef
• Kellett J. Acute soft tissue injuries-a review of the litera- ture. Med Sci Sports Exerc 1986;18:489-500. CrossRef
• Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg Am 1981;63:394-9.
• Speck M, Klaue K. Early full weightbearing and function- al treatment after surgical repair of acute achilles tendon rupture. Am J Sports Med 1998;26:789-93.
• Troop RL, Losse GM, Lane JG, Robertson DB, Hastings PS, Howard ME. Early motion after repair of Achilles tendon ruptures. Foot Ankle Int 1995;16:705-9. CrossRef
• Mandelbaum BR, Myerson MS, Forster R. Achilles ten- don ruptures. A new method of repair, early range of motion, and functional rehabilitation. Am J Sports Med 1995;23:392-5. CrossRef
• Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res 1977;128:247-55.
• 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.
• Aydin T, Yildiz Y, Yildiz C, Atesalp S, Kalyon TA. Proprio- ception of the ankle: a comparison between female teenaged gymnasts and controls. Foot Ankle Int 2002;23:123-9.
• Kaya D, Doral MN, Nyland J, Toprak U, Turhan E, Don- mez G, et al. Proprioception level after endoscopically guided percutaneous Achilles tendon. Knee Surg Sports Traumatol Arthrosc 2013;21:1238-44. CrossRef