Akut Aşil Tendon Rüptürlerinde Konservatif Tedavi, Perkütan ve Açık Cerrahinin Klinik Sonuçlarının Karşılaştırılması

Yıl 2025, Cilt: 15 Sayı: 3, 354 - 359, 15.09.2025

Umut Öktem , Muhammed Cihan Daştan , Ahmet Muhammed Harmankaya , İbrahim Bozkurt , Mehmet Orçun Akkurt

Öz

Amaç: Bu çalışma, akut Aşil tendonu rüpütürlerinin tedavisinde konservatif, perkütan ve açık cerrahi yaklaşımların klinik sonuçlarını karşılaştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Bu retrospektif çalışma, 2019 ve 2023 yılları arasında Ankara Bilkent Şehir Hastanesi
Ortopedi ve Travmatoloji Kliniğinde Kuwada Tip 2 akut Aşil tendonu rüpütürü tanısı alan 50 hastayı içermektedir. Hastalar tedavi yöntemine göre üç gruba ayrılmıştır: konservatif (n = 14), perkütan tamir (n = 21) ve
açık cerrahi tamir (n = 15). Fonksiyonel sonuçlar, Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS)
skoru ve Görsel Analog Skala (VAS) skorları kullanılarak tedavi sonrası 3., 6. ve 12. aylarda değerlendirilmiştir.
İstatistiksel analizler Kruskal-Wallis testleri kullanılarak yapılmıştır.
Bulgular: 3. ay VAS skorları, konservatif ve perkütan gruplara kıyasla açık cerrahi grubunda anlamlı olarak
daha yüksek bulunmuştur (p = 0,038). Ancak, 6. ve 12. ay VAS skorları arasında gruplar arasında anlamlı bir
fark bulunmamıştır. AOFAS skorlarının 3., 6. ve 12. aylarda gruplar arasında istatistiksel olarak anlamlı bir
fark göstermediği görülmüştür. Komplikasyonlar, açık cerrahi grubunda iki hastada (yara problemleri) ve
konservatif grupta bir hastada (yeniden rüpütür) gözlemlenmiştir.
Sonuç: Kuwada tip 2 akut aşil tendon rüptürü olan hastalarda uygulanan konservatif tedavi, perkütan tamir
ve açık cerrahinin klinik sonuçlar açısından birbirlerine üstünlüğü yoktur ancak açık cerrahi tedavinin postoperatif erken dönem ağrı skorları açısından dezavantajlı olduğu görülmüştür. Açık cerrahi tamir, özellikle aktif
bireyler için güvenilir bir yöntem olarak kalmaya devam etmektedir.

Anahtar Kelimeler

aşil tendonu , tendon yaralanmaları , minimal invaziv cerrahi işlemler

Comparison of Clinical Outcomes of Conservative Treatment, Percutaneous, and Open Surgery in Acute Achilles Tendon Ruptures.

Öz

Objective: This study aims to compare the clinical outcomes of conservative, percutaneous, and open surgical approaches in the treatment of acute Achilles tendon ruptures.
Material and Methods: This retrospective study included 50 patients diagnosed with Kuwada Type 2 acute
Achilles tendon rupture between 2019 and 2023 at the Orthopedics and Traumatology Clinic of Ankara Bilkent City Hospital. Patients were divided into three groups according to the treatment method: conservative
(n = 14), percutaneous repair (n = 21), and open surgical repair (n = 15). Functional outcomes were evaluated at 3, 6, and 12 months after treatment using the American Orthopaedic Foot & Ankle Society (AOFAS)
score and the Visual Analog Scale (VAS) score. Statistical analyses were performed using Kruskal-Wallis tests.
Results: At the 3rd month, VAS scores were found to be significantly higher in the open surgery group compared to the conservative and percutaneous groups (p = 0.038). However, no significant differences were
observed among the groups in VAS scores at 6 and 12 months. AOFAS scores showed no statistically significant differences among the groups at 3, 6, and 12 months. Complications were observed in two patients
(wound problems) in the open surgery group and in one patient (re-rupture) in the conservative group.
Conclusion: In patients with Kuwada Type 2 acute Achilles tendon rupture, conservative treatment, percutaneous repair, and open surgery show no superiority over one another in terms of clinical outcomes.
However, open surgical treatment appears to be disadvantageous regarding postoperative early pain scores.
Open surgical repair remains a reliable option, particularly for active individuals.

Anahtar Kelimeler

achilles tendon , tendon injuries , minimally invasive surgical procedures

Kaynakça

• 1. Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1-8.
• 2. Meulenkamp B, Woolnough T, Cheng W, Shorr R, Stacey D, Richards M, et al. What Is the Best Evidence to Guide Management of Acute Achilles Tendon Ruptures? A Systematic Review and Network Meta Analysis of Randomized Controlled Trials. Clin Orthop Relat Res. 2021;479(10):2119-31.
• 3. Fischer S, Colcuc C, Gramlich Y, Stein T, Abdulazim A, von Welck S, et al. Prospective randomized clinical trial of open operative, minimally invasive and conservative treatments of acute Achilles tendon tear. Arch Orthop Trauma Surg. 2021;141(5):751-60.
• 4. Seow D, Yasui Y, Calder JDF, Kennedy JG, Pearce CJ. Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Metaanalysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates. Am J Sports Med. 2021;49(13):3728-48.
• 5. Yang B, Liu Y, Kan S, Zhang D, Xu H, Liu F, et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg. 2017;40:178-86.
• 6. Bunnell S. Repair of nerves and tendons of the hand. J Bone Joint Surg 1928;10:1–26.
• 7. Shi F, Wu S, Cai W, Zhao Y. Multiple comparisons of the efficacy and safety for six treatments in Acute Achilles Tendon Rupture patients: A systematic review and network meta-analysis. Foot Ankle Surg. 2021;27(5):468-79.
• 8. Li Y, Jiang Q, Chen H, Xin H, He Q, Ruan D. Comparison of miniopen repair system and percutaneous repair for acute Achilles tendon rupture. BMC Musculoskelet Disord. 2021;22(1):914.
• 9. Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study. Arch Orthop Trauma Surg. 2021;141(3):383- 401.
• 10. Idarraga AJ, Bohl DD, Barnard E, Movassaghi K, Hamid KS, Schiff AP. Adverse Events Following Minimally Invasive Achilles Tendon Repair. Foot & Ankle Specialist. 2022;15(3):236-43.
• 11. Lawson J, Tarapore R, Sequeira S, Imbergamo C, Tarka M, Guyton G, et al. Open and Percutaneous Approaches Have Similar Biomechanical Results for Primary Midsubstance Achilles Tendon Repair: A Meta-analysis. Arthrosc Sports Med Rehabil. 2024;6(3):100924.
• 12. Attia AK, Mahmoud K, d'Hooghe P, Bariteau J, Labib SA, Myerson MS. Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2023;51(3):825-36.
• 13. Subaşı İÖ, Çepni Ş, Tanoğlu O, Veizi E, Alkan H, Yapici F et al. A clinical comparison of two different surgical techniques in the treatment of acute Achilles tendon ruptures: Limited-open approach vs. percutaneous approach. Ulus Travma Acil Cerrahi Derg. 2023;29(8):935-43.