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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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