Miniinvasive approach in treatment of Achilles tendon ruptures, based on 10 years experience

Abstract

There are many theories about the high rate of Achilles tendon traumas, but the accent is mainly on the `Sunday sport activities`. Searching of effective methods with lower patient morbidity and shorter period of recovery, Ma - Griffith in 1977 first described their miniinvasive percutaneal approach, that established new principle for Achilles treatment.Aim of the study: Presentation of long term experience (10 years) with low rate of complications, following the protocol of miniinvasive Achilles rupture treatment. Materials and methods: Patient group consists of 328 pts, with traumatic Achilles tendon rupture. Follow up in 265 of them was proceeded, according to described protocol. Patient distribution was as follows: gender: ♂- 215, ♀- 50, age: 21-66 years (mean 42,9), preoperative term: 0-14 days (mean 2 days). The percutaneal Achilles suture is accomplished in two layers through 10 - 12 skin incisions (5 mm each) on its medial and lateral aspect - 6 over and 4 - 6 below the rupture. Suturing is done by 2 threads Dexon (1) or (2) and Long straight needle - min 6 cm. The surgery is followed by a bellow knee plaster cast for 30 days with ankle joint in 90°, hospital staying - 24 hours for early analgesia and prevention of any circulatory disturbances without any specific wound care. Weight bearing starts on the 45th day and crutches are used for 2 months. Results: All included patients fulfilled 9 months follow up. The following facts were assessed - mild pain - 2-3 days postop `clicking` in the Achilles zone - after 3rd month during rehabilitation, restoration of ankle amplitude on the 3rd month in 235(89%) pts.: dorsal flexion - 10°, plantar flexion - 30°. Rare complications were observed, like reruptures - 13 (5%) pts, superficial infections and skin necrosis - 3(1%) pts, deep venous thrombosis - 2(0,5%) pts, sural neuralgia - 24(9%) pts. The only increased index of complications, assessed in the big study group is the sural neuralgia. It is accepted as a temporary sensory disturbance that disappears spontaneously. Patients are not critical to this `complication`.Conclusion: The miniinvasive percutaneal Achiles suture is safe and secure one stage method, reduced patient morbidity and increased patient satisfaction.