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Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up

Year 2015, Volume: 49 Issue: 6, 661 - , 28.10.2015

Alexandros Mavrodontidis Marios Lykissas Panayiotis Koulouvaris Vasilios Kontogeorgakos Dionysios Giannoulis Charalampos Zalavras

Abstract

Objective: The purpose of this study was to present the functional outcomes of percutaneous tenorrhaphy of the Achilles tendon with a minimum follow-up of 10 years.
Methods: The medical records of patients who underwent percutaneous surgery for acute unilateral Achilles tendon rupture between 2000 and 2004 were retrospectively reviewed.
Results: A total of 11 male patients met the inclusion criteria and were followed for a mean of 12.6 years (range: 10–13 years). The average age at the time of surgery was 39.3 years (range: 29–53 years). Patients returned to work at an average of 2.7 months (range: 1–4 months) after surgery and to normal daily activities (NDA) at an average of 4.1 months (range: 3–6 months) postoperatively. The mean strength ratio between the injured and normal sides was 90%. Compared with the contralateral normal side, the thickness of the operated tendon increased by a mean of 0.7 cm, while the circumference of the affected calf diminished by a mean of 1.1 cm. No difference in active and passive range of motion (ROM) was recorded between the affected and the contralateral normal ankle joints. Isometric plantar flexion was 87% of normal. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after surgery. The sensory defect had completely resolved by 6 months postoperatively.
Conclusion: Long-term outcomes of our series support the effectiveness of percutaneous tenorrhaphy in Achilles function rehabilitation of patients with acute ruptures.

DOI: 10.3944/AOTT.2015.14.0196

Keywords

Achilles tendon; long-term outcomes; percutaneous repair; rupture; sural nerve.

References

  • Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Can- ada. Foot Ankle Int 2005;26:932–6.
  • Józsa L, Kvist M, Bálint BJ, Reffy A, Järvinen M, Lehto M, Barzo M. The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociologi- cal study of 292 cases. Am J Sports Med 1989;17:338–43.
  • 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.
  • Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am 1999;81:1019–36.
  • Möller A, Astron M, Westlin N. Increasing inci- dence of Achilles tendon rupture. Acta Orthop Scand 1996;67:479–81.
  • Arİen A, Helgİ D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a pre- vious Achilles tendon rupture. Scand J Med Sci Sports 2004;14:30–3.
  • Pa¨ssler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol 1998;14:93– 95.
  • 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.
  • Rowley DI, Scotland TR. Rupture of the Achilles ten- don treated by a simple operative procedure. Injury 1982;14:252–4.
  • 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.
  • Zwipp H, Südkamp N, Thermann H, Samek N. Rupture of the Achilles tendon. Results of 10 years’ follow-up after surgical treatment. A retrospective study. [Article in Ger- man] Unfallchirurg 1989;92:554–9. [Abstract]
  • Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med 1978;6:107–11.
  • Krüger-Franke M, Scherzer S. Long-term results of sur- gically treated Achilles tendon ruptures. [Article in Ger- man] Unfallchirurg 1993;96:524–8. [Abstract]
  • Quigley TB, Scheller AD. Surgical repair of the ruptured Achilles tendon. Analysis of 40 patients treated by the same surgeon. Am J Sports Med 1980;8:244–50.
  • Sölveborn SA, Moberg A. Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures. Am J Sports Med 1994;22:607–10.
  • Winter E, Weise K, Weller S, Ambacher T. Surgical re- pair of Achilles tendon rupture. Comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998;117:364,7.
  • Gillies H, Chalmers J. The management of fresh ruptures of the tendo achillis. J Bone Joint Surg Am 1970;52:337– 43.
  • Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Intervention for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 2004;3:CD003674.
  • Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov 1991;76:223–8.
  • Webb JM, Bannister GC. Percutaneous repair of the rup- tured tendo Achillis. J Bone Joint Surg Br 1999;81:877– 80.
  • Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 2005;15:133–5.
  • Kerkhoffs GM, Struijs PA, Raaymakers EL, Marti RK. Functional treatment after surgical repair of acute Achil- les tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 2002;122:102–5.
  • 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.
  • Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med 2003;31:692–700.
  • Cretnik A, Zlajpah L, Smrkolj V, Kosanović M. The strength of percutaneous methods of repair of the Achil- les tendon: a biomechanical study. Med Sci Sports Exerc 2000;32:16,20.
  • Hockenbury RT, Johns JC. A biomechanical in vitro com- parison of open versus percutaneous repair of tendon Achilles. Foot Ankle 1990;11:67–72.
  • 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.
  • Park HG, Moon DH, Yoon JM. Limited open repair of ruptured Achilles tendons with Bunnel-type sutures. Foot Ankle Int 2001;22:985–7.
  • Ceccarelli F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and minimally invasive techniques of Achil- les tendon repair. Clin Orthop Relat Res 2007;458:188– 93.
  • Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture. Immobilization versus func- tional postoperative treatment. Clin Orthop Relat Res 1997;341:113–22.
  • Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo achillis repair. Foot Ankle Int 2004;25:215–8.
  • Aktan Ikiz ZA, Uçerler H, Bilge O. The anatomic features of the sural nerve with an emphasis on its clinical impor- tance. Foot Ankle Int 2005;26:560–7.
  • Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 2006;72:179–83.
  • Henríquez H, Muñoz R, Carcuro G, Bastías C. Is percu- taneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 2012;470:998– 1003.

Year 2015, Volume: 49 Issue: 6, 661 - , 28.10.2015

Alexandros Mavrodontidis Marios Lykissas Panayiotis Koulouvaris Vasilios Kontogeorgakos Dionysios Giannoulis Charalampos Zalavras

Abstract

References

  • Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Can- ada. Foot Ankle Int 2005;26:932–6.
  • Józsa L, Kvist M, Bálint BJ, Reffy A, Järvinen M, Lehto M, Barzo M. The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociologi- cal study of 292 cases. Am J Sports Med 1989;17:338–43.
  • 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.
  • Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am 1999;81:1019–36.
  • Möller A, Astron M, Westlin N. Increasing inci- dence of Achilles tendon rupture. Acta Orthop Scand 1996;67:479–81.
  • Arİen A, Helgİ D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a pre- vious Achilles tendon rupture. Scand J Med Sci Sports 2004;14:30–3.
  • Pa¨ssler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol 1998;14:93– 95.
  • 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.
  • Rowley DI, Scotland TR. Rupture of the Achilles ten- don treated by a simple operative procedure. Injury 1982;14:252–4.
  • 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.
  • Zwipp H, Südkamp N, Thermann H, Samek N. Rupture of the Achilles tendon. Results of 10 years’ follow-up after surgical treatment. A retrospective study. [Article in Ger- man] Unfallchirurg 1989;92:554–9. [Abstract]
  • Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med 1978;6:107–11.
  • Krüger-Franke M, Scherzer S. Long-term results of sur- gically treated Achilles tendon ruptures. [Article in Ger- man] Unfallchirurg 1993;96:524–8. [Abstract]
  • Quigley TB, Scheller AD. Surgical repair of the ruptured Achilles tendon. Analysis of 40 patients treated by the same surgeon. Am J Sports Med 1980;8:244–50.
  • Sölveborn SA, Moberg A. Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures. Am J Sports Med 1994;22:607–10.
  • Winter E, Weise K, Weller S, Ambacher T. Surgical re- pair of Achilles tendon rupture. Comparison of surgical with conservative treatment. Arch Orthop Trauma Surg 1998;117:364,7.
  • Gillies H, Chalmers J. The management of fresh ruptures of the tendo achillis. J Bone Joint Surg Am 1970;52:337– 43.
  • Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ. Intervention for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 2004;3:CD003674.
  • Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov 1991;76:223–8.
  • Webb JM, Bannister GC. Percutaneous repair of the rup- tured tendo Achillis. J Bone Joint Surg Br 1999;81:877– 80.
  • Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 2005;15:133–5.
  • Kerkhoffs GM, Struijs PA, Raaymakers EL, Marti RK. Functional treatment after surgical repair of acute Achil- les tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 2002;122:102–5.
  • 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.
  • Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med 2003;31:692–700.
  • Cretnik A, Zlajpah L, Smrkolj V, Kosanović M. The strength of percutaneous methods of repair of the Achil- les tendon: a biomechanical study. Med Sci Sports Exerc 2000;32:16,20.
  • Hockenbury RT, Johns JC. A biomechanical in vitro com- parison of open versus percutaneous repair of tendon Achilles. Foot Ankle 1990;11:67–72.
  • 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.
  • Park HG, Moon DH, Yoon JM. Limited open repair of ruptured Achilles tendons with Bunnel-type sutures. Foot Ankle Int 2001;22:985–7.
  • Ceccarelli F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and minimally invasive techniques of Achil- les tendon repair. Clin Orthop Relat Res 2007;458:188– 93.
  • Buchgraber A, Pässler HH. Percutaneous repair of Achilles tendon rupture. Immobilization versus func- tional postoperative treatment. Clin Orthop Relat Res 1997;341:113–22.
  • Haji A, Sahai A, Symes A, Vyas JK. Percutaneous versus open tendo achillis repair. Foot Ankle Int 2004;25:215–8.
  • Aktan Ikiz ZA, Uçerler H, Bilge O. The anatomic features of the sural nerve with an emphasis on its clinical impor- tance. Foot Ankle Int 2005;26:560–7.
  • Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg 2006;72:179–83.
  • Henríquez H, Muñoz R, Carcuro G, Bastías C. Is percu- taneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 2012;470:998– 1003.
There are 34 citations in total.

Details

Primary Language English
Journal Section Original Article
Authors

Alexandros Mavrodontidis This is me

Marios Lykissas

Panayiotis Koulouvaris This is me

Vasilios Kontogeorgakos This is me

Dionysios Giannoulis This is me

Charalampos Zalavras This is me

Publication Date October 28, 2015
Published in Issue Year 2015 Volume: 49 Issue: 6

Cite

APA Mavrodontidis, A., Lykissas, M., Koulouvaris, P., Kontogeorgakos, V., et al. (2015). Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthopaedica Et Traumatologica Turcica, 49(6), 661. https://doi.org/10.3944/AOTT.2015.14.0196
AMA Mavrodontidis A, Lykissas M, Koulouvaris P, Kontogeorgakos V, Giannoulis D, Zalavras C. Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthopaedica et Traumatologica Turcica. October 2015;49(6):661. doi:10.3944/AOTT.2015.14.0196
Chicago Mavrodontidis, Alexandros, Marios Lykissas, Panayiotis Koulouvaris, Vasilios Kontogeorgakos, Dionysios Giannoulis, and Charalampos Zalavras. “Percutaneous Repair of Acute Achilles Tendon Rupture: A Functional Evaluation Study With a Minimum 10-Year Follow-up”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 6 (October 2015): 661. https://doi.org/10.3944/AOTT.2015.14.0196.
EndNote Mavrodontidis A, Lykissas M, Koulouvaris P, Kontogeorgakos V, Giannoulis D, Zalavras C (October 1, 2015) Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthopaedica et Traumatologica Turcica 49 6 661.
IEEE A. Mavrodontidis, M. Lykissas, P. Koulouvaris, V. Kontogeorgakos, D. Giannoulis, and C. Zalavras, “Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 6, p. 661, 2015, doi: 10.3944/AOTT.2015.14.0196.
ISNAD Mavrodontidis, Alexandros et al. “Percutaneous Repair of Acute Achilles Tendon Rupture: A Functional Evaluation Study With a Minimum 10-Year Follow-up”. Acta Orthopaedica et Traumatologica Turcica 49/6 (October 2015), 661. https://doi.org/10.3944/AOTT.2015.14.0196.
JAMA Mavrodontidis A, Lykissas M, Koulouvaris P, Kontogeorgakos V, Giannoulis D, Zalavras C. Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthopaedica et Traumatologica Turcica. 2015;49:661.
MLA Mavrodontidis, Alexandros et al. “Percutaneous Repair of Acute Achilles Tendon Rupture: A Functional Evaluation Study With a Minimum 10-Year Follow-up”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 6, 2015, p. 661, doi:10.3944/AOTT.2015.14.0196.
Vancouver Mavrodontidis A, Lykissas M, Koulouvaris P, Kontogeorgakos V, Giannoulis D, Zalavras C. Percutaneous repair of acute Achilles tendon rupture: a functional evaluation study with a minimum 10-year follow-up. Acta Orthopaedica et Traumatologica Turcica. 2015;49(6):661.