Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?

Abstract

Background Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair. Questions/purposesWe compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications. Patients and Methods We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6-48 months).

Achilles tendon ruptures

“…In 2012, Diao et al [71] reported favorable short-term clinical outcomes using the Achillon device (Integra, Plainsboro, NJ). Similar favorable findings were demonstrated in numerous other studies [72][73][74][75] with regard to functional outcome, better cosmetic appearance, less wound complications, patient satisfaction, and imaging results using percutaneous techniques (Fig. 2).…”

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

“…2 After patients adopted the testing position, they performed 3 maximal attempts guided by pain perception of equal to or less than 8 of 10 during each evaluation. Pain perception was determined using a verbal analogue scale, ranging from 0 (absence of pain) to 10 (maximal pain).…”

“…A n Achilles tendon (AT) rupture is the most frequent tendon injury in the lower limb, with an incidence of 18 per 100 000 individuals each year, [1][2][3][4][5] most of whom are middle-aged [5][6][7] male amateur athletes. 1,8 Tendinous overload 6,9 and a nonuniform distribution of stress 10 promoted by neuromuscular imbalance 11 or pathologic muscular conditions 12 are mechanical factors that contribute to an AT rupture.…”

“…The other begins with some degree of immobilization or non-weight bearing in the first 4 weeks after AT repair, normally via a rest period during the first 2 weeks after surgery. 21 Currently, managing AT rehabilitation after operative repair remains controversial 1,2,4,5,8,16,22 because of the unknown mechanical tolerances of different operative techniques 4,6 for preventing clinical failure 22 ; the comorbidities associated with traditional management, [3][4][5][6]8,14,16,22 such as muscle atrophy, adherences, delayed collagen remodeling, thromboembolism, and high rerupture rates [2][3][4][5][6]22,23 ; and the risks and complications that can occur during early rehabilitation, 3,4,6,15,21,22 such as tendinous elongation and early reruptures. 3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,…”

Endoscopy Assisted Percutaneous Repair for Achilles Tendon Rupture Instead of Open Surgical Treatment

“…They occur more commonly in men in the third or fourth decade. Due to increasing of sport activities in the population there is an increase in sports injuries and also in AT ruptures [1,2].…”