A Prospective, Randomized Comparison of Functional Bracing Versus Rigid Immobilization after Modified Percutaneous Achilles Tendon Repair Under Local Anesthesia

Background: There is ongoing controversy over the optimal treatment and rehabilitation strategy of an acute Achilles tendon rupture (ATR). Percutaneous suturing seems to bridge the gap between open surgical and conservative treatment, but still raises scepticism due to concerns like strength of the repair, approximation of torn ends, re-rupture rate, sural nerve injuries, early functional rehabilitation and thus final outcome. The purpose of the study was to analyze the results of two ways of postoperative regimen after treatment with the modified and biomechanically significantly stronger percutaneous repair under local anesthesia.Methods: In a prospective, randomized study from the year 2001 to 2004, with a 3-year follow-up, there were 31 patients (32 ruptures) in the functional bracing group (FG) and 30 patients, who wore rigid immobilization for the period of 6 weeks (IG).Results: Both groups were comparable for gender (3 vs 2 women) and average age (41.93 years, SD ± 12.29 vs 42.20 years, SD ± 10.53). Most ATRs were sports related (62.5% in FG vs 60.0% in IG). There was 1 (3.3%) re-rupture in IG and no re-rupture in FG (1.6% altogether), 2 (6.2%) transient sural nerve disturbances in FG and 1 (3.3%) in IG (4.8% altogether), one suture extrusion problem in IG (3.3%) with no other major or minor complications (6.2% of altogether complications in FG vs 10.0% in IG)(p > 0.05)(overall 8.1%). Patients in FG were (subjectively) more satisfied with the treatment, reached sooner final range of motion (ROM) and muscular strength without limping and had higher average AOFAS score (96.87 vs 95.96)(p > 0.05). There were no statistically significant differences observed between groups according to final ROM, strength and return to pre-injury activities or sports.Conclusions: The results of the study support the choice of presented modified percutaneous suturing under local anesthesia with functional treatment and early mobilization as a reasonable treatment option for an acute ATR.Trial registration: KME, 54/03/00, 21. 03. 2000

Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures

Background: Conservative treatment of an acute Achilles rupture remains a viable and acceptable option as does surgical fixation, with open and percutaneous repair consisting the main operative techniques. The purpose of this study was to compare the outcomes and complication rates of open versus percutaneous surgical procedures. Methods: From 2009 to 2016, 131 patients were admitted to our department with clinically and radiologically confirmed acute Achilles tendon ruptures. Of those, 82 patients met our inclusion criteria and were randomized into 2 groups, group A (open repair) and group B (percutaneous suturing). Suture equipment was the same for both groups. All patients followed the same rehabilitation protocol. Functional evaluation was made using American Orthopaedic Ankle & Foot Society (AOFAS) hindfoot and Achilles tendon Total Rupture Score (ATRS) questionnaires at the 12-month follow-up. Ankle range of motion (ROM), return-to-work time, and complication rates were additionally measured. Results: Both techniques had similar results regarding complication rates and return-to-work time. The major complication in group A was superficial infection (7%) and skin necrosis (3%), whereas 3 patients in group B developed paresthesias due to sural nerve entrapment. Patients in group B had better AOFAS hindfoot (96/100) and ATRS (95/100) scores, but the difference was not significant. ROM was similar in both groups at the 12-month follow-up. Conclusion: Percutaneous suturing seems to be a safe and effective technique that offers good functional outcomes and low complication rates in patients with acute Achilles tendon ruptures who elect to have surgery. Level of Evidence: Level II, prospective case series.