SLR - July 2014 - Harsh Patel

Mini-Open Tenorrhaphy of Acute Achilles Tendon Repairs

Reference: Keller A and Wagner E. Mini-Open Tenorrhaphy of Acute Achilles Tendon Repairs. The American Journal of Sports Medicine 2014 42: 731.

Reviewed By: Harsh Patel, DPM 
Residency Program: Forest Hills Hospital

Podiatric Revelance: The rising rate of soft tissue complications after performing an open Achilles tendon repair has lead to development of minimally invasive surgical procedure. This article evaluates clinical results of procedures using the Dresden mini-open technique on acute Achilles tendon ruptures.

Methods: Between January 2005 and August 2011, a retrospective analysis was performed using 100 patients, 91 of them were men with mean age of 42.0 years. Dresdan procedures were performed on all patients. Inclusion criteria for this study were patients with acute spontaneous ruptures of Achilles tendon, seen within 15 days of the injury and rupture occurring between 2 and 8 cm proximal to calcaneal insertion of the tendon. The mean follow up was 42.1 months. At the latest follow up, clinical evaluation was performed using AOFAS score, time to return to work, time to return to sports and complications. An isokinetic test was performed on the first 21 patients of this series at one year postoperatively. A 30-day prophylaxis for deep venous thrombosis was given to all patients.

Results: The mean AOFAS score was 97.7 with the most frequent complaint being isolated local pain. The mean time to return to work was 56.0 days and the mean time to return to sports was 18.9 weeks. There were no soft tissue infections, wound dehiscence, or scar adherence. Five cases of deep venous thrombosis were observed. Two patients had persistent local discomfort around the wound due to prominent suture knots. There were two cases of rerupture. No patient had any kind of sural nerve damage. No loss of joint range of motion was noted compared with the uninjured side. The isokinetic evaluation showed good recovery of the involved muscles.

Conclusion: From the above results, the authors concluded that even though nonsurgical treatment is becoming increasingly popular, studies have shown that the surgical repair of Achilles tendon has resulted in lower rerupture rates and a better capacity to return to work and to patients’ previous sports level. The main complication of surgical repair is soft tissue complications and therefore to achieve the ideal repair, less invasive approaches have been developed. 

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