SLR - December 2009 - Janet Baatile
Reference:
Pajala, A., MD, Kangas,J., MD, Siira, P.,PhT,Pjtpmem,P., MSc, and Leppilahti,J.,MD, PhD (2009). Augmented Compared with Nonaugmented Surgical Repair of a Fresh Total Achilles Tendon Rupture - A Prospective Randomized Study. Journal of Bone and Joint Surgery (American), 91,1092-1100.
Scientific Literature Reviews
Reviewed by: Janet Baatile, DPM
Residency Program: Botsford Hospital, Farmington Hills, MI
Podiatric Relevance:
This is a Level I randomized control trial that evaluates the down turned gastrocnemius fascia flap (augmented) to the Krackow end-to-end suture repair (non-augmented). Although, the augmented technique may offer higher tensile strength, it is also associated with an increased risk of wound complications. Consequently, if no difference was found between the two techniques for strength of the repair, then the non-augmented approach would be the procedure of choice.
Methods:
A total of sixty patients with acute tendon ruptures were randomly assigned to either the augmented or non- augmented group at Oulu University Hospital in Finland. Both groups were demographically homogenious wherein the mean age was 38 years and the majority of the subjects were recreational athletes. Initial post-operative management included a below the knee brace for 3 weeks that allowed for plantarflexion and restricted dorsiflexion to the neutral position. Weight bearing was advanced gradually to 20 kilograms at 3 weeks, partial weight bearing between 3 and 6 weeks, and full weight bearing allowed at 6 weeks. The participants were instructed to perform a standard rehabilitation program at home. The following data was collected at weeks 2,6,12, and 52: the Leppilahti clinical scoring method, isokinetic and isometric muscle strength tests, and tendon elongation measurements. The power was determined to be 90% and the p value was set at 0.05.
Results:
Overall, the difference between the groups was not statistically significant for the Leppilahti clinical scoring method, isokinetic and isometric muscle strength tests, and tendon elongation measurements. None of the participants were lost to follow-up. The authors reported 5 patients had failure in the augmented group secondary to 3 re-ruptures and 2 deep infections. In addition, there was one case of deep venous thrombosis in the augmented group. Whereas, the non-augmented group had 3 re-ruptures and four superficial wound infections that resolved with oral antibiotics. The re-rupture rate in both groups was 10%.
Conclusions:
The augmented repair of acute Achilles tendon rupture is not superior to the end-to-end suture repair. In addition, the shorter incision and operating time for the non-augmented technique make it more favorable over the augmented approach.