"Mini-open" repair of acute tendo Achilles ruptures--the solution?

The standard surgical exposure for repair of acute tendo Achilles rupture gives favourable results, but such extensive exposure increases the possibility of peritendinous adhesion, wound breakdown and infections which increases morbidity and impairs functional outcome. Open repair also increases post-operative hospital stay and hence encroaches on valuable bed space availability. To evade this mini-open technique was developed which provide anatomic apposition of the tendon ends and minimal damage to epitendon.

We describe a retrospective case series of 21 patients who were treated with mini-open technique as a day case, between 2004 and 2007 operated by a single surgeon. They were followed up for a year. Both the Leppilahti score and the American Orthopaedic Foot and Ankle Society for the Ankle Hind foot Clinical Rating System (AOFAS) were calculated. The patients (8 males and 13 females) had a mean age of 43.4 years. Post-operatively the leg was placed in an air cast boot with 3 heel wedges allowing 30 degrees of plantar flexion. The foot is brought into plantigrade position by 6 weeks with serial removal of heel wedges followed by a rehabilitative training programme.

There was one superficial infection which settled on oral antibiotics, no re-rupture or sural nerve involvement was noted in this series. All patients returned to previous work and sports activities. All patients scored above 90 in the American Orthopaedic Foot and Ankle Hind foot Clinical Rating System and on the Leppilahti Scoring System. Mini-open procedure is an excellent alternative to open exposures reducing the inpatient post-operative stay. All patients were discharged home on the same day of the procedure.

Our pilot study has helped us to implement a standardised pathway by which patients have benefitted with improved rehabilitation and return to their pre-injury status.