[Effectiveness of a double-tsuge suture method in repairing Achilles tendon ruptures]

To investigate the effectiveness of a double-tsuge suture method with absorbable polydioxanone-cord (PDS-II) in repair of Achilles tendon ruptures.

Between January 2005 and December 2008, 36 patients suffering from Achilles tendon ruptures were treated operatively. Of 36 patients, there were 29 males and 7 females with a mean age of 36 years (range, 21-50 years), including 22 cases of acute closed injuries, 6 cases of fresh open injuries (the time between injury and hospitalization was 1-10 days, mean 6 days), and 8 cases of old closed injuries (the time between injury and hospitalization was 43-63 days, mean 51 days). The injury reasons were sport injury (25 cases), incised injury (6 cases), falling injury (4 cases), and other (1 case). The results of "heel test" and the Thompson sign were positive in all patients. Operation was performed by using a double-tsuge suture method with a No. 0 PDS-II. After the ankle joint was fixed with short leg plaster cast at 30 degrees plantar flexion position for 6 weeks, the cast was removed and then functional exercises were done.

Poor healing of incision occurred in 2 cases of old Achilles tendon ruptures and was cured after symptomatic treatment; healing of incision by first intention was achieved in the others. The patients were followed up 12 to 24 months (mean, 15 months). No rerupture, deep venous thromboembolism, or reflex sympathetic dystrophy occurred during follow-up. When compared with the range of motion of ankle joint of normal side, 7 cases had no change, 16 cases had a loss of 1-10 degrees, 12 cases had a loss of 10-20 degrees, and 1 case had a loss of 25 degrees. The average score was 90 (range, 74-96) according to Termann clinical evaluation criterion; the results were excellent in 24 cases, good in 11 cases, and fair in 1 case, and the excellent and good rate was 97.2%.

The double-tsuge suture method is easy-to-operate, which has the smallest interference to the blood supply of Achilles tendon because of no crossing or transversal intratendon suture. PDS-II can provide highly strong stability, furthermore, it can be degenerated completely with tiny foreign body reaction, so there is no tendency to develope local adhesion. This technique achieves good results and is associated with a low morbidity of complications.