Treatment of Achilles tendon rupture using different methods

Today there are controversies about searching for the ideal surgical method (conservatively with plaster cast, with open and percutaneous tenorrhaphy) for repairing a ruptured Achilles tendon. The aim of this study study was to examine the results of treating Achilles tendon ruptures in patients by using the following methods: percutaneous suturing, open surgery technique and non-surgical treatment by plaster cast immobilisation.

Forty two patients treated at our facility in the period August 2003 - September 2010 for Achilles tendon ruptures were included in the study. They were operated on by using different orthopedic procedures (percutaneous reconstruction of the Achilles tendon, open surgery, plaster cast only) and two anaesthesia technique (spinal aneasthesia and local infiltrational anaesthesia). The following parameters were monitored after interventions performed and compared: duration of hospital stay, postsurgical complications, incidence of the reruptures of the Achilles tendon and time for full leg functionality.

The patients sustained their respective injuries in the following manner: 8 of them while pursuing sports activities, 24 while pursuing recreational activities, 4 at workplace, 4 while performing everyday activities, and 2 of the patients did not know how they had sustained their injuries. The average age of the patients was 40.5, with 37 (88%) men and 5 (12%) women. Surgeries were performed under spinal anaesthesia in 29 (69%) patients, and in 5 (12%) patients tenorrhaphy was performed under local anaesthesia. Anaesthesia was not used in 8 (19%) patients treated with plaster cast. We performed percutaneous reconstruction of the Achilles tendon in 19 (45%) patients. A total of 14 (33%) patients were treated under spinal anaesthesia, and 5 (11.90%) under local infiltrational anaesthesia with 2% xylocain. We treated 15 (36%) patients with open surgery. The patients treated conservatively stayed in hospital on average for up to 5 hours. Those who underwent an percutaneous surgery stayed 2 days and those who underwent an open surgery stayed 9 days. A total of 28 (66%) patients from the given series experienced no complications. The patients treated with open surgical reconstruction experienced skin complications ranging from inflammatory changes on the skin in 6 (14%) patients to dehiscence and skin necrosis in 3 (7%). The 5 (11.9%) patients whose ruptured Achilles tendon was treated percutaneously experienced temporary redness and delayed healing of the incision(s) longer than 5 mm. A total of 3 (7%) patients treated with open surgery and 1 (2%) patient treated with percutaneous tenorrhaphy had temporary peroneal nerve prolapses. A total of 7 (16.6%) patients had reruptures: 4 were treated with plaster cast, 2 underwent open surgery, and 1 was treated percutaneously. Out of the 8 patients who were treated with plaster cast, 4 sustained reruptures and 3 of the 4 had diabetes.

Surgical treatment, percutaneous tenorrhaphy, performed in a small operating theatre under local anaesthesia, should be preferred in cases of fresh ruptures of the Achilles tendon.