Comparación entre la cirugía abierta y el método mínimamente invasivo para roturas agudas del tendón de Aquiles. [Comparison between open surgery and the minimally invasive method for acute Achilles tendon ruptures.]
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Publicado:
nov 8, 2016
Palabras clave:
Rotura del tendón de Aquiles, reparación abierta, reparación percutánea, comparación.Achilles tendon rupture, open repair, percutaneous repair, comparison.
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Resumen
Introducción. La reparación quirúrgica puede realizarse mediante cirugía abierta o por técnicas mínimamente invasivas. La técnica percutánea combina las ventajas del tratamiento quirúrgico abierto con el tratamiento ortopédico. El objetivo de este trabajo es comparar la técnica mínimamente invasiva de Dresden descripto por Amlang con la cirugía abierta convencional.Material y métodos. Estudio comparativo de 15 casos de roturas de tendón de Aquiles operados con técnica abierta convencional y 15 casos operados con la técnica percutánea de Dresden. Se evaluaron características del intraoperatorio y hospitalización, resultados funcionales de acuerdo a score AOFAS, ARPS (achilles ruptura performance score), escala visual análoga y rango de movilidad de tobillo.Resultados. Se mencionan los resultados comparativos del tiempo quirúrgico, trofismo, longitud de cicatriz, diferencia comparativa en el perímetro del gemelo. El AOFAS a 5 meses: Grupo A: 90 puntos, y grupo B: 95 puntos. Retorno a la actividad laboral: Grupo A, 7 meses promedio, Grupo B: 3,53 meses promedio. Retorno a actividad deportiva: en el grupo A: media 12,22 meses; Grupo B: media 6,53 meses.Conclusión: La reparación percutánea de Dresden, es una buena opción para las roturas de tendón de Aquiles; con buena evolución clínico-funcional minimizando los riesgos de re rotura y lesiones del nervio sural.
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Cómo citar
Arzac Ulla, I. R., De Silvestri, A., & Fiorentini, G. (2016). Comparación entre la cirugía abierta y el método mínimamente invasivo para roturas agudas del tendón de Aquiles. [Comparison between open surgery and the minimally invasive method for acute Achilles tendon ruptures.]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(4), 274-280. https://doi.org/10.15417/573
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Investigación Clínica
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Citas
1 - Grieco P, D Frumberg, Maxwell Weinberg, Pivec R, Naziri Q, Uribe J. Achilles Tendon Rupture Repair: A Biomechanical Evaluation of Varying the Number of Loops in a Physiological Model. Foot Ankle int. 2015 Apr;36(4):444-9.
2 - Henriquez H, Muñoz R,Carcuro G, Bastias C. Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture? Clin Orthop Relat Res (2012) 470:998–1003
3 - Hrnack S, Crates J, Barber A. Primary Achilles Tendon Repair with Mini-Dorsolateral Incision Technique and Accelerated Rehabilitation. Foot Ankle Int 2012 33: 848
4 – Vosseller T, Ellis S, Levine D, Kennedy J, Elliott A, Deland J, Roberts M, y colbs. Achilles Tendon Rupture in Women. Foot Ankle Int 2013 34: 49
5 - Suchak A, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005;26:932–936.
6 - Soroceanu A, Sidhwa, Aarabi S, Kaufman A, Glazebrook M. Surgical Versus Nonsurgical Treatment of Acute Achilles Tendon Rupture. A Meta-Analysis of Randomized Trials. J Bone Joint Surg Am. 2012;94:2136-43
7 - Groetelaers R, Janssen L, Van der Velden J, Wieland A, Amendt A, Geelen P, Janzing H. Functional Treatment or Cast Immobilization After Minimally Invasive Repair of an Acute Achilles Tendon Rupture: Prospective, Randomized Trial. Foot Ankle Int. 2014 May 21;35(8):771-778
8 - Duerden J, Keeling J. Disorders of the Achilles tendon. Current Orthopaedic Practice. May 2008 (19) :3 - 253–259
9 – Nyyssonen T, Luthje P, Kroger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg. 2008;97(3):272-5
10 – Cary DV. How to diagnose and manage an acute Achilles tendon rupture. JAAPA. 2009 Aug;22(8):39-43.
11 - Suchaka, Bostick G, PT, Beaupre L, Durand D, Jomha N. The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008 Sep;90(9):1876-83
12 - Cretnik A, Kosanovic M, Smrkolj V. Percutaneous Versus Open Repair of the Ruptured Achilles Tendon. A Comparative Study. Am J Sports Med. 2005 Sep;33(9):1369-79
13 - Keller A; Wagner E; Ortiz C; Mocoçain P; Figueroa M. Tecnica quirurujica. Sutura percutanea del tendon de aquiles en rotura aguda espontanea. Revista Flamecipp (2009) V2N1
14 - Yañez Arauz J, Del Vecchio J, Raimondi N. Rotura aguda del tendón de Aquiles. Comparación biomecánica de tres técnicas de sutura con polietileno trenzado combinado en modelos cadavéricos.
Rev Asoc Argent Ortop Traumatol Año 73, pp. 68-75
15 – Davies M, Solan M. Minimal Incision Techniques for Acute Achilles Repair. Foot Ankle Clin N Am 14 (2009) 685–697
16 – Ceccarell F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and Minimally Invasive Techniques ofAchilles Tendon Repair. Clinical Orthop and Related Research Number 458, pp. 188–193
17 – C. Ortiz, E. Wagner, P. Mocoçain, G. Labarca, A. Keller, A. Del Buono, N. Maffulli. Biomechanical comparison of four methods of repair of the Achilles tendon. J Bone Joint Surg Br 2012;94-B:663–7.
18 – Lim J, Dalal R, Waseem M. Percutaneous vs. Open Repair of the Ruptured Achilles Tendon. Foot Ankle Int. 2001 Jul;22(7):559-68.
19 – Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–170
20 – Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107–111
21 – Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790
22 – Passler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol. 1998;14:93–95
23 – Rowley DI, Scotland TR. Rupture of the Achilles tendon treated by a simple operative procedure. Injury. 1982;14:252–254
24 – Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–880
25 – Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–575.
26 – Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. 1991;76:223-228
27 - Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle Int. 1990;11:67-72
28 – Amlang MH, Christiani P, Heinz B Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden instrument. Oper Orthop Traumatol. 2006 Oct; 18(4):287-99
29 - Moller A, Astrom M, Westlin NE. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–481
30 – Raikin S, Garras D, Krapchev P. Achilles Tendon Injuries in a United States Population. Foot Ankle Int. 2013 34: 475
31 - Bradley JP, Tibone JE. Percutaneous and open surgical repairs of Achilles tendon ruptures: a comparative study. Am J Sports Med. 1990;18:188-195
32 - Khan, RJ; Fick, D; Keogh, A; et al.: Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 87(10):2202 –2210, 2005
33 - Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N. Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 2012:Epub
34 - Patel VC, Lozano-Calderon S, McWilliam J. ImmediateWeight Bearing After Modified Percutaneous Achilles Tendon Repair. Foot Ankle Int. 2012 Dec;33(12):1093-7
35 - Khan RJ, Carey Smith RL (2010) Surgical interventions for treating
Achilles tendon rupture. Cochrane Database Syst Rev 9:CD003674
36 - Maes R, Copin G. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg. 2006;72:179–183
37 – Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles Tendon. Foot & Ankle International June 2000 vol. 21 no. 6 475-477
38 - Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon. Foot Ankle Int. 2001;22:559–565
39 – Wilkins R, Bisson L. Operative Versus Nonoperative Management of Acute Achilles Tendon Ruptures. A Quantitative Systematic Review of Randomized Controlled Trials. Am J Sports Med 2012 40: 2154
40 – Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84(11):2016-2021
41 – Aktas S, Kocaoglu B (2009) Open versus minimal invasive
repair with the Achillon device. Foot Ankle Int 30(5):391–397
42 – Suchak, AA; Bostick, GP; Beaupre, LA; Durand, DC; Jomha. The influence of early weight-bearing compared with non-weightbearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 90(9):1876 –1883, 2008.
43 – Troop, RL; Losse, GM; Lane JG, et al.: Early motion after repair of Achilles tendon ruptures. Foot Ankle Int. 16(11):705 –709, 1995
2 - Henriquez H, Muñoz R,Carcuro G, Bastias C. Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture? Clin Orthop Relat Res (2012) 470:998–1003
3 - Hrnack S, Crates J, Barber A. Primary Achilles Tendon Repair with Mini-Dorsolateral Incision Technique and Accelerated Rehabilitation. Foot Ankle Int 2012 33: 848
4 – Vosseller T, Ellis S, Levine D, Kennedy J, Elliott A, Deland J, Roberts M, y colbs. Achilles Tendon Rupture in Women. Foot Ankle Int 2013 34: 49
5 - Suchak A, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005;26:932–936.
6 - Soroceanu A, Sidhwa, Aarabi S, Kaufman A, Glazebrook M. Surgical Versus Nonsurgical Treatment of Acute Achilles Tendon Rupture. A Meta-Analysis of Randomized Trials. J Bone Joint Surg Am. 2012;94:2136-43
7 - Groetelaers R, Janssen L, Van der Velden J, Wieland A, Amendt A, Geelen P, Janzing H. Functional Treatment or Cast Immobilization After Minimally Invasive Repair of an Acute Achilles Tendon Rupture: Prospective, Randomized Trial. Foot Ankle Int. 2014 May 21;35(8):771-778
8 - Duerden J, Keeling J. Disorders of the Achilles tendon. Current Orthopaedic Practice. May 2008 (19) :3 - 253–259
9 – Nyyssonen T, Luthje P, Kroger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg. 2008;97(3):272-5
10 – Cary DV. How to diagnose and manage an acute Achilles tendon rupture. JAAPA. 2009 Aug;22(8):39-43.
11 - Suchaka, Bostick G, PT, Beaupre L, Durand D, Jomha N. The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008 Sep;90(9):1876-83
12 - Cretnik A, Kosanovic M, Smrkolj V. Percutaneous Versus Open Repair of the Ruptured Achilles Tendon. A Comparative Study. Am J Sports Med. 2005 Sep;33(9):1369-79
13 - Keller A; Wagner E; Ortiz C; Mocoçain P; Figueroa M. Tecnica quirurujica. Sutura percutanea del tendon de aquiles en rotura aguda espontanea. Revista Flamecipp (2009) V2N1
14 - Yañez Arauz J, Del Vecchio J, Raimondi N. Rotura aguda del tendón de Aquiles. Comparación biomecánica de tres técnicas de sutura con polietileno trenzado combinado en modelos cadavéricos.
Rev Asoc Argent Ortop Traumatol Año 73, pp. 68-75
15 – Davies M, Solan M. Minimal Incision Techniques for Acute Achilles Repair. Foot Ankle Clin N Am 14 (2009) 685–697
16 – Ceccarell F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and Minimally Invasive Techniques ofAchilles Tendon Repair. Clinical Orthop and Related Research Number 458, pp. 188–193
17 – C. Ortiz, E. Wagner, P. Mocoçain, G. Labarca, A. Keller, A. Del Buono, N. Maffulli. Biomechanical comparison of four methods of repair of the Achilles tendon. J Bone Joint Surg Br 2012;94-B:663–7.
18 – Lim J, Dalal R, Waseem M. Percutaneous vs. Open Repair of the Ruptured Achilles Tendon. Foot Ankle Int. 2001 Jul;22(7):559-68.
19 – Assal M, Jung M, Stern R, Rippstein P, Delmi M, Hoffmeyer P. Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am. 2002;84:161–170
20 – Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107–111
21 – Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790
22 – Passler HH. The percutaneous Achilles tendon suture [in German]. Sportorthop Sporttraumatol. 1998;14:93–95
23 – Rowley DI, Scotland TR. Rupture of the Achilles tendon treated by a simple operative procedure. Injury. 1982;14:252–254
24 – Webb JM, Bannister GC. Percutaneous repair of the ruptured tendo Achillis. J Bone Joint Surg Br. 1999;81:877–880
25 – Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med. 2002;30:565–575.
26 – Klein W, Lang DM, Saleh M. The use of the Ma-Griffith technique for percutaneous repair of fresh ruptured tendo Achillis. Chir Organi Mov. 1991;76:223-228
27 - Hockenbury RT, Johns JC. A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles. Foot Ankle Int. 1990;11:67-72
28 – Amlang MH, Christiani P, Heinz B Zwipp H. The percutaneous suture of the Achilles tendon with the Dresden instrument. Oper Orthop Traumatol. 2006 Oct; 18(4):287-99
29 - Moller A, Astrom M, Westlin NE. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–481
30 – Raikin S, Garras D, Krapchev P. Achilles Tendon Injuries in a United States Population. Foot Ankle Int. 2013 34: 475
31 - Bradley JP, Tibone JE. Percutaneous and open surgical repairs of Achilles tendon ruptures: a comparative study. Am J Sports Med. 1990;18:188-195
32 - Khan, RJ; Fick, D; Keogh, A; et al.: Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 87(10):2202 –2210, 2005
33 - Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N. Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 2012:Epub
34 - Patel VC, Lozano-Calderon S, McWilliam J. ImmediateWeight Bearing After Modified Percutaneous Achilles Tendon Repair. Foot Ankle Int. 2012 Dec;33(12):1093-7
35 - Khan RJ, Carey Smith RL (2010) Surgical interventions for treating
Achilles tendon rupture. Cochrane Database Syst Rev 9:CD003674
36 - Maes R, Copin G. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg. 2006;72:179–183
37 – Webb J, Moorjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles Tendon. Foot & Ankle International June 2000 vol. 21 no. 6 475-477
38 - Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon. Foot Ankle Int. 2001;22:559–565
39 – Wilkins R, Bisson L. Operative Versus Nonoperative Management of Acute Achilles Tendon Ruptures. A Quantitative Systematic Review of Randomized Controlled Trials. Am J Sports Med 2012 40: 2154
40 – Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84(11):2016-2021
41 – Aktas S, Kocaoglu B (2009) Open versus minimal invasive
repair with the Achillon device. Foot Ankle Int 30(5):391–397
42 – Suchak, AA; Bostick, GP; Beaupre, LA; Durand, DC; Jomha. The influence of early weight-bearing compared with non-weightbearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 90(9):1876 –1883, 2008.
43 – Troop, RL; Losse, GM; Lane JG, et al.: Early motion after repair of Achilles tendon ruptures. Foot Ankle Int. 16(11):705 –709, 1995