Achilles tendon ruptures operated with percutaneous technique: Surgical results and post-operative complications
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Published:
May 11, 2018
Keywords:
Achilles Tendon, percutaneous technique, surgical complications.
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Abstract
IntroductionAchilles tendon ruptures have increased considerably in recent years. The treatment of these injuries can be either conservative or surgical. Despite extensive literature, no gold standard has been probed. Surgical options include open surgery, mini-open and percutaneous technique.The objective of this work is to characterize the clinical presentation and show surgical results and complications in patients with ruptured Achilles tendon treated surgically with percutaneous technique.Materials and methodsA retrospective descriptive study was carried out. Adult patients treated at the University Clinic of Puerto Montt were included and clinical and epidemiological data were obtained. All patients were operated with percutaneous technique using the Dresden Instrument.Results60 patients enrolled. All presented pain, associated with Thompson's sign and palpable gap in 92%. Complementary images were requested in 7 patients (12%). The average time until surgery was 4.28 days. 7 patients presented minor post-operative complications. No mayor complications were observed.DiscussionAchilles tendon ruptures are increasing due to older active population and weekend athletes. The diagnosis is mostly clinical, however, some patients may require complementary images for diagnosis. Strong evidence in the literature suggests that surgical treatment is superior to the classic conservative treatment. In comparison with open surgery, the percutaneous technique has shown better aesthetic results and fewer complications.
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Sanchez Villanueva, F. J., Hoffmann Heise, H., & Bustamante San Martin, C. (2018). Achilles tendon ruptures operated with percutaneous technique: Surgical results and post-operative complications. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(2), 113-117. https://doi.org/10.15417/issn.1852-7434.2018.83.2.796
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Clinical Research
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References
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9. Inglis A, Sculco T. Surgical repair of ruptures of the tendón Achillis. Clin Orthop Relat Res. 1981;156:160-169.
10. Ufberg J, Harrigan R, Cruz T, Perron A. Orthopedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med.2004;22:596-600.
11. Cuttica D, Hyer C, Berlet G. Intraoperative value of the Thompson test. J Foot Ankle Surg. 2015 Jan-Feb;54:99-101.
12. Chiodo C, Glazebrook M, Bluman E, Cohen B, Femino J, Giza E, et al. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:503-510.
13. Kocher M, Bishop J, Marshall R, Briggs K, Hawkins R. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790.
14. Maffulli N. Current Concepts Review: Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81:1019–1036.
15. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendón ruptures. Am J Sports Med. 2002;30:565–575.
16. Kadakia AR, Dekker RG, Ho BS. Acute Achilles Tendon Ruptures: An Update on Treatment. J Am Acad Orthop Surg. 2017 Jan;25:23-31.
17. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxen R, Olsson N, Eriksson BI, et al. Acute Achilles tendon rupture: A randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010;38: 2186-2193.
18. Wallace RG, Heyes GJ, Michael AL: The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br 2011;93:1362-1366.
19. Born C, Gil JA, Goodman A. Joint Contractures Resulting From Prolonged Inmovilization: Etiology, Prevention and Management. J Am Acad Orthop Surg. 2017 Feb;25:110-116.
20. Winter E, Weise K, Weller S, Ambacher T. Surgical repair of Achilles tendon rupture: comparison of surgical with conservative treatment. Arch Orthop Trauma Surg. 1998;117:364–367.
21. Truntzer, J, Triana B, Harris A, Baker L, Chou L, Kamal R. Cost-minimization Analysis of the Management of Acute Achilles Tendon Rupture. J Am Acad Orthop Surg. 2017 Jun;25:449-457.
22. Henríquez H, Muñoz R, Carcuro G, Bastías C. Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?. Clin Orthop Relat Res. 2012 Apr;470:998-1003.
23. Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–209.
2. Chen T, Rozen W, Pan WR, Ashton M, Richardson M, Taylor G. The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications. Clin Anat. 2009;22:377-385.
3. Gross C, Nunley J. Acute Achilles Tendon Ruptures. Foot Ankle Int. 2016 Feb;37:233-9.
4. Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J. Epidemiology of Achiles tendón ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports. 2015 Feb;25:133-8.
5. Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of Achilles tendon rupture in a Danish county. Injury.1998;29:651-654.
6. Amlang M, Christiani P, Heinz P, Zwipp H. Percutaneous technique for Achilles tendon repair with the Dresden Instruments. Unfallchirurg. 2005;108:529–536.
7. Moller A, Astrom M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:479–481.
8. 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.
9. Inglis A, Sculco T. Surgical repair of ruptures of the tendón Achillis. Clin Orthop Relat Res. 1981;156:160-169.
10. Ufberg J, Harrigan R, Cruz T, Perron A. Orthopedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med.2004;22:596-600.
11. Cuttica D, Hyer C, Berlet G. Intraoperative value of the Thompson test. J Foot Ankle Surg. 2015 Jan-Feb;54:99-101.
12. Chiodo C, Glazebrook M, Bluman E, Cohen B, Femino J, Giza E, et al. Diagnosis and treatment of acute Achilles tendon rupture. J Am Acad Orthop Surg. 2010;18:503-510.
13. Kocher M, Bishop J, Marshall R, Briggs K, Hawkins R. Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med. 2002;30:783–790.
14. Maffulli N. Current Concepts Review: Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81:1019–1036.
15. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendón ruptures. Am J Sports Med. 2002;30:565–575.
16. Kadakia AR, Dekker RG, Ho BS. Acute Achilles Tendon Ruptures: An Update on Treatment. J Am Acad Orthop Surg. 2017 Jan;25:23-31.
17. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxen R, Olsson N, Eriksson BI, et al. Acute Achilles tendon rupture: A randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 2010;38: 2186-2193.
18. Wallace RG, Heyes GJ, Michael AL: The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br 2011;93:1362-1366.
19. Born C, Gil JA, Goodman A. Joint Contractures Resulting From Prolonged Inmovilization: Etiology, Prevention and Management. J Am Acad Orthop Surg. 2017 Feb;25:110-116.
20. Winter E, Weise K, Weller S, Ambacher T. Surgical repair of Achilles tendon rupture: comparison of surgical with conservative treatment. Arch Orthop Trauma Surg. 1998;117:364–367.
21. Truntzer, J, Triana B, Harris A, Baker L, Chou L, Kamal R. Cost-minimization Analysis of the Management of Acute Achilles Tendon Rupture. J Am Acad Orthop Surg. 2017 Jun;25:449-457.
22. Henríquez H, Muñoz R, Carcuro G, Bastías C. Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?. Clin Orthop Relat Res. 2012 Apr;470:998-1003.
23. Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2008;16:204–209.