| Popis: |
Background: There is ongoing controversy over the optimal treatment and rehabilitation strategy of an acute Achilles tendon rupture (ATR). Percutaneous suturing seems to bridge the gap between open surgical and conservative treatment, but still raises scepticism due to concerns like strength of the repair, approximation of torn ends, re-rupture rate, sural nerve injuries, early functional rehabilitation and thus final outcome. The purpose of the study was to analyze the results of two ways of postoperative regimen after treatment with the modified and biomechanically significantly stronger percutaneous repair under local anesthesia.Methods: In a prospective, randomized study from the year 2001 to 2004, with a 3-year follow-up, there were 31 patients (32 ruptures) in the functional bracing group (FG) and 30 patients, who wore rigid immobilization for the period of 6 weeks (IG).Results: Both groups were comparable for gender (3 vs 2 women) and average age (41.93 years, SD ± 12.29 vs 42.20 years, SD ± 10.53). Most ATRs were sports related (62.5% in FG vs 60.0% in IG). There was 1 (3.3%) re-rupture in IG and no re-rupture in FG (1.6% altogether), 2 (6.2%) transient sural nerve disturbances in FG and 1 (3.3%) in IG (4.8% altogether), one suture extrusion problem in IG (3.3%) with no other major or minor complications (6.2% of altogether complications in FG vs 10.0% in IG)(p > 0.05)(overall 8.1%). Patients in FG were (subjectively) more satisfied with the treatment, reached sooner final range of motion (ROM) and muscular strength without limping and had higher average AOFAS score (96.87 vs 95.96)(p > 0.05). There were no statistically significant differences observed between groups according to final ROM, strength and return to pre-injury activities or sports.Conclusions: The results of the study support the choice of presented modified percutaneous suturing under local anesthesia with functional treatment and early mobilization as a reasonable treatment option for an acute ATR.Trial registration: KME, 54/03/00, 21. 03. 2000 |
