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Kim, Gwak, Lee, Kim, and Jeong: A Comparative Study of Surgical Treatment Result in the Ruptured Achilles Tendon: Minimal Incision Percutaneous Repair and Open Repair
Original Article

J Korean Orthop Assoc 2017;52(3):249-256.

Published online: 1 December 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.3.249

A Comparative Study of Surgical Treatment Result in the Ruptured Achilles Tendon: Minimal Incision Percutaneous Repair and Open Repair

Jung-Han Kim, M.D., Ph.D., Heui-Chul Gwak, M.D., Ph.D., Chang-Rack Lee, M.D., Jeon-Gyo Kim, M.D., Jun-Woo Jeong, M.D.

Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University School of Medicine, Busan, Korea

Correspondence to: Heui-Chul Gwak, M.D., Ph.D. Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea TEL: +82-51-890-6996 FAX: +82-51-890-6129 E-mail: ortho1@hanmail.net

Received 28 August 2015       Revised 10 December 2015       Accepted 18 October 2016

Copyright © 2017 The Korean Orthopaedic Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare and analyse the clinical outcomes between minimal-incision percutaneous repair and open repair among the surgical treatments for Achilles tendon ruptures.

Materials and Methods

We retrospectively analyzed and compared the outcomes between 25 patients with minimal incision percutaneous repair (group 1) and 30 patients with open repair (group 2), from January 2006 to June 2014. The postoperative clinical evaluations were done by Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, overall patient's satisfaction, and cosmetic satisfaction of scar.

Results

There were statistically significant differences between the two groups with respect to AOFAS hind foot score, mid-calf circumference differences, overall patient's satisfaction, and satisfaction of scar; the group 1 showed better achievement. There was no statistical difference between two groups in regards to other clinical outcomes. In group 1, there were 2 cases of sural nerve hypoesthesia, which fully recovered spontaneously at about 6 months after the surgery. In group 2, there were 3 cases of deep vein thrombosis, re-rupture, and deep infection.

Conclusion

We recommend minimal incision percutaneous repair as one of the effective surgical treatment options for Achilles tendon ruptures.

Keywords: Achilles tendon, rupture, minimal incision percutaneous repair, open repair

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Figure 1
Guiding instrument (A) and a straight needle (B). Cited from the article of Kong et al. (J Korean Foot Ankle Soc. 2012;16:181-9).10)
jkoa-52-249f1.tif
Figure 2
Preoperative marking of incision was made over the area of the rupture in mini-incision percutaneous repair (A) and open repair (B). Cited from the article of Kong et al. (J Korean Foot Ankle Soc. 2012;16:181-9).10)
jkoa-52-249f2.tif
Figure 3
The paratenon and skin were closed in mini-incision percutaneous repair (A) and open repair (B). Cited from the article of Kong et al. (J Korean Foot Ankle Soc. 2012;16:181-9).10)
jkoa-52-249f3.tif
Figure 4
One leg heel raise test after 6 months from surgery in mini incision percutaneous repair (A) and open repair (B). Cited from the article of Kong et al. (J Korean Foot Ankle Soc. 2012;16:181-9).10)
jkoa-52-249f4.tif
Table 1
Configuration of Demographics in Both Groups
Variable Minimal incision percutaneous repair (n=25) Open repair (n=30)
Sex (male/female) 10/15 16/14
Age (yr) 48.9 (37.0–60.7) 43.5 (32.2–54.7)
Sport injury 17 (68.0) 13 (43.3)
Level of rupture (cm) 5.1 (4.0–6.3) 5.6 (4.9–6.3)

Values are presented as number only, mean (range), or number (%).

Table 2
Configuration of Results in Both Groups
Variable Minimal incision percutaneous repair (n=25) Open repair (n=30) p-value
Mid-calf circumference difference e (cm) 0.8 (0.4–1.1) 1.1 (0.6–1.6) 0.003
AOFAS ankle-hindfoot functional score 95.1 (91.4–98.8) 91.1 (85.3–96.8) 0.009
Arner-Lindholm scale 0.750
Excellent 15 18
Good 10 10
Poor 0 0
Return to sports activity (mo) 8.4 (6.5–10.2) 9.2 (6.4–12.0) 0.780
One-leg heel raise test 25 28
Complications 2 (sural nerve hypoesthesia) 3 (DVT, re-rupture, deep infection)

Values are presented as mean (range) or number only. AOFAS, American Orthopedic Foot and Ankle Society; DVT, deep vein thrombosis.

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