ADVANTAGES OF SURGICAL TREATMENT OF ACHILLES TENDON RUPTURE BY PERCUTANEOUS SUTURE AS OPPOSED TO NON-SURGICAL TREATMENT
Goran Vidić¹, Vesna Milojković², Saša Milenković¹, Saša Stojanović¹, Zoran Golubović¹, Zoran Antić³, Zvezdana Antić³ i Dragan Živanović4
The Achilles tendon is the strongest tendon in the body, and its rupture appears to be the most common injury of the tendomuscular apparatus. This type of injury is more frequent in sportsmen, especially those who play tennis, gymnastics, skiing, handball, football, basketball and athletics. Also, the ruptures are common in people who engage in sports activities for recreation. They appear more often in males, in proportion of 3:1. It appears reciprocally in 25-30% of the cases. The rupture is easily diagnosed by means of clinical examination (Thompson's test) and ultrasonography. The aim of the analysis was to point to the advantages of surgical treatment of a fresh Achilles tendon rupture as opposed to non-surgical treatment by plaster immobilization. The examination was performed on 35 patients, of which 16 (45,71%) were treated operatively and 19 (54,29%) were treated nonoperatively. The average age of the patients was 38.8 years, that is 37.1 for those treated operatively and 40.2 for those treated nonoperatively. Among the examinees, there were 29(82,86%) men and 6(17,14%) women. The operative treatment method consisted of percutaneous suturing, whereas the nonoperative treatment involved the circular above the knee plaster immobilization. All operatively treated patients underwent the surgical treatment in the first 48 hours from the time when the injury had occured. Anesthesia was local and infiltrative. The obtained results showed that there were no unhealed ruptures or re-ruptures. In the group of patients who did not undergo the surgery, there was 1 re-rupture and 1 unhealed rupture, after which the surgical treatment had to be performed in both cases. In the group of operated patients there were no infections, however, 1 thromboembolism occured. Recovery of muscular strenght of the tendon and the realization of the full range of movement required less time in the operated patients. The ultrasonographic findings in the operated patients showed better consolidation of the rupture site, with less scar tissue formation. The conclusion, as a result of our experience, is that in the case of a fresh Achilles tendon rupture the priority must be given to surgical treatment by percutaneous suture, and each time when it is not possible to bring the ends of the tendon together. Acta Medica Medianae 2010;49(1):34-38.
Key words: Achilles tendon, rupture, treatment, percutaneous suture