0
Scientific Article   |    
Limited Open Repair of Achilles Tendon Ruptures A Technique with a New Instrument and Findings of a Prospective Multicenter Study
Mathieu Assal, MD; Maximilien Jung, MD; Richard Stern, MD; Pascal Rippstein, MD; Marino Delmi, MD; Pierre Hoffmeyer, MD
View Disclosures and Other Information
Investigation performed at the Orthopaedic Services, University Hospital of Geneva, Geneva; Cantonal Hospital of Fribourg, Fribourg; and Schulthess Klinik, Zurich, Switzerland

Mathieu Assal, MD
Richard Stern, MD
Marino Delmi, MD
Pierre Hoffmeyer, MD
Clinique d’Orthopédie et de Chirurgie de l’Appareil Moteur, Hôpital Cantonal Universitaire, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail address for R. Stern: richard.stern@hcuge.ch

Maximilien Jung, MD
Service d’Orthopédie, Hôpital Cantonal de Fribourg, Chemin des Pensionnaires, 1708 Fribourg, Switzerland

Pascal Rippstein, MD
Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland

One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

J Bone Joint Surg Am, 2002 Feb 01;84(2):161-170
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Controversy persists regarding the ideal surgical technique for repair of a ruptured Achilles tendon. We propose a limited open procedure with use of an instrument that provides the advantage of an open repair but avoids the soft-tissue problems with which open repair has been associated.

Methods: We first performed a cadaver study in order to develop an instrument and a technique for a limited open repair and then, using this procedure in conjunction with an early functional rehabilitation protocol, we began a prospective multicenter study. We are reporting on the first eighty-seven patients consecutively treated with the new instrument and followed for an average of twenty-six months (range, eighteen to forty-two months). All patients were assessed clinically and with an enhanced American Orthopaedic Foot and Ankle Society (AOFAS) rating score. In addition, all fifty patients who had been followed for at least twenty-four months were further evaluated with isokinetic dynamometry.

Results: Four patients were lost to follow-up and one patient died, which left eighty-two patients for evaluation. There were no problems with wound-healing, and there were no infections. No patient noted a sensory disturbance in the sural nerve distribution. All patients returned to their previous professional or sporting activities. The mean AOFAS score was 96 points (range, 85 to 100 points). Isokinetic dynamometry showed no significant difference in strength between the injured and uninjured limbs of the fifty patients who were tested. Complications occurred in three patients. Two of them were noncompliant and removed the orthosis, so that the repair was disrupted by a new injury within the first three weeks postoperatively. One patient fell twelve weeks after the surgery and sustained a rerupture. All three new injuries were repaired with an open surgical procedure.

Conclusions: This new procedure allows the surgeon to precisely visualize and control the tendon ends while avoiding excessive dissection and disturbance of local vascularity and minimizing nerve and wound-healing problems. Such a technique, along with an early functional rehabilitation program, allowed us to achieve a high rate of successful results with minimal morbidity.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/27/2014
    MA - Boston Medical Center and Boston University School of Medicine
    02/19/2014
    OH - University Hospitals Case Medical Center
    03/05/2014
    OK - The University of Oklahoma