SLR- January 2014- Christopher Baptist
Reference: Muezzinoglu S, Memisoglu K, Sarman H, Aydin A, Atmaca H. Internal Splinting: A New Technique for Achilles Tendon Repair. Techniques in Foot & Ankle Surgery. 2013 12(2): 92-98.
Scientific Literature Review
Reviewed By: Christopher Baptist, DPM
Residency Program: St. John Hospital and Medical Center
Podiatric Relevance: The surgical treatment of acute (<2 weeks) Achilles tendon ruptures varies widely from an open to a percutaneous approach and to the length and placement of the incision. Regardless of the technique, however, complications such as re-rupture, wound dehiscence, and nerve damage are encountered. This article proposes another possible approach that potentially has the benefits of both the percutaneous and open techniques without the drawbacks associated with each. The premise is based on the authors belief that disruption of the soft tissues overlying the rupture siteand the early formed hematoma following rupture results in a weaker, less well-developed healing potential that can be further complicated by the already relatively avascular portion of the tendon.
Methods: There were 24 patients total included in this study. Thirteen had mid-substance ruptures and 11 hadmore distal ruptures (rupture <3 cm from the insertion) and the techniquevaried slightly at the distal end based on the location of the rupture. Magnetic resonance imaging was performed pre-operatively in all patients. All patients had a history of indirect trauma. Exclusion criteria were patients with re-ruptures, previous ankle surgery, inflammatory disorders, history of radiotherapy, chemotherapy, or local or systemic steroid use.
Results: Twenty-four patients underwent the proceduredetailed above. There were two females and 22 males with a mean age of 38 years (27-53 yrs). Time to operation was on average 3.5 days (1-12 d) and the mean follow-up was 28.8 months (9-90 mo). Return to daily activity was 6-8 weeks, and return to light exercises was at 12 weeks. Complications were two cases of sural nerve hypoesthesia, which was resolved at six months, and one case of re-rupture in a patient who resumed dancing activity at two months against medical advice. AOFAS and Thermann Post Achilles surgery scores were obtained six months post-operatively with a mean score of 96.2 (86-100) and 87.9 (81-100), respectively.
Conclusions: Primary open repair of a ruptured Achilles tendon causes requires disruption of the skin and paratenon at the site of injury, which may affect healing. Percutaneous repair typically uses smaller sutures, which may result in a repair that is not as inherently strong. The proposed technique offers less disruptionat the injury site, which may potentially result in stronger physiologic healing, has less potential for wound complications, and allows a larger suture to be used and the knots buried under a thicker soft tissue envelope.