SLR - October 2016 - Isin Mustafa
Reference: Ververidis AN, Kalifis KG, Touzopoulos P, Drosos GI, Tilkeridis KE, Kazakos KI. (2016). Percutaneous Repair of the Achilles Tendon Rupture in Athletic Population. J Orthop. 2015 Oct 9;13(1):57–61.Scientific Literature Review
Reviewed By: Isin Mustafa, DPM
Residency Program: Chino Valley Residency Program
Podiatric Relevance: Achilles tendon ruptures have been becoming more common in recent years. Although conservative versus surgical treatment is controversial, the literature demonstrates a lower rerupture rate with surgical intervention in the athletic population. Percutaneous treatment may be a superior method of surgical intervention when considering patient outcomes, satisfaction rates, recovery rates and time to return to sports activity. As a podiatric surgeon, it will be increasingly important to understand new developments in the treatment of Achilles tendon ruptures. Especially treatment options that can reduce costs, shorten the duration of the surgical procedure, reduce complication rates and improve patient outcomes.
Methods: This article was a retrospective review of the literature. Databases utilized included Medline, Cochrane and Scopus. Relevant articles were chosen if they included clinical and functional results, and time to return to sports activity. Keywords searched included percutaneous repair, subcutaneous repair, subcutaneous suturing, percutaneous suturing and athletic/athletes. Cadaveric, nonhuman, biomechanical and in-vitro studies that did not have information regarding time to return to sports were excluded. A total of 11 full articles and two abstracts were used from 1990 to 2014 for the review.
Results: There were a total of 13 studies ranging from 1990 to 2014 with a total of 670 repairs reported. Follow-up was on average of one year or more. Eighty-one patients were reported as being professional athletes. The majority of patients were male (M/F: 558/100). Functional outcomes were high. In five studies, the American Orthopedic Foot and Ankle Society clinical outcome score was used with an average of 96.1 (range was 44 to 100). Three studies used Achilles Tendon Total Rupture Score with an average of 89 (range 84.3 to 91.4). The average time to return to sports activity for nine out of the 13 studies was 18.1 weeks. Complication rates were low. Rerupture occurred in 14 out of the 670 patients (2.1 percent). Infection or delayed healing occurred in 14 out of the 670 patients (2.1 percent). DVT was reported in two out of 12 studies with a rate of 0.6 percent (4/670).
Conclusion: Percutaneous treatment of Achilles tendon rupture should be the surgical treatment of choice when dealing with the athletic population considering the low rerupture rate and time to return to sports activity.