SLR - September 2011 - Christopher Schmitt
Reference: Mafulli, N., Longo, UG., Mafulli, GD., Denaro, V. (2011). Achilles tendon ruptures in diabetic patients. Arch Orthop Trauma Surg, 131, 33-38.
Scientific Literature Review
Reviewed by: Christopher Schmitt, DPM
Residency Program: St John Hospital and Medical Center, Detroit, Michigan.
Podiatric Relevance:
This prospective study provides useful data on the technique of percutaneous repair of an acute Achilles tendon rupture as a treatment option in the diabetic patient.
Methods:
Thirty-nine consecutive diabetic patients sustained an acute tear of the Achilles tendon and had percutaneous repair of the Achilles tendon with absorbable suture. All patients were treated by a single fellowship trained orthopedic surgeon using the technique described by McClelland and Maffulli. Prophylactic antibiotics and anti-thrombotic prophylaxis were not routinely given. Following repair, patients were immobilized with their ankle in gravity equinus. They were given instruction to bear weight on the operated limb as quickly as possible. They followed up two, six and twelve weeks post operation and further assessment was performed at each visit. They then followed up at three month intervals and were discharged at nine or twelve months after operation after they could perform five toe raises and could return to pre-injury function on the surgical side.
Results:
Evaluation of the patients was performed preoperatively on the day of surgery and final evaluation an average of sixty-four months later. Of the thirty-nine patients, the mean operating time was 20+/- 9 minutes. All of the patients operated on were able to fully weight bear by the end of the eighth post-operative week. Six of the patients were lost to follow-up. Eleven of the patients suffered from superficial infection of the surgical wound, two of which required surgical debridement and washout. Other complications encountered included hypersensitivity of the surgical wound (6/33), hypertrophic scar formation (2/33), pain on weight bearing after long periods (4/33), pain during cold weather (5/33), pain during rest occasionally (3/33), swelling around ankle (19/33) and cramps in the affected leg (15/33).
Conclusions:
The option of percutaneous repair of the Achilles tendon with absorbable suture is a viable option producing acceptable outcome. With the percutanous technique, there is a decrease in postoperative pain and a minimal surgical incision. These factors decrease wound complications and protect against wound breakdown.