ISSN: 2640-2734
Authors: Basaran T* and Basaran PO
Objectives: Although there is a lot of study about the treatment of Achilles tendon ruptures, it is controversial how to perform the treatment of Achilles tendon rupture and follow-up. It is aimed to compare the results of classical rehabilitation after open surgical repair and early mobilization after percutaneous repair of patients who applied to our hospital with acute tendon rupture. Materials and Methods: A total of 44 patients (12 females; 32 males) applied to emergency service with Achilles tendon ruptures were evaluated between January 2011 and June 2016. The patient was scheduled to undergo surgery for those who have a total Achilles rupture detected in magnetic resonance and who’s the Thompson test was positive, who is with a palpable ecchymosis. The mean age of the patients is 41,3 (25-58). While patients in the percutaneous repair group were treated early by local anesthesia, the open surgical repair group was operated on an average of 2 days (1-4 days). Patients were followed for a mean of 24 months. Results: Patients were evaluated with Achilles tendon total rupture score (ATRS) and the visual analogue scale (VAS). In the 12th month check-ups, the patients had a magnetic resonance imaging test and it was found that there were no problems with them. The mean ATRS (Achilles tendon total rupture score) was 71,1 in the 0th month, 76,9 in the 3rd month, 81,8 in the 12th month and 91,5 in the 24th month. The mean VAS score was 8,6 in the 0th month, 5,6 in the 3rd month, 3.1 in the 12th month and 1,5 in the 24th months. It was seen that the patients were limping due to pain while walking. It was observed that there were no problems with the wound sites and the pain decreased at 6th -week control. There were no gaps in the Achilles rupture zone, but there was thickening in the healing zone. Physical therapy was not needed because Achilles tension was not seen in the patients. They were observed as they walked slightly with a limp. The mean ATRS score was 85,7 in the 0th month, 87,1 in the 3rd month, 90,3 in the 12th month and 91,9 in the 24th month. The mean VAS score was 8,0 in the 0th month, 3,8 in the 3rd month, 2,0 in the 12th month and 1,3 in the 24th month. The surgery duration was 48,1 minutes in group A and 15,0 minutes in group B, the difference between them was statistically significant (p<0,05). While the discharge duration was 3,3 days in group A, it was 1 day in group B, and the difference between them was statistically significant (p<0,05). While the return-to-work was 81,7 days in group A, it was 22,3 days in group B, the difference between them was statistically significant (p<0,05). While VAS value was statistically significantly lower at month 0th month (p<0,05), 3rd month (p<0,05) and at 12th month (p<0,05) in group B, but no statistically significant difference was found between groups at 24th month (p=0,176). While ATSR value was statistically significantly lower at month 0th month (p<0,05), 3rd month (p<0,05) and at 12th month (p<0,05) in group b, but no statistically significant difference was found between groups at 24th month (p=0,942). Conclusion: The main purpose of the treatment of Achilles tendon rupture is to return to the pre-injury quality of life. Open surgical tendon repair requires long-term rehabilitation for preoperative preparation, general or spinal anesthesia, postoperative wound care, prolonged splint-splint use, and subsequent ankle stiffness. Re-rupture and calf atrophy can be seen with conservative treatment and again a long time splint is required. With percutaneous Achilles tendon repair, the duration of surgery and the length of stay were significantly reduced. Hospital costs were significantly reduced. The return of the patient to the work was significantly accelerated. The actual patient costs can be reduced by providing minimum rehabilitation period with repair of percutaneous rheumatoid rupture and early mobilization or by the help of some approaches such as ambulatory treatment, avoiding the systemic side effects of anesthesia, shortening of operating room time, more effective use of rehabilitation units, not using the device and early return to work.
Keywords: Surgery; Tendons; Human Body; Muscles
