Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Surgical Treatment of Achilles Tendon Rupture with Absorbable Suture Materials Only

흡수성 봉합사만를 이용한 아킬레스건 파열의 수술적 치료

  • Bae, Su-Young (Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University) ;
  • Park, Jae Gu (Department of Orthopedic Surgery, Daelim St. Mary's Hospital) ;
  • Jung, Eui Yub (Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University)
  • 배서영 (인제대학교 상계백병원 정형외과학교실) ;
  • 박재구 (대림성모병원 정형외과) ;
  • 정의엽 (인제대학교 상계백병원 정형외과학교실)
  • Received : 2013.07.14
  • Accepted : 2013.08.20
  • Published : 2013.09.15
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Abstract

Purpose: To report the clinical results from using absorbable suture materials instead of nonabsorbable materials which have been used more commonly to repair Achilles tendon. Materials and Methods: We retrospectively reviewed 21 cases of acute Achilles tendon rupture, treated surgically from 2004 to 2011. Mean follow-up period is 6 months. We repaired Achilles tendon using size 1 Vicryl (Polyglactin 910, Ethicon) for core suture and size 3-0 Vicryl for epitendinous suture. At three months after surgery, we evaluated clinical results with single heel raise height by centimeters, differences of calf circumference and passive range of motion of ankle joint, compared to contralateral side. Also we recorded clinical results with subjective satisfaction grades. Results: At three months after surgery, 20 of 21 patients were able to perform single heel raise over 5 cm in height. Calf circumference differences were less than 1 cm in 12 cases, between 1 cm to 3 cm in 5 cases, more than 3 cm in 4 cases. There was no difference in range of passive motion in 19 cases. All patients satisfied with daily activity except 2 cases with mild discomfort. There was no complication such as rerupture, elongation or infection. Conclusion: We experienced excellent clinical results from repairing Achilles tendon with using absorbable suture materials in terms of functional outcomes and patient's satisfaction without any complication. So we may consider using absorbable suture materials instead of nonabsorbable materials to repair Achilles tendon.

Keywords

References

  1. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med.1993;21:791-9. https://doi.org/10.1177/036354659302100606
  2. Inglis AE, Sculco TP. Surgical repair of ruptures of the tendo Achillis. Clin Orthop Relat Res. 1981;160-9.
  3. Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg Am. 1981;63:394-9. https://doi.org/10.2106/00004623-198163030-00012
  4. Wills CA, Washburn S, Caiozzo V, Prietto CA. Achilles tendon rupture. A review of the literature comparing surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1986; 207:156-63.
  5. Trail IA, Powell ES, Noble J. An evaluation of suture materials used in tendon surgery. J Hand Surg Br. 1989 Nov; 14(4):422-7. https://doi.org/10.1016/0266-7681(89)90160-5
  6. Wada A, Kubota H, Akiyama T, Hatanaka H, Miura H, Iwamoto Y. Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg Am. 2001 May;26(3):398-406. https://doi.org/10.1053/jhsu.2001.24134
  7. Yildirim Y, Saygi B, Kara H, Cabukog˘lu C, Esemenli T. [Tendon holding capacities of the suture materials used in repairing Achilles tendon rupture]. Acta Orthop Traumatol Turc. 2006;40(2):164-8.
  8. Kang HJ, Lee DC, Kim JS, Ki SH, Roh SY, Yang JW. Flexor tenorrhaphy using absorbable suture materials. Arch Plast Surg. 2012 Jul;39(4):397-403. https://doi.org/10.5999/aps.2012.39.4.397
  9. Najibi S, Banglmeier R, Matta J, Tannast M. Material properties of common suture materials in orthopaedic surgery. Iowa Orthop J. 2010;30:84-8.
  10. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg Am. 1997;79:1799-808. https://doi.org/10.2106/00004623-199712000-00005
  11. Lea RB, Smith L. Nonsurgical treatment of tendo-Achilles rupture. J Bone Joint Surg. 1972;54-A:1398-407, 1972.
  12. Lee EW, Kang KS, Kang SY and Jin WJ. Comparison of conservative and operative treatment of Achilles tendon rupture. J Korean Orthop Assoc. 1996;31:598-605.
  13. Persson A, Wredmark T. The treatment of total rupture of the Achilles tendon by plaster immobilization. Int Orthop. 1979;3:149-52.
  14. Rubin BD, Wilson HJ Jr. Surgical repair of the interrupted Achilles tendon. J Trauma. 1980;20:248-9. https://doi.org/10.1097/00005373-198003000-00011
  15. Kellam JF, Hunter GA, McElwain JP. Review of the operative treatment of Achilles tendon rupture. Clin Orthop Relat Res. 1985;201:80-3.
  16. Beskin JL, Sanders RA, Hunter SC, et al. Surgical repair of Achilles tendon ruptures. Am J Sports Med. 1987;15:1-8. https://doi.org/10.1177/036354658701500101
  17. Akgun U, Erol B, Karahan M. [Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures]. Acta Orthop Traumatol Turc. 2006;40:228-33.
  18. Jacobs D, Martens M, Van Audekercke R, et al. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107-11. https://doi.org/10.1177/036354657800600302
  19. Carden DG, Noble J, Chalmers J, et al. Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg Br. 1987;69:416-20.
  20. Aoki M, Ogiwara N, Ohta T, et al. Early active motion and weightbearing after cross-stitch Achilles tendon repair. Am J Sports Med 1998;26:794-800. https://doi.org/10.1177/03635465980260061001
  21. Choi YR, Lee SY, Lee SC, et al. Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture. J Korean Orthop Assoc. 2012;47:111-8. https://doi.org/10.4055/jkoa.2012.47.2.111
  22. Baek JR, Kwak JI, Won JS, Park HG. Clinical Result of Modified Percutaneous Repair Technique of Ruptured Achilles Tendon. J Korean Foot Ankle Soc. 2011:15(3);144-8.
  23. Kim DY, Kim SB, Heo YM, Lee JB, Lim JW, Oh HT. Surgical Treatment of the Ruptured Achilles Tendon: A Comparative Study between Percutaneous and Open Repair Year. J Korean Foot Ankle Soc. 2011;15(2):79-85.
  24. Jeon TS, Kim SB, Jung WY, Heo YM, Park CY. Percutaneous Repair of Acute Achilles Tendon Ruptures. J Korean Orthop Assoc. 2009;44:661-7. https://doi.org/10.4055/jkoa.2009.44.6.661
  25. Pabari A, Iyer S, Branford OA, et al. Palmar granuloma following flexor tendon repair using Ticron: a case for absorbable suture material?. J Plast Reconstr Aesthet Surg. 2011;64:409-11. https://doi.org/10.1016/j.bjps.2010.04.015
  26. O'Broin ES, Earley MJ, Smyth H, Hooper AC. Absorbable sutures in tendon repair. A comparison of PDS with prolene in rabbit tendon repair. J Hand Surg Br. 1995 Aug;20(4):505-8. https://doi.org/10.1016/S0266-7681(05)80164-0
  27. Molloy A, Wood EV. Complications of the treatment of Achilles tendon ruptures. Foot Ankle Clin. 2009 Dec;14(4): 745-59. https://doi.org/10.1016/j.fcl.2009.07.004
  28. Young JS, Kumta SM, Maffulli N. Achilles tendon rupture and tendinopathy: management of complications. Foot Ankle Clin. 2005 Jun;10(2):371-82. https://doi.org/10.1016/j.fcl.2005.01.004
  29. R. Cetti, S.E. Christensen, R. Ejsted, N.M. Jensen, U. Jorgensen. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993 Nov-Dec; 21(6):791-9. https://doi.org/10.1177/036354659302100606
  30. S. Terry Canale, James H. Beaty. Campbell's Operative Orthopaedics. 12th ed. Philadelphia: Mosby;2012. 3959.
  31. Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. 1989;71(1):100-1.
  32. Lagergren C, Lindholm A. Vascular distribution in the Achilles tendon; an angiographic and microangiographic study. Acta Chir Scand. 1959;116(5-6):491-5.
  33. Lee HJ, Chu IT, Choi SP. Treatment of the Chronic Achilles Tendon Rupture by Lindholm Method. J Korean Foot Ankle Soc. 2009;13(1):28-33.
  34. Jung HG, Paik HD. Surgical Repairof Achilles Tendon Rupture by Minimal Incision Technique. J Korean Foot Ankle Soc. 2005;9(2):173-8.
  35. Chung HJ, Park JS, Kim HH, Park YW. Early Mobilization after Operative Treatment of a ruptured Achilles tendon. J Korean Foot Ankle Soc. 2003;7(1):78-82.