REPAIR VERSUS OPEN REPAIR FOR ACUTE

Transcription

1 RETROSPECTIVE ANALYSIS OF MINI-OPEN REPAIR VERSUS OPEN REPAIR FOR ACUTE ACHILLES TENDON RUPTURES Erin E. Klein, DPM, MS Lowell Weil, Jr., DPM, MBA Jeffrey R. Baker, DPM Lowell Scott Weil, Sr., DPM Jessica Knight, DPM Weil Foot & Ankle Institute Des Plaines, Illinois

2 RETROSPECTIVE ANALYSIS OF MINI-OPEN REPAIR VERSUS OPEN REPAIR FOR ACUTE ACHILLES TENDON RUPTURES Erin E Klein, DPM, MS My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this presentation.

3 INTRODUCTION & PURPOSE Open techniques are associated with Wound healing mordibity 1-3 Scar and adhesion formation 4,5 Mini-open techniques Similar patient outcomes 7-10 Reported to be of equivalent strength to open repair in cadaveric biomechanical studies Purpose: Retrospectively compare the outcomes of the miniopen repair to the open repair of the Achilles tendon.

4 METHODS Retrospective review January 2002 January 2010 Open Achilles Repair Mini-open Achilles Tendon Repair Minimum 12 months follow up Complete medical records Post-operative VISA-A score

5 SURGICAL TECHNIQUES OPEN REPAIR Longitudinal incision Atraumatic dissection Krakow suture technique with large gauge non absorbable suture Closure in layers Gravity equinus cast x2-4 weeks MINI OPEN REPAIR Transverse incision over rupture Achillon jig to place proximal and distal sutures All sutures within the paratenon Layered closure Gravity equinus cast x2 weeks

6 RESULTS Patients population Open repair: 16 Mini open repair: 18 Patient age Open repair: years Patient Age (years) Mini-open Repair Mini open repair: years Surgical timing Open repair: days Mini open repair: days Surgical Timing (days) Mini-open Repair

7 RESULTS Initiation of functional rehabilitation Open repair: Post op day Mini open repair: Post op day p < 0.01 Unrestricted return to activity Open repair: Post op month Mini open repair: Post op month p < 0.01 Rehab Initiation (days) Return to Activity (months) * Mini-open Repair * Mini-open Repair VISA A Score * Open repair: Mini open repair: VISA-A Score p < Mini-open Repair

8 UNANTICIPATED PATIENT EVENTS Open repair (21%) 3 wound dehiscences Mini open repair (11%) 1 wound dehiscence; 1 rerupture Complication Rate (%) Sural neuritis was not 5 noted in either group. 0 Mini-open Repair

9 CONCLUSION Mini-open technique provides a reliable means of tendon repair Maximizing outcomes Early return to activities Decreased scar formation Fewer adhesions Minimizing complications

10 REFERENCES 1. Carter, T.R., P.J. Fowler, and C. Blokker, Functional postoperative treatment of Achilles tendon repair. Am J Sports Med, (4): p Cetti, R., et al., Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, (6): p Maffulli, N., et al., Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med, (5): p Mortensen, H.M., O. Skov, and P.E. Jensen, Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg Am, (7): p Willits, K., et al., Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am, (17): p Kakiuchi, M., A combined open and percutaneous technique for repair of tendo Achillis. Comparison with open repair. J Bone Joint Surg Br, (1): p Assal, M., et al., Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am, A(2): p De Carli, A., et al., Spontaneous Achilles tendon ruptures treated with a mini-open technique: clinical and functional evaluation. J Sports Med Phys Fitness, (3): p Mukundan, C., et al., "Mini-open" repair of acute tendo Achilles ruptures--the solution? Foot Ankle Surg, (3): p Rippstein, P.F., M. Jung, and M. Assal, Surgical repair of acute Achilles tendon rupture using a "mini-open" technique. Foot Ankle Clin, (3): p Heitman, DE; Ng, Kenneth; Crivell, KM. Biomechanical comparison of the achillon tendon repair system and the krackow locking loop technique. Foot Ankle Int, (9): Ismail, M., et al., The Achillon achilles tendon repair: is it strong enough? Foot Ankle Int, (8): p Aktas, S. and B. Kocaoglu, Open versus minimal invasive repair with Achillon device. Foot Ankle Int, (5): p