小切口加腱皮减张缝合法治疗闭合性跟腱断裂22例

目的 探讨急性闭合性跟腱断裂一种新的治疗方法。方法 从1994年～2001年8月，采用小切口加腱皮减rner-Lindholm疗效评定标准，优19例(86．4％)，良3例(13．6％)，优良率达100％。结论 小切口加腱皮减张缝合法治疗急性闭合性跟腱断裂，能有效分散断端张力，有效保护断端血供，创伤小，伤口无异物反应，再断裂及感染机会少，功能恢复快，是治疗急性闭合性跟腱断裂的较好方法。     

微创腱皮缝合治疗急性跟腱断裂的生物力学评价

目的评价微创腱皮缝合技术治疗急性闭合性跟腱断裂的生物学特性。方法采用微创腱皮缝合和常规Kessler缝合两种方法治疗日本大耳白兔急性闭合性跟腱断裂,取生长14周时的大耳白兔跟腱标本和健侧正常跟腱各5条,分为3组,做生物力学检验。通过对不同分组跟腱的最大载荷、应变值、强度、拉伸刚度、吸收能量和比能以及应力和应变的关系的检测,并做统计学分析。结果通过检测和结果统计分析,3组的生物力学性能均有一定的差异,微创腱皮缝合技术的生物力学特性接近于正常组（P〉0.05）,并且比对照组的力学性能好（P〈0.05）。结论微创腱皮缝合技术具有良好的愈合强度,优于常规直接开放手术方法。     

闭合性跟腱断裂微创腱皮缝合的远期疗效观察

[目的]通过对长期疗效和可能并发症的观察,介绍并评价微创腱皮缝合术治疗急性闭合性跟腱断裂的临床效果。[方法]自1996年1月～2005年4月间,随机选取跟腱断裂的患者28名,经术前查体和MRI证实,均为新鲜完全性闭合性跟腱断裂。首先微创暴露跟腱断端,清除断端的瘢痕和血凝块,梳理对合两断端,在皮外经跟腱断端以远健康部位做减张缝合。患者常规术后随访,平均随访4年（1～7年）。随访包括常规的临床评价和术后MRI检查,并应用Arner-Lindholm疗效评定标准对术后效果进行评定。其中2例未能按时随访。[结果]对所有26例患者,按Arner-Lindholm疗效评定标准进行评定,其中优19例,良6例,差1例,优良率为97%,无感染发生,再断裂1例,为长期局部类固醇封闭患者。术后MRI显示,全部患者的跟腱得到了良好的修复,跟腱断端连续性好,疤痕小。[结论]通过长期随访,微创腱皮缝合是一种修复急性闭合性跟腱断裂较好的方法,具有创伤小,有效保护跟腱血运,术后并发症少的优点。     

改良经皮缝合法与开放缝合法修复新鲜闭合性跟腱断裂的疗效比较

目的通过与开放缝合法比较,探讨改良经皮缝合法修复新鲜闭合性跟腱断裂的疗效。方法 2006年1月-2009年10月,收治50例新鲜闭合性跟腱断裂患者,根据治疗方法不同分为两组,22例采用改良经皮缝合法治疗(改良组),术中于跟腱两侧平行各作5个孔,采用"之"字形方式缝合;28例采用Kesller缝合法治疗(常规组)。两组患者性别、年龄、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果常规组术后1例切口感染,1例跟腱再断裂,2例切口瘢痕挛缩;改良组患者切口均Ⅰ期愈合,无并发症发生。改良组手术时间为(38.7±6.6)min,明显短于常规组(52.3±6.9)min(t=—12.29,P=0.00);改良组术中失血量为(4.9±2.0)mL,显著低于常规组(40.7±7.1)mL(t=—25.20,P=0.00)。两组患者均获随访,随访时间2～3年,平均29.9个月。术后2年应用美国矫形足踝协会(AOFAS)评分标准评定,改良组为(99.6±1.0)分,常规组为(98.4±3.0)分,差异无统计学意义(t=1.66,P=0.10)。结论与开放缝合法比较,改良经皮缝合法具有手术操作简便、并发症少、踝关节功能恢复快等优点,是治疗新鲜闭合性跟腱断裂的较好选择之一。     

TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂

目的 探讨TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂的临床疗效.方法 采用TwinFix带线锚钉辅助改良Kessler法修补陈旧性跟腱断裂患者11例,术中用改良Kessler法对位缝合跟腱断端,再用2枚TwinFix带线锚钉辅助固定断裂跟腱.术后予患侧下肢屈膝90°、踝跖屈30°位长腿石膏托固定,3周后改踝跖屈石膏托固定.结果 11例均获随访,时间3～18个月.患者均未发生切口延期愈合、感染、皮肤坏死和跟腱再断裂等并发症.采用Arner-Lindholm评分标准评价疗效:优7例,良3例,差1例.结论 TwinFix带线锚钉辅助改良Kessler法手术操作简便,是修补陈旧性跟腱断裂的有效方法.     

A New Model for Repair of the Achilles Tendon in the Rat

ABSTRACT

The Sprague-Dawley rat is an excellent model for studies of Achilles tendon repair. Most researchers use a modification of the Kessler technique for suture repair of the Achilles tendon in rats. While this technique provides adequate strength, early mobilization is not recommended. Prior to healing, the load will be borne completely by the suture repair, subjecting it to rupture. To prevent this complication, investigators employing the Kessler repair often immobilize the operative extremity with a cast or splint. This has also been shown to be detrimental to the peak load borne by the tendons prior to rupture. A double-loop locking technique of suture repair for rat Achilles tendons is favored over the modified Kessler technique. As force is applied across the repair, the suture pulls on the tendon, sharing the load. This allows for early mobilization of repaired tendons, with minimal risk of rupture. Additionally, no immobilization is required for the operative extremity. One hundred repairs have been performed using this double-loop locking technique. All animals have been able to mobilize with minimal limp immediately after recovering from anesthesia, and there have been no ruptures. No other complications have occurred (hematoma, seroma, infection, dehiscence). This technique of tendon repair is ideal for use in studies of tendon repair in the rat, since it is easy to perform and eliminates the need for immobilization of the operative leg.     

卵圆钳辅助穿针技术与开放Kessler缝合在急性跟腱断裂中的临床疗效研究

目的探讨卵圆钳辅助穿针技术治疗急性闭合性跟腱断裂的临床疗效及可行性。方法回顾性分析2013年1月至2019年6月我院43例接受手术治疗的急性闭合性跟腱断裂患者,其中17例采用卵圆钳辅助穿针技术(微创组),26例采用开放Kessler缝合治疗(开放组),观察并比较两组患者的手术疗效。结果卵圆钳辅助微创组在手术时间、术中出血量、住院时间均短于开放组,且差异有统计学意义(P<0.05)。微创组并未出现术后并发症,而开放组出现的术后伤口感染、延迟愈合、皮缘坏死和再次断裂发生率分别为:11.54%、15.38%、15.38%和11.54%。结论卵圆钳辅助穿针技术是一种安全可靠的治疗跟腱断裂的方法,与开放手术相比,能够减少软组织并发症的发生,并可减少手术时长、住院天数及康复时间;提高了患者的生活质量并降低了社会成本。     

吻合口无结Kessler缝合法修复指屈肌腱的疗效观察

目的通过与传统Kessler缝合法比较,分析吻合口无结Kessler缝合法修复指屈肌腱的疗效及优势。方法回顾分析2005年2月-2010年2月采用吻合口无结Kessler缝合法治疗的122例163指243根指屈肌腱断裂患者临床资料(试验组),术中一期显微缝合指屈肌腱,修复腱外膜、腱鞘及腱周组织,应用透明质酸钠充填治疗。并与2001年2月-2005年2月采用传统Kessler缝合法治疗的96例130指186根指屈肌腱断裂患者(对照组)临床资料进行比较。两组患者性别、年龄、损伤原因、损伤部位、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后3周内采用Kleinert橡皮筋牵引疗法(动态支具保护),并于24 h后开始手指功能锻炼。结果术后试验组2例、对照组5例切口发生感染,经换药后2周愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6～14个月,平均9个月。术后6个月手指功能采用主动活动度(total active movement,TAM)法评定,试验组TAM为(192.0±13.1)°;其中获优54例,良58例,中8例,差2例,优良率为92%。对照组TAM为(170.0±15.2)°;其中获优23例,良30例,中22例,差21例,优良率为55%。两组TAM比较,差异有统计学意义(P<0.01)。结论吻合口无结Kessler缝合法治疗指屈肌腱断裂,辅以腱外膜、腱鞘及腱周组织修复后,手指功能恢复优于传统Kessler缝合法,但远期疗效仍需进一步观察。     

A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture

ObjectiveAcute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture.MethodsFifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography.ResultsMean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients.ConclusionsThe novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.     

Assessment of the Resistance of Several Suture Techniques in Human Cadaver Achilles Tendons

Many treatments are available for acute Achilles tendon ruptures, conservative and surgical, with none superior to another. For surgical treatment, one can use various techniques. Recent studies have shown that double stitches are superior to simple sutures. Therefore, in the present study, we sought to determine the suture technique that is the most resistant to rupture. We performed an experimental anatomic study with 27 fresh-frozen human cadaveric Achilles tendons obtained through the body donation program of the University of Barcelona, testing the maximum strength. We simulated a rupture by performing resection in the middle portion of the tendon, 4 cm proximal to the calcaneus insertion. We then evaluated the double Kessler, double Bunnell, Krackow, and percutaneous Ma and Griffith technique. We used absorbable suture (polydioxanone no. 1) with all the techniques. Traction was performed using a machine that pulls the tendon at 10 to 100 N in 1000 repetitive cycles. Statistical analysis was performed using the χ² test and analysis of variance, with the 95% confidence intervals (p < .05). All repairs failed at the site of the suture knots, with none pulling out through the substance of the tendon. We found no significant differences among the different open suture techniques (p > .05). The Krackow suture presented with superior resistance, with a rupture rate 16.70% but with a mean elongation of 7.11 mm. The double Bunnell suture had the same rupture rate as the Krakow suture (16.70%) but with an inferior mean elongation of 4.53 mm. The Krackow and Bunnell suture were superior in endurance, strength of failure, and primary stability compared with the other suture types. However, the former presented with greater tendon elongation, although the difference was not statistically significant. Therefore, according to our findings and the published data, we recommend double Bunnell sutures for the surgical treatment of acute Achilles tendon rupture.     

Interlocking horizontal mattress suture versus Kakiuchi technique in repair of Achilles tendon rupture: a biomechanical study

Background

In recent years, the type of surgical treatment for Achilles tendon rupture has been the subject of controversial debate. This biomechanical study evaluates for the first time in literature the ultimate failure load (UFL) of interlocking horizontal mattress (IHM) suture as compared with Kakiuchi suture in Achilles tendon rupture. The hypothesis is that IHM suture can be performed also for Achilles tendon rupture and ensures higher resistance compared with the traditional Kakiuchi suture.

Materials and methods

Twenty fresh bovine Achilles tendons were obtained. Ten preparations were randomly assigned to each of two different groups: group A (10 specimens) sutured by IHM technique, and group B (10 specimens) sutured by Kakiuchi technique. Each construct was mounted and fixed on a tensile testing machine. Static preconditioning of 50 N was applied for 5 min as initial tensioning to stabilize the mechanical properties of the graft, then a load to failure test was performed at crosshead speed of 500 mm/min.

Results

Ten specimens were tested for each group. The mean UFL was 228.6 ± 98.6 N in the IHM suture group and 96.57 ± 80.1 N in the Kakiuchi suture group. Statistical analysis showed a significant difference (p < 0.05) with better UFL in the IHM group. In both groups, the failure mode registered in each specimen was suture breakage (rupture of suture thread).

Conclusions

IHM suture achieved better UFL compared with Kakiuchi suture in an animal model of Achilles tendon repair. These results seem to support IHM as a valid option in Achilles tendon rupture.

     

塑型卵圆钳经皮缝合与切开缝合治疗新鲜闭合性跟腱断裂的对照研究

目的 比较塑型卵圆钳经皮微创缝合技术和切开缝合技术治疗新鲜闭合性跟腱断裂的临床疗效。方法 回顾性研究自2014年1月至2016年10月收治的73例新鲜闭合性跟腱断裂病人,最终入组共70例,根据手术方式的不同分为两组：微创组（36例）借助自制的塑型卵圆钳,通过小切口经皮缝合修复跟腱;常规组（34例）采用常规跟腱内侧纵行切口,连续锁边缝合修复跟腱。记录两组手术时间、术中出血量、术后并发症、恢复至伤前运动水平的时间、末次随访时的美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分,术后1年复查MRI评估跟腱修复状况。结果 两组病人获得16~44个月（平均30个月）随访,其中微创组手术时间为（45.34±6.73） min,术中出血量为（15.12±4.11） ml;常规组手术时间为（69.33±13.44） min,术中出血量为（25.47±7.19） ml,两组比较,差异均有统计学意义（P均＜0.05）。微创组2例病人切口延迟愈合,2例出现线结刺激症状,1例腓肠神经损伤,1例于术后半年外伤后再断裂;常规组3例伤口浅表感染,2例出现深部感染,无腓肠神经损伤及跟腱再断裂。末次随访AOFAS评分：微创组为（95.81±2.35）分,常规组为（93.61±4.83）分;微创组有29例病人（21.0±4.7）周（20~24周）恢复至伤前运动水平,常规组有26例（23.0±3.5）周（21~31周）恢复至伤前运动水平;上述指标比较,差异均无统计学意义（P均＞0.05）。术后1年MRI均显示跟腱连续性完整,未观察到跟腱囊性变。结论 自制塑型卵圆钳经皮缝合技术修复新鲜闭合性跟腱断裂手术时间短,术后恢复更快,且并不增加跟腱再断裂发生率。     

Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model

BackgroundThe advantages of barbed suture for tendon repair could be to eliminate the need for a knot and to better distribute the load throughout the tendon so as to reduce the deformation at the repair site. The purpose of this study was to evaluate the breaking force and the repair site deformation of a new barbed tenorrhaphy technique in an animal model.ResultsThe two-sample Student t-test demonstrated a significant increase in 2-mm gap formation force and in breaking force with barbed sutures, independently from suture material, when compared to traditional Kessler suture. Concerning the tendon profile, we registered less bunching at the repair site in the two barbed groups compared with the Kessler group.ConclusionsThis study confirms the promising results achieved in previous ex vivo studies about the use of barbed suture in flexor tendon repair. In our animal model, tenorrhaphy with Quill™ SRS suture guarantees a breaking force of repair that exceeds the 40–50 N suggested as sufficient to initiate early active motion, and a smoother profile at the repair site.Level of evidence Not applicable.     

应用双津下缝合法修复跟腱断裂疗效分析

目的探讨采用0号可吸收普迪思圈套线(PDS-Ⅱ线)双津下缝合法修复跟腱断裂的临床疗效。方法 2005年1月-2008年12月,收治36例跟腱断裂患者。男29例,女7例;年龄21～50岁,平均36岁。运动损伤25例,摔伤4例,锐器割伤6例,其他伤1例。新鲜闭合损伤22例,新鲜开放损伤6例,伤后至入院时间1～10 d,平均6 d;陈旧性闭合损伤8例,伤后至入院时间43～63 d,平均51 d。提踵试验及Thopmson征均呈阳性。患者均采用0号可吸收PDS-Ⅱ线双津下缝合法修复。术后于踝跖屈30°位短腿石膏固定6周后,开始功能锻炼。结果术后2例陈旧性跟腱断裂患者切口愈合不良,经对症治疗后切口愈合;其余切口均Ⅰ期愈合。患者均获随访,随访时间12～24个月,平均15个月。随访期间均未发生跟腱再次断裂及反射性交感神经营养不良。患者踝关节活动度与健侧相比,7例无减少,16例减少1～10°,12例减少10～20°,1例减少25°。根据Termann跟腱损伤临床评价标准,评分为74～96分,平均90分;获优24例,良11例,可1例,优良率为97.2%。结论双津下缝合法手术操作简便,缝线在腱内无横行交叉,修复断裂跟腱后对其血运影响小。PDS-Ⅱ线可提供高强度张力,并可完全吸收,不易发生局部粘连。采用该方法修复跟腱断裂术后并发症发生率较低,可获得较好疗效。     

Management of Acute Achilles Tendon Rupture Using the Krackow and Tendon-Bundle Techniques

Background Acute Achilles tendon rupture is a severe injury of the lower extremities;however,optimal treatment options are not yet available.This study aimed to investigate the surgical method and clinical effect of the Krackow and tendon-bundle techniques for managing acute Achilles tendon rupture.Methods This retrospective case series study analyzed 17 cases of acute Achilles tendon rupture at the Beijing Jishuitan Hospital from December 2012 to January 2020.There were 16 men and one woman,aged 27–45 years,with an average of 39.6 years.Thirteen patients were injured while playing basketball or badminton,and 4 patients were injured while participating in a football match or other sports.All injuries were repaired using the Krackow and tendon-bundle techniques.Postoperative evaluation indicators included active range of motion during ankle plantar flexion and dorsiflexion,height of single foot heel lifting,Amer-Lindholm Achilles tendon function score,and American Orthopedic Foot and Ankle Society(AOFAS)score.Results The patients were followed-up for 6–45 months(average,18.9 months).There was no re-rupture of the Achilles tendon,wound infection,or sural nerve injury.At the final follow-up,the affected and contralateral sides exhibited plantar flexion of 42.1±4.4°and 43.8±2.8°,dorsiflexion of 15.8±2.9°and 16.6±2.9°,respectively,and one foot exhibited a heel lifting height of 7.2±1.0 cm and 7.5±0.9 cm,respectively.There was no significant difference between the affected and contralateral sides(P>0.05).At the final follow-up,the Amer-Lindholm Achilles tendon function score was excellent in 94.1%(16/17)of the patients and good in 5.9%(1/17)of the patients.The AOFAS scores ranged from 90 to 100,with an average of 96.4±3.7.Conclusion Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends,and thus it is an effective repair method for closed Achilles tendon injury.     

小切口辅助经皮缝合系统修复急性闭合跟腱断裂并发症

目的：分析小切口辅助经皮修复急性跟腱断裂术后并发症的原因、处置及预防对策。方法 ：回顾性研究2008年8月至2019年11月采用小切口辅助经皮跟腱缝合系统（micro incision percutaneous Achilles tendon suture system,MIPAS）治疗的急性闭合性跟腱断裂患者279例,其中男269例,女10例;右侧96例,左侧183例;年龄18～64(36.9±11.4)岁;伤后至手术时间0.5～7(2.7±0.9) d。收集记录术后18个月内切口相关情况、再断裂、腓肠神经损伤、静脉血栓、跟腱粘连、局部疼痛和踝关节僵硬,以及相应处置措施和并发症转归,总结分析原因和预防策略。结果：所有患者未出现切口浅表及深部感染,未出现症状性跟腱粘连和踝关节僵硬。发生迟发性线结反应2例（0.7%）,再断裂5例（1.8%）,腓肠神经损伤3例（1.1%）,穿刺点皮肤内陷21例（7.5%）,症状性静脉血栓2例（0.7%）,一过性内踝后方疼痛45例（16.1%）。经个体化处理,功能良好,美国足踝外科协会（American Orthopaedic Foot&Ankle ...     

Endoscopic-assisted repair of acute Achilles tendon rupture with Krackow suture: An anatomic study

PurposeTo study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered.Type of studyAnatomic study.MethodsTwelve Achilles tendons in six cadavers were cut at 6 cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches.ResultWith endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal.ConclusionsKrackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.     

Rates of complications in Achilles tendon rupture repair using absorbable and nonabsorbable suture material; A systematic review

BackgroundThe impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair.MethodsA systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair.Results12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001).ConclusionNonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair.     

Value of magnetic resonance imaging in monitoring Achilles tendon healing after percutaneous suture using the Dresden technique

PurposeTendon healing is a complex process taking place in several stages. There is a paucity of data on tendon morphology after percutaneous repair for acute Achilles tendon rupture.Materials and methodsWe used high field MRI (1.5 Tesla to 3 Tesla) with T1 and T2-weighted sequences including fat suppression to assess the healing process after percutaneous Achilles tendon repair using the Dresden technique. MRI was performed at 3, 6, 8 and 12 months postoperatively.ResultsDuring tendon repair a gradual transition from an irregular and hyperintense signal toward a more homogeneous and hypointense signal was observed inside the Achilles tendon after percutaneous repair. These changes took place centripetally. During the early and late remodeling phase at 6 and 12 months, respectively, the tendons look thickened and homogeneous in both sequences.ConclusionsMRI represents an excellent means of monitoring the healing process after percutaneous Achilles tendon repair. The results of the present study confirm that the percutaneous, peritendineum preserving technique with the Dresden instrument results in a near physiologic centripetal tendon healing.     

Rupture of the Achilles tendon--fibrin gluing or suture?]

The rise of recreational sports activities and the incidence of ruptures of the Achilles tendons has increased simultaneously. Recently the use of fibrin sealing for surgical therapy of ruptured Achilles tendons has emerged as an alternative technique. Between 1982 and 1989 62 consecutive patients were operated for unilateral Achilles tendon rupture. Following causes for ruptures are known: 36 indirect traumas in sport (74%), 9 direct blunt injuries at occupational work (18%), 3 traffic-accidents (11%) and 1 rupture after operation of a Haglund exostosis. 25 patients (56%) were treated by suture technique and 20 patients (44%) with fibrin sealant. The mean long term follow-up of 49 months is known of 49 patients. There were 3 (12%) postoperative infections in the suture group and none in the fibrin group. After suturing the Achilles tendon 3 (12%) reruptures occurred 8-10 weeks after tendon repair and 1 (5%) rerupture after fibrin sealing. All reruptures are caused by a new adequate trauma. The time of return to social and recreational activities was 9 months in the suture group and 7 months in the fibrin group. The functional and cosmetic results after use of fibrin was significant better, and the long-term results were very satisfactory. We prefer fibrin sealing for the treatment of acute ruptures of Achilles tendons.