Etiology and pathophysiology of tendon ruptures in sports

Of all spontaneous tendon ruptures, complete Achilles tendon tears are most closely associated with sports activities (1–3). Schönbauer (3) reported that 75% of all ruptures of the Achilles tendon are related to sports. In Plecko & Passl (2) the number was 60%. In our material of 430 cases, the number of sports-related Achilles ruptures was very similar (62%), while only 2% of ruptures of other tendons were sports-related (P<0.001) (1). Also, the majority of Achilles reruptures occurred in sports. The ruptures occurred most often in soccer (34%), track and field (16%) and basketball (14%). The distribution of Achilles ruptures according to different sports varies considerably from country to country, according to the national sport traditions. For example, in northern and middle Europe, soccer, tennis, track and field, indoor ball games, downhill skiing, and gymnastics are the most common; and in North America, football, basketball, baseball, tennis and downhill skiing dominate the statistics (1, 2, 4). In sports, some Achilles ruptures are not spontaneous or degeneration-induced but may occur as a consequence of the remarkably high forces that are involved in the performance (2). Ruptures in the high jump or triple jump are good examples. In such cases, failure in the neuromuscular protective mechanisms due to fatigue or disturbed co-ordination can frequently be found. The spontaneous complete rupture of the supraspinatus tendon of the rotator cuff does not occur very frequently in sports. Those sports that include high-energy throwing movements, such as American and Finnish baseball, American football, rugby and discus and javelin throwing, may, however, produce this injury. Partial tears and inflammations of the rotator cuff complex are much more frequent in throwing sports. The complete rupture of the proximal long head of the biceps brachii tendon is rare among competitive and recreational athletes. In our material, under 2% of these ruptures were associated with sports activities (5). The rupture (avulsion) of the distal tendon of the biceps muscle is rare. In sports, gymnastics, body building and weight lifting have been said to be able to produce this injury (6). In general, complete ruptures of the quadriceps tendon and the patellar tendon occur most often in older individuals. In our study, the mean age of these patients was 65 years (5). However, these injuries do also occur in younger age groups, especially in athletes. In athletes, the rupture most frequently occurs in high-power sports events, such as high jump, basketball and weight lifting, at the age of 15-30 years. A chronic patellar apicitis (jumper's knee) may predispose rupture of the tendon (7). As is the case with the rotator cuff complex, overuse inflammation and partial tears of the quadriceps and patellar tendons are one of the most characteristic athletic injuries. Complete spontaneous ruptures of other tendons in sports are rare, although the literature does provide case studies from almost every tendon the human body possesses (8–18).     

Potential risk of rerupture in primary achilles tendon repair in athletes younger than 30 years of age

BACKGROUND: Complete Achilles tendon ruptures are found more often in athletes who participate in sports involving explosive acceleration or maximal effort. In most studies, the consensus for athletes is surgery. This form of treatment has been shown to exhibit the best functional performance with a lower rerupture rate. HYPOTHESIS: Achilles tendon ruptures in a young population (<30 years) have a higher rerupture rate than similar injuries in an older age group (31-50 years), in which the injury is more common. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: Retrospective study was carried out by chart review. Magnetic resonance images were obtained comparing appearance of repair in young and old patients at 8 to 12 weeks after operation. RESULTS: There were a total of 4 reruptures in the 89 Achilles tendon repairs. This was an overall rerupture rate of 4.5%, which was consistent with the literature. When the reruptures were critically analyzed, it was noted that the 4 reruptures of the repaired tendon occurred in a young population. Of the 89, there was a subgroup of athletes (n=24) who were 30 years of age or younger at the time of injury. The incidence of rerupture for these individuals was 16.6%. In the remaining athletes (n=65) older than 30 years, the incidence of rerupture was zero. There were no significant differences (P < or =.05) in all parameters measured (average days in a boot, average days to active range of motion, average time to full weight-bearing, average days to bike or use a stair climbing machine, average return to sports) between age groups except in the time from injury to surgery (7.1 days, for athletes < or =30 years vs 2.65 days for athletes >31 years). CONCLUSIONS: The results of Achilles tendon repair with an early weightbearing and an early range of motion rehabilitation program are good. However, caution may need to be taken in the younger athlete (< or =30 years) during rehabilitation. CLINICAL RELEVANCE: Although the authors recommend aggressive rehabilitation for Achilles tendon repairs, caution should be observed in the younger athlete.     

A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon

In patients with a chronic rupture or rerupture of the Achilles tendon, the recommended treatment is surgical. Various surgical techniques have been reported in the literature; however, the outcome is rarely evaluated with a sufficiently long follow-up, using appropriate end-points. The purpose of this study was to evaluate the subjective and objective outcome following a new surgical treatment for chronic rupture or rerupture of the Achilles tendon using augmentation with a free gastrocnemius aponeurosis flap. A total of 28 consecutive patients (22 male and 6 female) with a mean (SD) age of 46 (10.4) years were evaluated at a median (range) of 29 (12-117) months after surgery. The surgical technique involved making a single incision and then using a free gastrocnemius aponeurosis flap to cover the tendon gap after an end-to-end suture. The patients were evaluated using the Achilles tendon rupture score (ATRS) and a detailed questionnaire relating to symptoms, physical activity and satisfaction with treatment. The functional evaluation consisted of a validated test battery measuring different aspects of muscle/tendon function of the gastrocnemius/soleus and Achilles tendon complex. The median (range) ATRS was 83 (24-100). There were no reruptures. In terms of surgical complications, there was one deep infection, three wound closure complications and deep venous thrombosis in two patients. All but one patient returned to work within 6 months of surgery. Sixteen (57%) patients were satisfied with the treatment. There was a significant decrease in the level of physical activity after the injury compared with before the injury (p = 0.004). Of the 25 patients who participated in recreational sports prior to injury, 13 (52%) returned to the same activity level after treatment. In terms of jump performance, no significant differences were found between the healthy and injured sides. There was, however, a significant decrease in strength, in terms of both concentric and eccentric-concentric toe raises and the toe-raise test for endurance compared with the healthy side. The use of a free gastrocnemius aponeurosis flap to treat chronic ruptures and reruptures of the Achilles tendon rendered a good overall subjective and objective outcome in the majority of patients. The use of a single incision in combination with a free flap augmentation produced favourable results.     

Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study

Endoscopy-assisted percutaneous repair of Achilles tendon ruptures were investigated in a cadaveric and clinical study. Sixteen above-knee fresh amputation specimens in which different types of Achilles tendon ruptures were created were repaired percutaneously with the visualization of the tendon ends by endoscopy. Neither malalignment nor damage to the neurovascular structures was observed. Eleven patients were treated in this way. No reruptures, wound problems, or neurovascular injury were observed. All patients returned to daily activities 10-11 weeks after the repair. This technique seems to overcome certain problems of conservative, surgical, or percutaneous repair of the Achilles tendon ruptures.     

Long-term results after surgical management of partial Achilles tendon ruptures

Although Achilles tendon injuries are common overuse injuries in sports, the exact incidence is unknown, primarily as a result of varying definitions and diagnoses of the underlying pathological changes. Despite numerous studies of treatment of the Achilles tendon injuries, the longterm results are not well known. The results after surgical treatment of chronic partial Achilles tendon ruptures in 64 patients with a follow-up of 6 (1.5–11) years were evaluated in a retrospective study. The ruptures were divided into three groups: (I) proximal (more than 3 cm above the calcaneus), (II) distal and (III) combined (proximal and distal). All patients underwent an operation involving the excision of the devitalized tendon tissue and, in groups (II) and (III), also the excision of the deep Achilles bursa and removal of the dorsal corner of the calcaneus. The functional results were satisfactory in 43 (67%) patients and unsatisfactory in 21 (33%). The results were better in patients with proximal ruptures than in patients with either distal or combined ruptures. Males experienced better results than females. Post-operative immobilization in a plaster cast had no significant influence on the final result. Nine (14%) patients with either a distal or a combined rupture were re-operated on and in seven of them the final result was satisfactory. The conclusion of this study is that partial Achilles tendon ruptures are often difficult to treat and only two out of three patients can be expected to obtain satisfactory results after surgical treatment.     

Histopathological findings in spontaneous tendon ruptures

A spontaneous rupture of a tendon may be definied as a rupture that occurs during movement and activity, that should not and usually does not damage the involved musculotendinous units (1). Spontaneous tendon ruptures were uncommon before the 1950s. Böhler found only 25 Achilles tendon ruptures in Wien between 1925 and 1948 (2). Mösender & Klatnek treated 20 Achilles tendon ruptures between 1953 and 1956, but 105 ruptures between 1964 and 1967 (3). Lawrence et al. found only 31 Achilles tendon ruptures in Boston during a period of 55 years (1900-1954) (4). During the recent decades tendon ruptures have, however, become relatively common in developed countries, especially in Europe and North America. A high incidence of tendon ruptures has been reported in Austria, Denmark, Finland, Germany, Hungary, Sweden, Switzerland and the USA; somewhat lower incidences have been reported in Canada, France, Great Britain and Spain. On the other hand, Greece, Japan, the Netherlands and Portugal have reported a clearly lower incidence. Interestingly, Achilles tendon ruptures are a rarity in developing countries, ecpecially in Africa and East-Asia (5). In many developed countries, the increases in the rupture incidence have been dramatic. In the National Institute of Traumatology in Budapest, Hungary, the number of patients with an Achilles tendon rupture increased 285% in men and 500% in women between two successive 7-year periods, 1972-1978 and 1979–1985(5).     

Nonoperative treatment of acute rupture of the achilles tendon: results of a new protocol and comparison with operative treatment

BACKGROUND: Excellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture. PURPOSE: To describe a new nonoperative treatment protocol for Achilles tendon ruptures and compare outcomes with operative treatment. STUDY DESIGN: Retrospective cohort study. METHODS: We treated 23 patients nonoperatively with an equinus ankle cast and boot and compared their outcome with that of a group of 24 patients previously treated operatively. Muscle strengthening and walking with full weightbearing were started as soon as tolerated in both groups. Follow-up examinations were performed for 18 nonoperatively treated patients after 23 months and for 15 operatively treated patients after 49 months. RESULTS: Subsidence of pain, return to unaided walking, and return to work was faster in the nonoperatively treated group. Patient satisfaction, return to sports, and ultimate strength was the same for both groups. The complication rate was similar, except for reruptures: four early in the nonoperative group and one late in the operative group. Two types of reruptures occurred in the nonoperative group: 1). normally healing tendon subjected to new trauma, rerupturing in the healing zone, and achieving a good result with continued nonoperative treatment; and 2). tendon failing proximal to the initial rupture at the muscle-tendon junction, without trauma, requiring operative repair and augmentation. CONCLUSIONS: Results of operative and nonoperative treatment were equivalent.     

Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes.

OBJECTIVE: To study the cumulative incidence of Achilles tendon rupture and tendinopathy among former top-level athletes. DESIGN: Historical cohort study. SETTING: Finland. PARTICIPANTS: Male former elite athlete cohort members (n = 785; median age, 69 years when responding to the questionnaire; range, 54-97) and their matched controls (n = 416; median age, 68 years; range, 56-94). OUTCOME MEASUREMENTS: Questionnaire-reported Achilles tendinopathy and tendon rupture diagnosed by physicians before the age of 45 years and within the subjects' lifetimes. RESULTS: Cumulative incidence of Achilles tendinopathy before the age of 45 was high for middle and long-distance runners (adjusted odds ratio, 31.2 compared with controls; P < 0.001), and cumulative incidence of Achilles tendon rupture was high for sprinters (odds ratio, 14.9; P < 0.001). CONCLUSIONS: Achilles tendon problems seem to constitute clinically significant and common problems in specific sports.     

Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture

The purpose of this study was to examine the outcome after surgery for an acute Achilles tendon rupture. In particular, we wanted to study whether persons who have suffered an Achilles tendon rupture are at greater risk of a contralateral tendon rupture. From September 1990 to April 1997, 168 acute Achilles tendon ruptures in 26 women and 142 men were treated operatively. In August 1998 (median: 4.2 years post injury), 154 of these patients (92%) responded to a follow-up questionnaire. Local symptoms (pain, decreased strength and/or reduced range of motion) were reported pre injury by 25% of the patients; at follow-up this had increased to 52%. Ten patients (6%) experienced a rupture on the contralateral side during the follow-up period (OR: 176 [70-282] vs. the expected rate based on the general population risk of this injury, P<0.001). Thus, this study suggests that patients with an Achilles tendon rupture are at significantly increased risk of a contralateral tendon rupture, as well. Also, as many as half of the patients suffered from post-injury problems at long-term follow-up.     

跟腱再断裂的手术治疗15例报告

目的了解跟腱再断裂的临床表现及再手术的方法与疗效。方法15例跟腱再断裂的患者在我所进行手术治疗,术中全面观察跟腱再断裂的表现,根据不同的断裂情况选择手术方式。结果15例患者再断裂部位均为跟骨结节上3~4cm,均为原断裂部位。跟腱断端瘢痕化增粗,粘连明显。其中12例为横行断裂,2例为短马尾状断裂,1例为大部分撕裂。15例患者中9例为闭合性再断裂,6例为开放性再断裂。10例患者坚持随访至少1年,按Amer-Lindholm评分优良率为70%。结论跟腱再断裂均发生在原断裂部位,断端瘢痕化,粘连明显,多为横行断裂,急诊再手术缝合修补效果满意。     

Management of partial tears of the gastro-soleus complex

Although Achilles tendon is the strongest tendon in the human body, it is one of the most commonly injured tendons. Most Achilles ruptures are associated with sports activity. Up to one-fourth of all Achilles tendon pathologies are partial ruptures. Increased recognizability of partial rupture of Achilles tendon is connected with the development of ultrasound and MRI techniques. Partial ruptures of Achilles tendon are a clinical demonstration of asymmetric loading of Achilles tendon caused by its special anatomic structure. To describe those partial injuries, the author created histologic and anatomic classification. In this article detailed treatment options has been proposed.     

跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后

目的:探讨跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后。方法:回顾性研究1994年1月至2008年12月在我所行跟腱断裂修补术后发生再断裂和(或)感染的患者,记录其性别、年龄、职业、生活习惯、内科合并症、受伤机制、断裂及手术时间、断裂形态、治疗方式、术后康复等数据,分析总结跟腱再断裂与感染的发病率、危险因素与临床预后。结果:跟腱断裂行修补手术共计916例,术后发生跟腱再断裂和(或)感染28例(其中4例再断裂合并感染),再断率2.3%(21例),感染率1.2%(11例)。跟腱再断裂多发生于运动员或戏剧演员;跟腱感染多见于高龄,合并糖尿病、高脂血症,跟腱炎、局部激素治疗以及断裂后治疗延迟(>14天)的患者。术后随访16例(9例再断裂,5例感染,2例再断裂合并感染),平均随访49.4个月(12～124个月),优良率87.5%。其中3年以上患者全部为优,结果明显好于1～3年的患者(P=0.019),感染组预后略差于再断组。结论:跟腱术后再断裂和感染是跟腱断裂修补术后的两大常见且严重的并发症。从事运动或戏剧表演职业的患者易于发生跟腱术后再断裂,而高龄、高脂血症、跟腱炎、激素治疗史,及伤后延迟治疗等是跟腱术后感染的高危险因素。治疗得当,长期(3年以上)临床预后较好;跟腱感染患者预后略差于跟腱再断裂患者。     

Dynamic ultrasound as a selection tool for reducing achilles tendon reruptures

BACKGROUND: The optimal method of treatment for acute tendo-Achilles ruptures continues to be debated. HYPOTHESIS: The reported lower rerupture rate for operatively treated patients is an effect of tendon end apposition during the healing process, and patients in whom apposition can be demonstrated using ultrasound will have a similar rate of rerupture if treated nonoperatively. STUDY DESIGN: Cohort study; Level of evidence, 2. METHOD: The authors reviewed all patients with an Achilles tendon rupture who were treated to a standard protocol during a 5-year period (2000-2005). Patients with a gap of 5 mm or more in equinus on ultrasound underwent surgery; those with a gap of less than 5 mm received nonoperative treatment. All patients were followed up to a minimum of 12 months. RESULTS: After exclusions, 125 patients were included: 67 treated operatively and 58 nonoperatively. There were 2 reruptures in the nonoperative group and 1 with surgery. There was no significant difference between the groups for any complication. CONCLUSION: Reduction of rerupture and surgery risks may be possible using dynamic ultrasound case selection. Further studies are needed to show whether functional results are the same with surgical and nonsurgical treatment when dynamic ultrasound criteria are used for case selection.     

Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study

BACKGROUND: Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains. PURPOSE: To compare the results of percutaneous and open Achilles tendon repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The results of 132 consecutive patients with acute complete Achilles tendon rupture who were operated on exclusively with modified percutaneous repair under local anesthesia from 1991 to 1997 and followed up for at least 2 years were compared to the results of 105 consecutive patients who were operated on exclusively with open repair under general or spinal anesthesia in the same period. RESULTS: There were significantly fewer major complications in the group of percutaneous repairs in comparison with the group of open repairs (4.5% vs 12.4%; P = .03), particularly necrosis (0% vs 5.6%; P = .019), and a lower total number of complications (9.7% vs 21%; P = .013). There were slightly more reruptures (3.7% vs 2.8%; P = .680) and sural nerve disturbances (4.5% vs 2.8%; P = .487) in the group of percutaneous repairs, with no statistically significant difference. Functional assessment using the American Orthopaedic Foot and Ankle Society scale and the Holz score showed no statistically significant difference. CONCLUSION: The results of the study support the choice of (modified) percutaneous suturing under local anesthesia as the method that brings comparable functional results to open repair, with a significantly lower rate of complications.     

Percutaneous and open surgical repairs of Achilles tendon ruptures. A comparative study

A comparative study between percutaneous repair and open surgical repair of acute spontaneous Achilles tendon ruptures in young athletic patients is presented. Twenty-seven patients with acute Achilles ruptures were evaluated objectively and with subjective questionnaires. Fifteen of the patients were treated by reconstruction with a gastrocsoleus fascial graft (followup, 4.6 years) and 12 treated by percutaneous repair (followup, 1.8 years). Subjectively, both groups were very satisfied with the results of their treatment. Cybex II dynamometer measuring strength, power, and endurance revealed no statistical significant differences between groups, even in light of the shorter followup of the percutaneous group. The percutaneous repairs demonstrated significantly more symmetry in injured/uninjured tendon size than did the open surgical repairs. Two reruptures occurred in the percutaneous group. No other complications were noted. After evaluation of both subjective and objective data we recommend percutaneous repair in the recreational athlete and in patients concerned with cosmesis. Open repair is recommended for all high-caliber athletes who cannot afford any chance of rerupture.     

Intra-articular knee injuries in patients with knee extensor mechanism ruptures

The knee extensor mechanism is composed of the quadriceps tendon, patella and patellar tendon. Rupture of either the quadriceps tendon or patella tendon is a rare but significant injury. The purpose of our study is to determine if there are any associated injuries with these ruptures necessitating the need for further evaluation such as MRI or arthroscopy. We retrospectively reviewed all patients with ruptures of the knee extensor mechanism who required operative repair at our institution over the last 10 years. We reviewed the chart for any documented associated injury. The type and incidence of associated injuries were recorded. We further divided these patients into two groups: low energy indirect mechanism or high-energy direct impact mechanism. Sixty-four patients met our requirements for inclusion in this study. Thirty-three patients with patellar tendon ruptures and thirty-one patients with quadriceps tendon ruptures were included. Ten out of 33 (30%) patients with a patellar tendon rupture had an associated injury. Four out of 25 (16%) patients with patellar tendon ruptures in the low energy mechanism category had an associated injury. Six out of 8 (75%) patients with a high-energy direct impact patellar tendon rupture had an associated injury. Three out of 31 (10%) patients with quadriceps tendon rupture had an associated injury. The most common associated injuries in the patellar tendon rupture patients were anterior cruciate ligament tears (18%) and medial meniscus tears (18%). We found almost one-third of all patients with a patellar tendon rupture had an associated intra-articular knee injury. We found 10% of patients with quadriceps tendon rupture had an associated intra-articular knee injury. We also found an even higher incidence of associated injuries in patients with high-energy direct impact mechanism patellar tendon ruptures (75%). The most common associated injuries in patients with patellar tendon ruptures were tears of the anterior cruciate ligament (18%) and medial meniscus (18%). We recommend that consideration be given in obtaining a MRI or diagnostic arthroscopy in patients with patellar tendon ruptures especially those with high-energy direct impact mechanism. To our knowledge this has not previously been documented in the literature.     

Avoiding sural nerve injuries during percutaneous Achilles tendon repair

BACKGROUND: Sural nerve injury is a reported risk during percutaneous repair of the Achilles tendon. HYPOTHESIS: Exposure of the sural nerve during percutaneous repair can minimize the risk of nerve injury. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: The authors retrospectively examined the results of 84 patients who were treated for acute Achilles tendon rupture at 2 different hospitals. Both hospitals used the same percutaneous repair technique, except that the sural nerve was exposed in the 38 patients (mean age, 38 years; range, 23-68 years) of one hospital; the nerve was not exposed in the 46 patients (mean age, 42 years; range, 24-71 years) of the other hospital (the nonexposure group). RESULTS: All patients recovered and returned to work after 44 days (range, 5-202 days). All patients returned to their previous sports levels within 1 year. On the 100-point Hannover Achilles Tendon Score, the mean score was 81 points (range, 44-100 points). The overall incidence of sural nerve related complications was 18%. All sural nerve lesions occurred in the nonexposure group. In the total study population, there were 3 cases of deep vein thrombosis, 1 rerupture, and 1 case of infection. CONCLUSION: Sural nerve injuries can be minimized during surgery by carefully placing the stab incisions to expose the nerve so as to avoid it during repair. If the sural nerve is exposed, percutaneous repair of the ruptured Achilles tendon is a safe and reliable method of treating Achilles tendon ruptures.     

Surgical repair of Achilles tendon ruptures

We evaluated the surgical results of 42 consecutive patients with spontaneous rupture of the Achilles tendon treated from 1973 to 1984 to determine the causes of rupture and to evaluate our treatment methods. Patients were divided into early and late repair groups and their charts reviewed to determine common clinical features. A new method of repair with early functional range of motion exercises before casting was used and compared to other techniques in common use. Thirty-one patients were contacted for long-term followup (average, 4.7 years). Twenty-three of these patients returned for intensive reevaluation and Cybex testing. We found a high incidence of gout (14.3%) and previous steroid injections (7.1%) in our patients. Good results were obtained from the four surgical methods used. There were no reruptures and only 7% of the patients experienced minor wound problems. Patients treated with early functional range of motion exercises averaged 12.5 degrees more dorsiflexion at the time of cast removal and did not require adjunctive protective devices. Long-term results, however, revealed equilibration of range of motion and near normal function in all repair techniques with 88% of all patients returning to preinjury activity levels.     

Achilles tendon rupture – treatment and complications: A systematic review

Achilles tendon rupture is a frequent injury with an increasing incidence. Until now, there is no consensus regarding optimal treatment. The aim of this review was to illuminate and summarize randomized controlled trials comparing surgical and non‐surgical treatment of Achilles tendon ruptures during the last 10 years. Seven articles were found and they were all acceptable according to international quality assessment guidelines. Primary outcomes were re‐ruptures, other complications, and functional outcomes. There was no significant difference in re‐ruptures between the two treatments, but a tendency to favoring surgical treatment. Further, one study found an increased risk of soft‐tissue‐related complications after surgery. Patient satisfaction and time to return to work were significantly different in favor of surgery in one study, and there was also better functional outcome after surgery in some studies. These seven studies indicate that surgical patients have a faster rehabilitation. However, the differences between surgical and non‐surgical treatment appear to be subtle and it could mean that rehabilitation is more important, rather than the actual initial treatment. Therefore, further studies will be needed in regard to understanding the interplay between acute surgical or non‐surgical treatment, and the rehabilitation regimen for the overall outcome after Achilles tendon ruptures.     

Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study

There is no agreement on the ideal type of surgical management for Achilles tendon rupture. The present randomized prospective study was performed to compare outcome data of open and percutaneous repair in the treatment of Achilles tendon rupture. Forty consecutive patients with acute rupture of Achilles tendon were recruited. Patients were randomized to receive open (group A) or percutaneous repair with Tenolig^® (group B). All patients followed the same rehabilitation protocol except for slight differences in the duration of immobilization. Follow-up included objective evaluation (at 4 and 12 months), subjective evaluation using the SF-12^® questionnaire (at 24 months), and bilateral ultrasound scanning and isokinetic testing (at 12 months). The differences in the parameters evaluated clinically were not significant except for ankle circumference, which was significantly greater in group B. There were two minor complications in the open repair group and one case of failed repair in the percutaneous group. SF-12^® questionnaire, ultrasound and isokinetic test data did not show significant differences between the groups. The present study demonstrates that the open and the percutaneous technique are both safe and effective in repairing the ruptured Achilles tendon and that both afford the same degree of restoration of clinical, ultrasound and isokinetic patterns. Medium-term results were substantially comparable. Percutaneous repair is performed on a day-surgery basis, it reduces cutaneous complications and operation times, and enables faster recovery, enhancing overall patient compliance. To us, these characteristics make it preferable to open repair in managing subcutaneous ruptures of Achilles tendon in non-professional sports practicing adults.