Rerupture and Deep Infection Following Treatment of Total Achilles Tendon Rupture

Pajala, Ari; Kangas, Jarmo; Ohtonen, Pasi; Leppilahti, Juhana

doi:10.2106/00004623-200211000-00017

Cited by 181 publications

(150 citation statements)

References 22 publications

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“…Three of our patients developed a deep infection that required surgical debridement. Infection is a serious complication that can compromise final outcome [14]. The other feared complication of Achilles tendon rupture, rerupture, may actually be diminished by an augmented reconstruction although we did have one case in our series [22].…”

Section: Discussionmentioning

confidence: 81%

“…On the contrary, augmented reconstruction provides a stronger repair that may allow a more aggressive rehabilitation program and reduce the incidence of rerupture. These advantages have to be balanced against the potential for an increased rate of wound complications and infection [14] due to the more extensive approach and prolonged operative and tourniquet times.…”

Section: Discussionmentioning

confidence: 99%

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Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

Garabito

Martinez-Miranda

Sánchez-Sotelo

2004

International Orthopaedics (SICOT)

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Fifty-four consecutive acute Achilles tendon ruptures were treated with end-to-end suture augmented with gastrocnemius fascial flaps. Surgery was performed within 24 h. Mean patient age was 35 (23-57) years, and 46 were men. Mean follow-up time was 4.8 (2-8) years. At follow-up, the mean visual analogue scale for pain was 0.49, and the mean AOFAS ankle-hindfoot score was 95 (74-100) points. Fifty-three patients were able to stand on their tiptoes for 30 s and perform repeated toe raises, and 50 patients were able to perform single-limb hopping. Complications included rerupture in one case, deep infection in three cases, delayed wound healing in eight cases, and deep venous thrombosis in one case. Reconstruction of acute ruptures of the Achilles tendon augmented with gastrocnemius-soleus fascial flaps provided a good outcome but was associated with a high complication rate.Résumé Cinquante-quatre ruptures récentes, consécu-tives, du tendon d'achille ont été traitées par suture bout à bout augmentée par un lambeau fascial du muscle jumeau. La chirurgie a été exécutée dans les vingt-quatre heures suivant la rupture. L'âge moyen des malades était de 35 ans (23-57) et 46 étaient de sexe masculin. Le temps de suivi moyen était de 4,8 ans (2-8). Au dernier examen la cotation visuelle moyenne pour la douleur était 0,49 et le score moyen de cheville AOFAS était de 95 points (74-100). Cinquante-trois malades étaient capables de se tenir sur la pointe des pieds trente secondes et d'exécuter des extensions d'orteils répétées, et 50 malades étaient capables d'exécuter un sautillement monopodal. Les complications ont été une rupture itérative dans un cas, une infection profonde dans trois cas, un retard de cicatrisation cutanée avec évolution favorable dans huit cas, et une thrombose veineuse profonde dans un cas. La reconstruction des ruptures récentes du tendon d'achille avec utilisation d'un lambeau du fascia des jumeaux a fourni un bon résultat mais avec un taux élevé de complications.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

Garabito

Martinez-Miranda

Sánchez-Sotelo

2004

International Orthopaedics (SICOT)

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“…2 This may also explain the recurrence of Achilles tendon ruptures despite previous surgical treatment. 44 Furthermore, the period of prolonged rehabilitation may inhibit their training, potentially affecting their performance as well. Early administration of pulsed ultrasound could promote a faster recovery of the mechanical strength of the injured tendon.…”

Section: Discussionmentioning

confidence: 99%

Pulsed ultrasound treatment accelerates the repair of Achilles tendon rupture in rats

Yeung

Guo

2005

Journal Orthopaedic Research

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A rat tenotomy model was used to investigate the effect of combined conservative management and pulsed ultrasound (PUS) on the repair of tenotomized Achilles tendon. Hemitenotomy of right medial Achilles tendon was performed in 48 rats without suture, and patella tenotomy was performed to mimic immobilization and limb disuse of an injured limb. PUS and sham PUS were applied to the healing wound for the treatment group and control group for 5 min, 3 times per week for 2 or 4 weeks, respectively. Tensile tests showed that the ultimate tensile strength (UTS) and stiffness of the repaired tendon in the treatment group at 2 weeks reached 48.92 AE 18.39% and 62.48 AE 32.46% of the contralateral normal tendon strength, which were significantly higher than those of the control group (UTS, 30.36 AE 15.46%; stiffness, 33.90 AE 17.59; p < 0.05). At 4 weeks, UTS increased to 77.09 AE 15.31% and stiffness to 92.48 AE 31.12% in the treatment group, significantly higher than those in the control group (UTS, 54.33 AE 18.40%, p < 0.01; stiffness, 65.02 AE 25.48%, p < 0.05). Light microscopy revealed more regular, denser, and better aligned collagen fibers in the healing scar of the PUS-treated healing tendons. The findings suggested that PUS were able to accelerate the healing of the ruptured tendons. ß

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“…Primary open repair of acute Achilles tendon rupture is a common procedure and the results of this procedure are good but several complications such as; wound problems or infection, can be observed after surgery [2,3]. Also, there are many accepted suture materials on open repair surgery and selection of suture material depend on surgeon preference.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Evaluation of Absorbable and Nonabsorbable Sutures for Open Repair of Achilles Tendon Rupture: A Pilot Study

Park

Chun

Lee

et al. 2017

Korean J Phys Anthropol

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: This pilot study was performed to compare the functional and clinical results including complications after surgery in the open repair of Achilles tendon rupture with regard to the type of suture material. A consecutive series of twenty patients with acute Achilles tendon rupture who underwent open repair were enrolled in this pilot study. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The Korean version of the Foot and Ankle Outcome Score (FAOS) and complications were assessed to evaluate functional and clinical result. Mean total Foot and Ankle Outcome Score (FAOS) was 89.8 (range, 71.1~100) in the nonabsorbable suture group and 82.7 (range, 61.9~92.5) in the absorbable suture group (p = 0.22). All patients returned to their previous life activity. The absorbable suture group had fewer postoperative complications (10%) than the nonabsorbable suture group (20%), but there was no significant difference between two groups (p = 0.45). This pilot study showed that use of an absorbable suture for Achilles tendon repair had functional and clinical results comparable to those of the nonabsorbable suture. However, a use of an absorbable suture was associated with a lower incidence of complications than the use of nonabsorbable suture. Therefore, these results have to be confirmed in a randomized controlled cohort trial with larger population.

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Rerupture and Deep Infection Following Treatment of Total Achilles Tendon Rupture

Cited by 181 publications

References 22 publications

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

Pulsed ultrasound treatment accelerates the repair of Achilles tendon rupture in rats

A Comparative Evaluation of Absorbable and Nonabsorbable Sutures for Open Repair of Achilles Tendon Rupture: A Pilot Study

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