[Evaluation of functional treatment of the acute Achilles tendon rupture according to the Thermann score scale (ten years experience)].
BACKGROUND
The injury of Achilles tendon most frequently occurs as a result of overburdening of the tendon, particularly in sportsmen (runners and jumpers) even though they are not rare in the rest of the population. Biomechanical distrubances on the burdening tendon, or its continuous burdening, result in the degenerative changes in the form of pathological tenosynovial adhesions in and around the tendon that precedes the tendon rupture. In the recent years conservative functional treatment increasingly became the method of choice due to final results of the treatment. Basic principle of this method of treatment is to establish disrupted balance between the synergist and the antagonist of the lower leg, which was caused by rupture. This helps to reduce the kinetics of the ankle and the knee joint, and to avoid long lasting classical immobilisation which has found its substitution in a vario stable shoe, which allows possibility of flexibile arthrodesis of ankle with usage of insole.


METHODS
The conservative functional treatment of the acute Achilles tendon rupture has been carried out on 19 patients during the period 1993-1998, at the University of Sarajevo, Clinical Center. Sex structure was 17 males and 2 female patients. Average age of the patients was 27,1 (working population). The study was shortterm with first results obtained after 12 weeks. Etiologically, in the mechanisms of the injury there were 15 spontaneous ruptures from jumps and 3 from in landing after a jump, and in a direct trauma there was one rupture reported. Two of these were sport injuries. Clinical evaluation has been done according to the Thermann score scale. Ultrasound diagnostics was done immediately after the injury, followed by control examinations in the 4th, the 8th, and the 12th week. If the vario stable boot is missing, the modified program can be applied.


RESULTS
After 12 weeks, the Thompson, the Simmond and the Matles signs were evaluated and the results were negative. No patient reported suffering pain. The muscular atrophy of the lower leg up to 2 cm was reported in six patients, and up 3 cm in 3 patients, while other patients had tolerable 0.5 to 1 cm atrophy. There were no reports of thromboembolism. The largest number of ruptures was verified on the crossing between the middle and the lower third by ultrasound examination (8). Complete ruptures were reported in 14 examinees, partial in 5. There were no reports of desinsertions and distensions. In the 12th week we followed the ultrasound adaptation, i.e. diastases of tendon ends in neutral position (0(0)) and functional with 20(0) of plantar flexion. There were 16 examinees without functional deficit, one with the reduced plantar flexion od 5(0), 1 with the reduced dorsal flexion od 5(0), and also one patient with 10(0) reduced dorsal flexion. After ten years (2003-2004) we reevaluated six patients according to the Thermann scor scale. Functional examinations each patients have been excellent.


CONCLUSIONS
All patients returned to their daily working activities. We did not record a single case with complicatoions. With regard to other methods of treatment the functional treatment is apparently without an alternative, but at the same time requires methods that seek full engagement of a surgeon, a physiatrist and the radiologist. In order to avoid compromising and make the treatment successful, it is necessary to keep up with the implementation protocol, to have available adequate corrective shoes or other means, and to possess certain level of clinical experience.
Vavra-Hadziahmetović
Narcisa
N
Institut za fizikalnu medicinu i rehabilitaciju.
Hadziahmetović
Zoran
Z
Smajlović
Fahrudin
F
D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D006801:Humans; D012421:Rupture; D013708:Tendon Injuries / Q000145:classification / Q000175:diagnosis / Q000628:therapy*