title: Augmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture: Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up.
abstract: BACKGROUND
  This prospective randomized trial with a mean fourteen-year follow-up compared simple end-to-end repair with fascial flap-augmented repair for acute Achilles tendon ruptures.
  
  
  METHODS
  From 1998 to 2001, sixty patients with acute Achilles tendon rupture were randomized to receive simple end-to-end repair or augmented repair; both groups were treated with postoperative bracing allowing free active plantar flexion. After a follow-up of thirteen years or more, fifty-five patients (twenty-eight in the nonaugmented-repair group and twenty-seven in the augmented-repair group) were reexamined. Outcome measures included the Leppilahti Achilles tendon score, isokinetic plantar flexion strength (peak torque and the work-displacement deficit at 10° intervals over the ankle range of motion), tendon elongation, and the RAND 36-item health survey.
  
  
  RESULTS
  After a mean of fourteen years of follow-up, the mean Leppilahti score was 87.1 points for the nonaugmented repairs and 91.5 points for the augmented repairs, with a mean difference of 4.3 points (95% confidence interval [CI], -0.1 to 8.8 points). The surgical technique did not have an impact on strength parameters, with a mean peak torque of 112.6 Nm after the nonaugmented repairs and 107.3 Nm after the augmented repairs (mean difference, 5.3 Nm [95% CI, -22.2 to 11.6 Nm]) and a median work-displacement deficit of 6.7% to 20.3% after the nonaugmented repairs and 12.8% to 18.0% after the augmented repairs (p = 0.9). Strength did not significantly change between the twelve-month and fourteen-year follow-up examinations. At a mean of fourteen years, the injured side showed a 12.2% to 18.0% median work-displacement deficit compared with the unaffected side (p < 0.001). RAND-36 scores indicated no between-group difference in health domains.
  
  
  CONCLUSIONS
  Augmented repair of total Achilles tendon ruptures provided no advantage over simple end-to-end repair. Achilles tendon ruptures result in a permanent calf muscle strength deficit, but its clinical relevance remains unclear.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Juuso
authors.initials: J
authors.lastname: Heikkinen
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Iikka
authors.initials: I
authors.lastname: Lantto
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Flinkkilä
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Pajala
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: Pertti
authors.initials: P
authors.lastname: Siira
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland juhana.leppilahti@oulu.fi.
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D001915:Braces; D016001:Confidence Intervals; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012421:Rupture / Q000601:surgery; D013524:Surgical Flaps / Q000637:transplantation*; D013708:Tendon Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome