title: Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.
abstract: The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery.
authors.affiliation: Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey. Electronic address: hakansarman@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarman
authors.affiliation: Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Umit Sefa
authors.initials: US
authors.lastname: Muezzinoglu
authors.affiliation: Associate Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Kaya
authors.initials: K
authors.lastname: Memisoglu
authors.affiliation: Surgeon, Artroklinik, Kocaeli, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Aydin
authors.affiliation: Associate Professor, Department of Orthopedics and Traumatology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Halil
authors.initials: H
authors.lastname: Atmaca
authors.affiliation: Surgeon, Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Baran
authors.affiliation: Assistant Professor, Department of Sports Management, Kocaeli University Physical Education and Sports High School, Kocaeli, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Odabas Ozgur
authors.affiliation: Associate Professor, Department of Sports Management, Kocaeli University Physical Education and Sports High School, Kocaeli, Turkey.
authors.forename: Turgay
authors.initials: T
authors.lastname: Ozgur
authors.affiliation: Resident Physician, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Cengizhan
authors.initials: C
authors.lastname: Kantar
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Achilles tendon; elongation; internal splint; isokinetic study; magnetic resonance imaging; surgical technique