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The Journal of Bone and Joint Surgery (American) 84:161-170 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Limited Open Repair of Achilles Tendon Ruptures

A Technique with a New Instrument and Findings of a Prospective Multicenter Study

Mathieu Assal, MD, Maximilien Jung, MD, Richard Stern, MD, Pascal Rippstein, MD, Marino Delmi, MD and Pierre Hoffmeyer, MD

Investigation performed at the Orthopaedic Services, University Hospital of Geneva, Geneva; Cantonal Hospital of Fribourg, Fribourg; and Schulthess Klinik, Zurich, Switzerland

Mathieu Assal, MD
Richard Stern, MD
Marino Delmi, MD
Pierre Hoffmeyer, MD
Clinique d’Orthopédie et de Chirurgie de l’Appareil Moteur, Hôpital Cantonal Universitaire, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail address for R. Stern: richard.stern{at}hcuge.ch

Maximilien Jung, MD
Service d’Orthopédie, Hôpital Cantonal de Fribourg, Chemin des Pensionnaires, 1708 Fribourg, Switzerland

Pascal Rippstein, MD
Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland

One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Controversy persists regarding the ideal surgical technique for repair of a ruptured Achilles tendon. We propose a limited open procedure with use of an instrument that provides the advantage of an open repair but avoids the soft-tissue problems with which open repair has been associated.

Methods: We first performed a cadaver study in order to develop an instrument and a technique for a limited open repair and then, using this procedure in conjunction with an early functional rehabilitation protocol, we began a prospective multicenter study. We are reporting on the first eighty-seven patients consecutively treated with the new instrument and followed for an average of twenty-six months (range, eighteen to forty-two months). All patients were assessed clinically and with an enhanced American Orthopaedic Foot and Ankle Society (AOFAS) rating score. In addition, all fifty patients who had been followed for at least twenty-four months were further evaluated with isokinetic dynamometry.

Results: Four patients were lost to follow-up and one patient died, which left eighty-two patients for evaluation. There were no problems with wound-healing, and there were no infections. No patient noted a sensory disturbance in the sural nerve distribution. All patients returned to their previous professional or sporting activities. The mean AOFAS score was 96 points (range, 85 to 100 points). Isokinetic dynamometry showed no significant difference in strength between the injured and uninjured limbs of the fifty patients who were tested. Complications occurred in three patients. Two of them were noncompliant and removed the orthosis, so that the repair was disrupted by a new injury within the first three weeks postoperatively. One patient fell twelve weeks after the surgery and sustained a rerupture. All three new injuries were repaired with an open surgical procedure.

Conclusions: This new procedure allows the surgeon to precisely visualize and control the tendon ends while avoiding excessive dissection and disturbance of local vascularity and minimizing nerve and wound-healing problems. Such a technique, along with an early functional rehabilitation program, allowed us to achieve a high rate of successful results with minimal morbidity.


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