The object of this study was to compare treatment of ruptured Achilles tend
on by operative "end to end" surgery, percutaneous repair, or conservative
therapy clinically; a subject of considerable controversy in the literature
.
These three methods were compared in 73 patients in a randomized trial betw
een 1994 and 1996. After 2.5 years (11-41 months), the actual activities we
re assigned to the Hannover Achilles tendon score and the ability of doing
work or sport activities was assessed.
After this period, 59.3 % of the patients showed good and excellent results
on the Achilles tendon score, with over 79 points (open surgery 59.1 %, pe
rcutaneous 60 %, conservative treatment 58.3 %). None of the patients reach
ed the maximum score of 100 points. During the isometric strength tests, th
e patients with percutaneous repair had a lower weakening of the treated le
g (8.9 %) compared to the open-operated (12.7 %) and non-operated patients
(17.8 %). Of the patients who had percutaneous surgery, 88 % rated their tr
eatment as good or excellent; those who had open surgery 77.3 %, and those
with conservative treatment 75 %. The percutaneous group were able to resum
e work and sport much sooner than the other two groups.
Bearing in mind the literature and these results, we have developed an algo
rithm for treating Achilles tendon rupture to assist decision making in dai
ly routine. In this way, the use of percutaneous Achilles tendon repair can
be carried out in most of cases.