ABSTRACT
Purpose: We investigated whether percutaneous
suturing of Achilles tendon ruptures showed better results and superiority in
terms of clinical outcomes when compared to open suturing. Methods: We
conducted a case-control study. Between 2009 and 2014, we performed surgical revisions
of closed acute Achilles tendon ruptures in our hospital in 146 patients, of
which 71 patients (2012-2014) received percutaneous suturing using Dresden
instruments, and 75 patients (2009-2012) underwent open suturing. After a
minimum period of 1 year post surgery, we performed clinical follow-up in 25
patients of each of the groups using the AOFAS hind foot score and the SF-12
questionnaire. Furthermore, we implemented a clinical questionnaire with a
reference population of 200 healthy individuals. Results: Mean age in the total
population of 146 patients was 47 years (range 21 to 83 years) at the time of
surgery. The duration of the surgical procedure with percutaneous suturing was
significantly shorter (24 versus 43 minutes, p < 0.0001), the complication
rate was significantly lower (2.81% versus 10.7%, p < 0.0001), and the time
of hospitalisation was significantly shorter (3 versus 4 days, p < 0.0001)
when compared to open suturing. During follow-up,
no significant differences between the two groups were observed in terms
of descriptive parameters. Furthermore, ultrasound examinations of both
follow-up populations did not show any
significant difference. From a clinical perspective, the good to very good
results achieved with open suturing
(as measured with the AOFAS hind foot score and the SF-12 questionnaire)
have not been significantly improved with percutaneous suturing. The additional
use of a new clinical score (with the reference population) demonstrated good
to very good consistency with the established scores. Conclusion: In our
population, percutaneous Achilles tendon suturing showed significantly lower complication rates and significantly shorter
procedure times when compared to open suturing. However, percutaneous
suturing did not show clinical improvements of
the good to very good results that were achieved with open suturing (as
measured with the AOFAS back foot
score and the SF-12 questionnaire). The implementation of a new and simple score for the clinical evaluation of Achilles tendon injuries resulted in good
to very good consistency with the established questionnaires and, thus, offered
a straightforward and rapid alternative when compared to the more elaborate scores.