CLINICAL OUTCOME OF TENDO ACHILLES REPAIR BY SPECIAL SUTURE TECHNIQUE WITH TWO LOOP PDS

Abstract

Introduction: Tendo Achilles repair is a controversial subject. We have treated 19 patients with acute Tendo Achilles rupture with this technique.

Method: Retrospective and Prospective study. Patients with acute Tendo Achilles ruptures were selected for this study. By standard postero-medial incision, Tendo Achilles repair was undertaken with 1 Loop Polydiaxone ‘suture frame’ to maintain the length: tension ratio of the tendon, Tendon edges were approximated without bunching so that the original tendon length is restored. As a consequence of the restoration of tendon length and the strength of the suture frame we are able to immediately place the foot in a plantigrade position. This helps in accelerated rehabilitation programme. Post operatively below knee back slab and non weight bearing for two weeks, followed by full cast, wt bearing as pain allowed.

Results: Sex distribution was Male: Female 12:7, average age 43, average follow-up was 43 months, most common mechanism of injury was sporting activities(78%). All patients were discharged on the next day except one (medical problem). There was no complication before discharge. There was no evidence of re-rupture or Sural nerve damage. The average time taken for surgery was 42minutes. All patients are back to their occupation at an average time of 10 weeks, 70% are back to the sporting activities at 22 weeks. Patient satisfactory score was 9.2 out of 10(VAS), no knot palpability in any patient. Patients have normal ankle movements and all patients are able to stand on the tip toes.

Discussion: This is a new and simple technique and results are encouraging. Early rehabilitation, less complications, high patient satisfaction rate. There was no change in occupation, 100 % were back to work, 70 % have returned to the sporting activities.