Riassunto
Obiettivi
Diverse sono le tecniche chirurgiche proposte per il trattamento delle lesioni sottocutanee del Tendine d’Achille. L’obiettivo di questo studio retrospettivo è di valutare i risultati di un gruppo di pazienti con lesione del tendine d’Achille trattata con tenorrafia termino-terminale e rinforzata con sintetico Poly-Tape (Polietilene-Tereftalato), conosciuto anche come protesi Leeds-Keio.
Materiali e metodi
Abbiamo valutato 15 casi consecutivi di lesione del tendine d’Achille operati nel triennio fino al maggio 2009: 12 uomini con età media 41 anni e 2 donne con età media di 47 anni. Non abbiamo trovato sicure correlazioni fra la lesione e cause predisponenti. Tutti i pazienti sono stati sottoposti ad esame anamnestico e clinico e valutati con la scheda ICOT e VAS FA.
Risultati
Il follow-up medio è di 16 mesi. Due pazienti hanno presentato edema severo della ferita, uno ha richiesto la rimozione del sintetico perché infettatosi. Non abbiamo registrato recidive della lesione, deiscenza della ferita chirurgica o altre complicanze. A due mesi i pazienti deambulavano senza stampelle e presentavano una marcia abbastanza normale.
Conclusioni
La tecnica, di facile applicazione, appare valida se confrontata con le tecniche tradizionali o percutanee. Rispetto a queste ultime, si riduce drasticamente la possibilità della recidiva e della guarigione della lesione in allungamento.
Summary
Controversy still rages regarding its optimal management, and conservative management, open and percutaneous repair are all advocated.
Purpose
Acute lesions of the Achilles tendon occur frequently. Various treatment techniques have been described, however, there is no consensus among orthopaedic surgeons regarding the best surgical technique. The Authors present their experience in the surgical treatment on such lesions.
Material and methods
Fifteen consecutive patients with Achilles tendon rupture, all operated on between 2006 and may 2009, were included. We have treated 12 men, the average was 41 years and 2 women, the average was 47 years. No sicure correlations it was with a drug o sport accident. We have performed tenorraphy with mini-open surgery and Poly-Tape support (polyethylene terephthalate). Functional outcome was determined using ICOT and VAS FA questionnaire. Post-operative complications and recurrence rate of rupture were noted.
Results
None patients were lost to follow-up. Median post-operative follow-up was 16 months (range: 2-33). We have observed 2 cases of edema after surgery. One patient, after 4 months of surgery, was requested a new surgery to remove the Poly-Tape for infection. No wound problems, no re-ruptures o vascular complications were found. All patients aim a normal walking ability after two months.
Conclusions
The use of this technique to treat this type of lesions must therefore be considered effective, simple and safe, compared with traditional technique and other percutaneous technique. Early weight bearing and the use of the percutaneous repair did correlate to increased postoperative tendon lengthening and re-rupture. The Poly-Tape, inserted whit a mini-open surgery, it reduces significantly the risk of re-rupture and decadence of the results on the time. Enough, it gaves significantly better results than the other surgical procedures.