Article

In the past few decades, the incidence of Achilles tendon rupture
has increased in parallel with increased sports participation. Although the
optimal treatment remains controversial, there is a trend towards surgical
treatment in athletes. HYPOTHESIS: Surgical repair of ruptured Achilles tendon in
athlete results in good functional and objective recovery, irrespective of the
type of surgery performed. Subsidiarily, are the results different between
percutaneous surgery (PS) and standard open surgery (OS)? MATERIALS AND METHODS:
This was a cross-sectional study of 31 patients who presented with a ruptured
Achilles tendon that occurred during sports participation. Percutaneous surgery
was performed in 16 patients and open surgery in 15 patients between 2005 and
2009. The objective recovery status was evaluated by open chain goniometry,
measurement of leg muscle atrophy and assessment of isokinetic strength. The
functional analysis was based on the delay, level of sports upon return, AOFAS
and VAS for pain. RESULTS: Our series of Achilles tendon rupture patients
consisted of 88% men and 12% women, with an average age of 38 years. In 71% of
cases, the rupture occurred during eccentric loading. After a follow-up of 15
months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A
strength deficit of 19% in the plantar flexors was found in the two groups. No
patient experienced a rerupture. The return to sports occurred at 130 days after
PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS
was 0.5. There were no differences in ankle range of motion between the two
groups. The majority (77%) of patients had returned to their preinjury level of
sports activity. DISCUSSION: The return to activities of daily living was slower
in our study than in studies based in Anglo-Saxon countries; this can be
explained by the different sick leave coverage systems. Percutaneous surgery
resulted in a faster return to sports (about 130 days) and less muscle atrophy
than open surgery. Our results for return to sports and return to preinjury
levels were similar to published results for athletes and were independent of the
type of surgery performed. The AOFAS score was comparable to published studies.
We found no difference in muscle strength between the two surgery groups 15
months after the procedure. Apart from venous thrombosis typically described
after lower-limb immobilization, secondary postoperative complications mostly
consisted of sural paresthesia, which had resolved at the 15-month postoperative
follow-up evaluation. CONCLUSION: The results of surgical treatment for ruptured
Achilles tendon are good overall. By combining the simplicity of conservative
treatment and the reliability of standard surgical treatment, percutaneous
surgery is the treatment of choice to achieve excellent results. The return to
sports occurred earlier, the muscle atrophy was less and the functional score was
better in our patients treated by percutaneous surgery. LEVEL OF EVIDENCE: Level
IV.
CI - Copyright (c) 2013 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS