To Investigate The Clinical Efficacy Of Two Types Of Surgery For The Treatment Of Closed Ruptures Of The Achilles Tendon

Objective:To investigate the clinical efficacy of two types of surgery for the treatment of closed ruptures of the Achilles tendon, thus providing future reference regarding the choice of the type of surgical repair for the treatment of closed ruptures of the Achilles tendon.Methods:Among the 124 patients that were hospitalized at our.hospi tal from October 2011 to June 2014,109 patients with closed ruptures of the Achilles tendon that met the enrollment criteria were included for retrospective analysis. These patients were assigned to the Krackow suturegroup and modified Kessler suturegroup based on the specific type of surgery the patient underwent. In either group, routine gypsum plaster immobilization was postoperatively performed during which the patients were placed with the knees bended and the anklesinto a plantar-flexed position. Functional exercises were initialized for the toes andquadriceps femoris of the affected sideat postoperative 24 hours. The stitches were removed from the incision based on wound healing at postoperative approximately 2 weeks. Non-weight bearing exercises were initialized 4 weeks after long leg cast immobilization and 2 weeks after shank cast immobilization (where the ankle joint was placed in the neutral position). The plaster cast was removed at postoperative 6 weeks. Mild weight-bearing exercises were performed in a gradual manner. The patients were able to completely bear weight and carry out f latfoot walk and jogging exercises at postoperative 6 months. The follow-up time for the 109 patients included averaged at 12 months. Postoperative rehabilitation exercises, postoperative complications, etc were recorded in accordance with the American Orthopaedic Foot & Ankle Society (AOFAS) scoring and Arner-Lindholm criteria at postoperative 6 and 12 months, respectively.Results:All of the 109 patients were postoperatively followed up. The follow-up time ranged from 6 to 18 months, with an average of 12 months. In the Krackow suture group,15 patients experienced incisional wound infection and9 patients experienced secondary rupture while in the modified Kessler suture group,4 patients experienced incisional wound infection and 3 patients experienced secondary rupture. These patients were released from hospital with incisional wound fully recovered following symptomatic treatment. No statistically significant differences in the general materials, age or type were preoperatively seen between two groups. Statistically significant differences in the AOFAS score and Arner-Lindholm criteria at postoperative 6 months and 12 months, however, were observed (P<0.05). Statistically significant differences in the postoperative infection rate and secondary rupture were also seen (P<0.05).,.Conclusions:Although both suture methodsare effective in treating closed ruptures of Achilles tendon, the modified Kessler suture group achieved better clinical outcome in terms of postoperative incisional wound infection rate, Achilles tendon secondary rupture rate, AOFAS score and Arner-Lindholm criteria as compared with the Krackow suture group.