[Open augmented repair according to Silfverskjöld for Achilles tendon rupture: an alternative for athletes?]. / Die Umkipp-Plastik nach Silfverskjöld bei Achillessehnenruptur: Eine Alternative für Sportler?

AIM: The most recent meta-analysis of randomized trials recommended open repair for competitive athletes suffering from Achilles tendon rupture due to low re-rupture rates and recommended for all other patients percutaneous repair. The report did not include patients with open augmented repair. The aim of this study was to analyse our results with open augmented repair after Silfverskjöld and to discuss whether this method is an alternative form of treatment, especially for athletes. METHODS: This retrospective study included all patients who received open augmented repair in the Silfverskjöld technique between the years 1996 and 2002. A total of 104 patients were clinically evaluated, involving ultrasound as well, and were scored according to the Thermann scale. The average age was 43 years. The operation took place on average within 5.7 days. Twenty athletes were identified and were compared with non-athletes using the Thermann scale and the two randomsample t-tests. The follow-up period averaged 3.7 years. RESULTS: Overall, the results were rated as good, with an average of 88.1 points. The re-rupture rate was 1.9% (2 out of 104) with a deep infection incidence of 2.8% (3 out of 104). Athletes averaged 88.7 and non-athletes 88.0 points. No significant difference was recorded (t=0.98). Nineteen out of 20 (95%) athletes and 48 out of 84 (57%) non-athletes were able to return to their original level of sport activity. CONCLUSIONS: Open augmented repair after Silfverskjöld is found to be a real alternative to simple open reconstruction of Achilles tendon ruptures. Clinical outcome in both athletes and nonathletes was recorded as good to very good. Especially athletes were able to regain their original activity level with an overall low re-rupture and infection rate.

[No influence of physiotherapy on outcome after open repair of achilles tendon ruptures?]. / Kein Einfluss der Physiotherapie auf das klinische Ergebnis nach operativ behandelter Achillessehnenruptur?

AIM: Many studies have been performed to analyse the influence of surgical techniques and the postoperative aftercare after Achilles tendon ruptures on the outcome. However, there is no study investigating the influence of physiotherapy on outcome after surgical repair and standardised early functional rehabilitation of Achilles tendon rupture, so that this was the objective of the present study. PATIENTS AND METHODS: In this retrospective study, 104 patients with Achilles tendon ruptures, all treated by open repair followed by a standardised early rehabilitation, were evaluated by the Thermann score. The average age was 42 years. We could identify 3 patient groups. Group I (n=23) did not receive any physiotherapy. Group II (n=41) received physiotherapy for 3-6 weeks, and group III (n=40) received more than 6 weeks of physiotherapy. Physiotherapy consisted of 3 units per week. Each unit lasted for 30 min. All groups were compared statistically via variance analysis. RESULTS: Group I scored on average 88.8 points, group II 88.6 and group III 87.0 points. There were no statistically significant differences between the three groups (p=0.50). The age of patients had also no relevant influence on the outcome (p=0.48). CONCLUSIONS: Physiotherapy and age of the patients involved were not found to influence the outcome after open augmented repair of Achilles tendon ruptures followed by a standardised early rehabilitation. These results should be confirmed by a prospective randomised trial. Also elderly patients participating in demanding sport activities should receive a surgical repair.

[Open augmented repair according to Silfverskjöld for Achilles tendon rupture: an alternative for athletes?]. / Die Umkipp-Plastik nach Silfverskjöld bei Achillessehnenruptur: Eine Alternative für Sportler?

AIM: The most recent meta-analysis of randomized trials recommended open repair for competitive athletes suffering from Achilles tendon rupture due to low re-rupture rates and recommended for all other patients percutaneous repair. The report did not include patients with open augmented repair. The aim of this study was to analyse our results with open augmented repair after Silfverskjöld and to discuss whether this method is an alternative form of treatment,especially for athletes. METHOD: This retrospective study included all patients who received open augmented repair in the Silfverskjöld technique between the years 1996 and 2002. A total of 104 patients were clinically evaluated, involving ultrasound as well,and were scored according to the Thermann scale. The average age was 43 years. The operation took place on average within 5.7 days. Twenty athletes were identified and were compared with all non-athletes using the Thermann scale and the two random sample t-tests. The follow-up period averaged 3.7 years. RESULTS: Overall, the results were rated as good,with an average of 88.1 points. The re-rupture rate was 1.9% (2 out of 104) with a deep infection incidence of 2.8% (3 out of 104). Athletes averaged 88.7 and non-athletes 88.0 points. No significant difference was recorded (t = 0.98). Nineteen out of 20 (95%) athletes and 48 out of 84(57%) non-athletes were able to return to their original level of sport activity. CONCLUSIONS: Open augmented repair after Silfverskjöld is found to be a real alternative to simple open reconstruction of Achilles tendon ruptures. Clinical outcome in both athletes and non athletes was recorded as good to very good. Especially athletes were able to regain their original activity level with an overall low re-rupture and infection rate.