[Evaluation of operative treatment of subcutaneous rupture of the achilles tendon--correlation between clinical presentation and ultrasound examination].

Abstract

Objective: To improve of the effectiveness of surgical procedures in the repair of rupture of the Achilles tendon, some surgeons use various augmented techniques. The purpose of this study was to evaluate the value of the use of graft from the fascia lata to add strength to the Bunnell suture in the treatment of subcutaneous tear of the Achilles tendon on the base of clinical and ultrasonographic results.

Materials and methods: 44 cases of the Achilles tendon lesion in 43 patients were included to the study. The patients were placed quasi-randomly into one of the two groups--group A of 26 tendons, repaired using the Bunnell suture with the reinforcement by a graft of the fascia lata, and group B of 18 tendons, repaired with simple end-to-end Bunnell suture. Results of the treatment were evaluated by the objective 100-point Hannover scale and subjectively by the modified Rupp scale. Results of the static and dynamic ultrasound examination were also analysed.

Results: There was no statistically significant difference due to Hannover and Rupp scales in results between the two repair methods. The analysis of results of ultrasound examinations demonstrated that the decreased visibility of internal structures was statistically greater in the patients whose tendon was sutured using a graft from the fascia lata. The treatment method did not, however, influence the presence of inflammatory changes or the quality of sliding ability, as seen in ultrasound.

Conclusions: Open reconstruction of the subcutaneous rupture of the Achilles tendon, regardless fascia lata was used or not, gives a high percent of positive results, both in subjective and objective evaluations. Use of the fascia lata in repair of the Achilles tendon increases the probability of ultrasonographically visible structural changes in the tendon without clinical consequences.