Abstract

Background. The Achilles tendon is the strongest tendon in the human body. Despite the high incidence of injuries and a well-known problem of treating heel tendon injuries, there has been no consensus on the proper treatment, (both surgical and rehabilitation) in professional literature so far. Choosing an operating method that gives “better” treatment results can facilitate the choice of a more effective treatment. It should also be remembered that a properly conducted rehabilitation process is an extremely important element following the surgery.
Aim of the study. The study aimed to evaluate the effectiveness of the surgical treatment of patients with Achilles tendon injuries using the minimally invasive and classic methods.
Material and Methods. The study material included 62 patients treated surgically for Achilles tendon injury in the Department of Orthopedics and Traumatology of CSK MSW in Warsaw in the years 2011-2016. 31 patients were operated using the minimally invasive method (the study group) and 31 patients using the conventional method (the control group). The research group consisted of 27 men and 4 women. The comparative group consisted of 27 males and 4 females. The following research tools were used to evaluate the treatment results: 1. Author’s questionnaire 2. AOFAS score (American Orthopedic Foot and Ankle Society Score) 3. Measuring instrument for maximum force moments in ankle joint JBA “Staniek” 4. HUR stabilographic platform 5. Ultrasonography.
Results. 4 patients, (12.9%) in the control group re-ruptured the tendon after operative treatment. In the study group, 2 patients (6.5%) experienced a complete heel tendon rupture in the postoperative period. The problem of postoperative wound healing disorders was observed among 2 patients (6.5%) from the study group. In the group treated with the classical technique, 5 (16.1%) patients experienced a delay in the healing of the surgical wound due to bacterial infection. Paresthesia, from the sural nerve was observed in only 1 patient in the MIS (Minimal Invasive Surgery) group. 27 patients (87.1%) returned to their sports activity after percutaneous surgery, and 22 patients (71%) after conventional treatment. On average, patients from both groups needed 6 months to return to sports activities.
Conclusions. 1. The number of renewed ruptures after minimally invasive treatment of a damaged Achilles tendon is low and comparable to that of a group of patients treated with the classic technique. 2. Postoperative wound healing disorders are rare in both groups. 3. Calf nerve injury was reported only in one case, while using a minimally invasive procedure. 4. Patients return to work and sports at the same time after surgery in both groups which is influenced by properly implemented physiotherapy 5. Patients presented a similar balance control on the stabilographic platform in both groups. 6. Similar values of maximum force moments in ankle joint were recorded in both groups. 7. In the ultrasound image, there were no morphological differences in Achilles tendon formation in either study group.

Key words:

Achilles tendon, surgical treatment, injury, rupture, physiotherapy