Augmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up

作者：Heikkinen Juuso; Lantto Iikka; Flinkkila Tapio; Ohtonen Pasi; Pajala Ari; Siira Pertti; Leppilahti Juhana^*

来源：Journal of Bone and Joint Surgery-American Volume, 2016, 98A(2): 85-92.

DOI：10.2106/JBJS.O.00496

Background: This prospective randomized trial with a mean fourteen-year follow-up compared simple end-to-end repair with fascial flap-augmented repair for acute Achilles tendon ruptures.
Methods: From 1998 to 2001, sixty patients with acute Achilles tendon rupture were randomized to receive simple end-to- end repair or augmented repair; both groups were treated with postoperative bracing allowing free active plantar flexion. After a follow-up of thirteen years or more, fifty-five patients (twenty-eight in the nonaugmented-repair group and twenty-seven in the augmented-repair group) were reexamined. Outcome measures included the Leppilahti Achilles tendon score, isokinetic plantar flexion strength (peak torque and the work-displacement deficit at 10 degrees intervals over the ankle range of motion), tendon elongation, and the RAND 36-item health survey.
Results: After a mean of fourteen years of follow-up, the mean Leppilahti score was 87.1 points for the nonaugmented repairs and 91.5 points for the augmented repairs, with a mean difference of 4.3 points (95% confidence interval [CI], - 0.1 to 8.8 points). The surgical technique did not have an impact on strength parameters, with a mean peak torque of 112.6 Nm after the nonaugmented repairs and 107.3 Nm after the augmented repairs (mean difference, 5.3 Nm [95% CI, - 22.2 to 11.6 Nm]) and a median work-displacement deficit of 6.7% to 20.3% after the nonaugmented repairs and 12.8% to 18.0% after the augmented repairs (p = 0.9). Strength did not significantly change between the twelve-month and fourteen-year follow-up examinations. At a mean of fourteen years, the injured side showed a 12.2% to 18.0% median work-displacement deficit compared with the unaffected side (p < 0.001). RAND-36 scores indicated no between-group difference in health domains.
Conclusions: Augmented repair of total Achilles tendon ruptures provided no advantage over simple end-to-end repair. Achilles tendon ruptures result in a permanent calf muscle strength deficit, but its clinical relevance remains unclear.

• 出版日期2016-1-20