Surgical treatment of 102 tendo achillis ruptures-- suture or tenontoplasty?
A series of 102 patients with total subcutaneous rupture of the achilles tendon treated surgically from 1944 to 1972 is presneted. All patients were treated early after the acute event, and the diagnosis was made on clinical examination. Group I comprises 54 patients treated over the first part of the period by simple tendon suture, and group II comprises 48 patients from the second part of the period treated by tenontoplasty ad modum Silfverskjöld. The results in the two groups are compared and also contrasted with the results following conservative treatment more recently reported. Operative treatment is recommended rather than conservative bandaging. There were no recurrent ruptures in group II, but 2 patients in group I had rupture recurrence. The functional results were not statistically significantly different in the two groups. There was no operative mortality. Surgical complications were infrequent, and, in general, did not affect the period of treatment, nor the duration of incapacity. Recent studies reported in the literature cast doubt on frequent previous reports of pathological changes in the tendon predisposing to rupture. Some constitutional weakness would appear to be etiological from this study where some familial incidence was noted, and particularly there was an incidence of not simultaneous bilateral rupture. The risk of contralateral rupture if patients returned to sporting activity to the same extent as before the primary injury was 26% (12-45%).