Over a period of 25 years (1972-1997), 1,075 patients with injuries of the Achilles tendon were treated at the Hospital for Orthopedic Surgery and Sports Medicine. In a retrospective study, 565 cases of ruptures of the Achilles tendon presented over the past ten years were analyzed. A further 60 cases were analyzed in a prospective study. The hospital has treated a total of 1,643 tennis players (1,190 men and 453 women) in 25 years. The lower extremity was affected in 1,300 cases. Of the 570 Achilles tendon ruptures, 140 occurred in soccer players (24.6%), 60 in tennis players (10.5%), 44 in handball players (7.7%), 36 among volleyball players (6.3%) and 28 among badminton players (4.9%). Only 2.5% had a direct trauma. Starting or twisting were the most common causes of the injury. An Achilles tendon rupture is usually 3-5 cm proximal of the calcaneus. The first clinical examination in Achilles tendon ruptures showed inability to slowly flex one foot to standing (98%), a positive Thompson test (89%) and a palpable sulcus (86%). Plantar flexion against resistance was weakened (60%) or impossible (35%). MRI and ultrasound were highly sensitive and specific. Surgical treatment was provided in 97% of the cases. Post-operative complications (granuloma, ruptures) occurred in 8.3% of patients. The outcomes were rated satisfactory in 86% of cases. A prospective randomized study was performed with 60 patients, comparing open, percutaneous and conservative treatment. The same functional treatment was provided in all groups. The conservative regimen showed some excellent results, but also the highest failure rate (30%). Operative treatment involves a number of peri-operative risks. The best results were found for the percutaneous operative technique with a PDS special suture.
© Copyright 2000 Alle Rechte vorbehalten.