Outcome of Primary Repair of Severed (Partial/ Complete) Tendoachilles
Authors: Chowdhury Dr. Farhan Imtiaz , Ovi Dr. Mir Rasekh Alam , Khalil Dr. Md. Musab , Nasrin Dr. Shamima 
Published: October 2020

Rupture of the Achilles tendon was reportedly first described by Ambroise Pare in 1575 and was reported in the literature in 1633. After the 1920s the use of operative treatment increased, primarily because of reports by Abrahamsen in 1923 and Quenu and Stoianovitch in 1929 who advocated surgical repair, based on accumulated cases from the literature. In this series we used 5 parameters according to Juhana Leppilahti Modified scoring system to assess the final outcome of the patient functionally. These were stand on affected tip toe unsupported, range of motion of affected side ankle, power of planter flexion, calf muscle wasting and complications. These parameters were also used in various study described in various literature. So, early repair of open Tendo Achilles injury provided an effective outcome, which was comparable with the result described in others. The study was designed as a prospective cohort study conducted at Rajshahi Medical College Hospital from January 2017 to December 2017. Study was carried out on 50 patients hospital admitted with ruptured tendoachillis, irrespective of age and sex. Modified Kessler was the procedure as operative treatment for their disease. Outpatient follow-up was undertaken. In our study among 50 patients 38(76%) were male and 12(24%) were female. Mean age was 30.02 years with standard deviation of ± 7.7. Most of the cases were operated within 6 hours of injury. After final toileting wound swab was sent for culture sensitivity and found in 60% cases E. Coli, 6% Pseudomonas, 4% Klebshiela and in 30% cases no growth. Mean delay of repair was 6 hours 7 minutes, with standard deviation ± 2.362 minutes. In our study median level of cut was 3.0 cm proximal to the insertion of Tendo Achilles and where interquartile range was 2.5 to 3.5 cm. Mean follow up period was 9 months with standard deviation was 2.37. Ankle motion were normal in 35 cases (70%) and changes of motion were up to 6-10 degree in 13(26%) patients in this series, which was very much acceptable in comparison to above studies. Only 2(4%) patients had more than 10 degree motion restricted. Common complications were superficial skin infection 4 cases (37%), mild swelling 4 cases (36%), ugly scar 2 cases (18%) and wound gap 1 cases (9%). In our study no major complication occurred but minor complications like superficial skin infection, delayed wound healing occurred which were successfully managed with an oral antibiotic regimen with no long term sequelae. In this series we assessed fifty acute open Tendo Achilles injured patients after 16 weeks of treatment. Among them 90%(45) can stand on affected tip toes unsupported, around 4 cases (8%) cannot stand on tip toes of affected foot can’t support but able to stand on affected foot with unsupported. Around 2% (1 case) failed to stand on affected foot without support due to severe infection and wound gap. The final result was as followed excellent in 28 cases (56%), good in 16 cases (32%), fair in 4 cases (8%), poor in 2 cases (4%). In this study it was found that 85% satisfactory result among 50 patients of acute open tendo Achilles injured patients by immediate repair. If this procedure put in total population then satisfactory result was found in following confidence interval (at 5% level of significance). According to Juhana Leppilahti Modified Score at 95% Confidence Interval satisfactory outcome is 78.99% to 97.00%, which was comparable with the result described in others. Early repair of open Tendo Achilles complete or partial provided an effective outcome, which was comparable with the result described in others.