Open augmented repair according to Silfverskjold for achilles tendon rupture: An alternative for Atheletes?

Aim: The most recent meta-analysis of randomized trials recommended open repair for competitive athletes suffering from Achilles tendon rupture due to low re-rupture rates and recommended for all other patients percutaneous repair. The report did not include patients with open augmented repair. The aim of this study was to analyse our results with open augmented repair after Silfverskjold and to discuss whether this method is an alternative form of treatment, especially for athletes. Method: This retrospective study included all patients who received open augmented repair in the Silfverskjold technique between the years 1996 and 2002. A total of 104 patients were clinically evaluated, involving ultrasound as well, and were scored according to the Thermarm scale. The average age was 43 years. The operation took place on average within 5.7 days. Twenty athletes were identified and were compared with all non-athletes using the Thermarm scale and the two randomsample t-tests. The followup period averaged 3.7 years. Results: Overall, the results were rated as good, with an average of 88.1 points. The re-rupture rate was 1.9% (2 out of 104) with a deep infection incidence of 2.8% (3 out of 104). Athletes averaged 88.7 and non-athletes 88.0 points. No significant difference was recorded (t = 0.98). Nineteen out of 20 (95 %) athletes and 48 out of 84 (57%) non-athletes were able to return to their original level of sport activity. Conclusions: Open augmented repair after Silfverskjold is found to be a real alternative to simple open reconstruction of Achilles tendon ruptures. Clinical outcome in both athletes and nonathletes was recorded as good to very good. Especially athletes were able to regain their original activity level with an overall low re-rupture and infection rate.