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Absorbable sutures associated with reduced Achilles tendon repair complications
Patients regained Achilles tendon function regardless of whether their tendon tears were treated with absorbable or nonabsorbable sutures.
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BARCELONA — Use of absorbable sutures limited the incidence of most surgical complications in Achilles tendon repair compared with nonabsorbable sutures. However, functional outcomes were not significantly different for the two treatments, according to results presented here.
“We can conclude the repair with absorbable sutures could be used for Achilles tendon ruptures with relatively low complication rates,” Baris Kocaoglu, MD, of Acibadem University School of Medicine, said at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress.
The purpose of the study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable and absorbable sutures at a minimum follow-up.
Comparable functional results
“We hypothesized that braided absorbable polyglactin suture, which we called Vicryl, has comparable functional results with braided nonabsorbable polyethylene terephthalate suture, which we called Ethibond,” Kocaoglu said.
Kocaoglu and colleagues randomly assigned 48 patients (mean age 38 years) with Achilles tendon ruptures to undergo treatment with either Ethibond nonabsorbable braided polyethylene terephthalate sutures (Ethicon) or Vicryl absorbable braided polyglactin suture (Ethicon). Surgeons used the Achillon Achilles tendon suture-guiding system (Integra LifeSciences).
The researchers assessed patients according to the criteria established by the clinical American Orthopaedic Foot and Ankle Society (AOFAS) rating score. They clinically evaluated all patients after surgery after 15 days, 30 days, 45 days and 90 days, and then at the end of 1 year.
Return to work
The time from injury to operation was similar in both groups at 2 days. Primary outcome measures used included the number of major surgical complications, such as infections, Achilles tendon re-ruptures and open wounds based on suture retraction.
Results showed all patients regained Achilles tendon function postoperative and returned to their previous work. The AOFAS hind foot clinical outcome scores were 98 in the nonabsorbable suture group (range 90 to 100) and 96.8 in the absorbable suture group (range 87 to 100). However, compared with the nonabsorbable group, there were fewer postoperative complications in the absorbable suture group (16% vs. 4%), Kocaoglu noted. This difference was statistically significant.
“When we look at our results, we see there is no difference between the AOFAS clinical outcome scores, but we can see some differences in terms of complications,” Kocaoglu said. “Absorbable suture group had fewer postoperative complications than nonabsorbable group.” – by Casey Tingle
- Reference:
- Kocaoglu B, et al. Abstract #FP07-1676. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
- For more information:
- Baris Kocaoglu, MD, can be reached at Acibadem University School of Medicine, Orthopedics, Acibadem, tekin Sok. No: 8 34718, Istanbul, Turkey; email: baris.kocaoglu@acibadem.edu.tr.
Disclosure: Kocaoglu reports no relevant financial disclosures.
Perspective
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Paul Ackermann, MD, PhD
Since patient outcome after acute Achilles tendon rupture repair is highly variable, there is a big need to improve care and operative techniques. The authors should be commended for pursuing these aims and performing a randomized trial comparing absorbable vs. nonabsorbable sutures.
Although the authors used a minimally invasive repair system, the nonabsorbable suture group demonstrated as high as 16% postoperative complications as compared to 4% in the absorbable suture group.
These results are interesting, but would seem to need further verification. A post-hoc power analysis of the data demonstrates the study would need 97 patients in each group, instead of the 24 patients used, to show a significant difference between 4% and 16% postoperative complications with 80% power.
We recently published a study on 150 patients with acute Achilles tendon rupture (ATR) who underwent operative repair using absorbable sutures (PDS II, Ethicon). In that study, we demonstrated 4% postoperative infections, but up to almost 50% incidence of deep venous thrombosis. Thus, there is a great need to further study and improve the care of ATR patients.
Reference:
Arverud ED, et al. Bone Joint J. 2015;doi:10.1302/0301-620X.97B5.34581.
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