İHMAL EDİLMİŞ AŞİL TENDON RÜPTÜRLERİNDE PRİMER ONARIM VE PLANTARİS TENDONU İLE ÖGMENTASYON TEKNİĞİNİN ORTA DÖNEM SONUÇLARI Mid-Term Results of Primary Repair and Plantaris Tendon Augmentation Technique in Neglected Achilles Tendon Rupture

OZET Amac: Ihmal edilmis Asil tendon rupturlerine uyguladigimiz primer onarim ve plantaris tendonu ile ogmentasyon tekniginin klinik ve fonksiyonel sonuclarini degerlendirmek. Gerec ve yontemler: Bu calismada 2011-2014 yillari arasinda ihmal edilmis Asil tendon rupturu nedeniyle, primer onarim ve plantaris tendonuyla ogmentasyon teknigi ile cerrahi tedavi uyguladigimiz yirmi hasta retrospektif olarak incelendi. Hastalar son takiplerde klinik olarak Amerikan Ortopedik Ayak ve Ayak Bilegi Toplulugu (AOFAS) arka ayak skoru, Vizuel Agri Skalasi (VAS) skoru, baldir cevresi uzunlugu, topuk yukseltme testi ve ayak bilegi eklem hareket acikligi dereceleri ile degerlendirildi. Bulgular: Yaralanma ile ameliyat arasinda gecen sure ortalama 7,8 (4-16) hafta olarak bulundu. Ameliyat sirasinda tendon gudukleri arasindaki ortalama defekt miktari 44 (30-75) mm olarak olculdu. Ortalama takip suresi 62 (56-84) aydi. Son takiplerde AOFAS skoru ortalamasi 93,6 (86-100) olarak bulundu ve VAS skoru tum hastalarda sifirdi. Ortalama baldir cevresi uzunlugu, ayak bilegi plantar fleksiyon ve dorsifleksiyon dereceleri etkilenmemis taraf ile karsilastirildiginda istatistiksel olarak anlamli farklilik saptanmadi (p degerleri sirasiyla 0,40-0,59-0,68). Bir hasta haric tum hastalar topuk yukseltme testini gerceklestirebilmekteydi. Bir hastada antibiyotik tedavisi ile iyilesen yuzeysel cilt enfeksiyonu gozlendi. Hicbir hastada derin ven trombozu, cilt nekrozu ve tekrar ruptur tespit edilmedi. Sonuc: Ihmal edilmis Asil tendon rupturlerinde, primer onarim ve plantaris tendonu ile ogmentasyon teknigi, orta donemde, klinik ve fonksiyonel olarak basarili sonuclar ile iliskilidir Anahtar Sozcukler: Asil; Tendon; Ruptur; Ihmal edilmis; Kronik; Plantaris. ABSTRACT Objective: To assess clinical and functional outcomes of primary repair and plantaris tendon augmentation technique employed in neglected Achilles tendon rupture. Methods: We retrospectively reviewed 20 patients underwent surgical treatment with primary repair and plantaris tendon augmentation technique for neglected Achilles tendon rupture between 2011 and 2014. At the last follow-up, the patients were clinically assessed by American Orthopedic Foot & Ankle Society (AOFAS) hindfoot score, Visual Analogue Scale (VAS) score, calf circumference, single-limb heel rise test and range of motion in ankle. Results: Mean time from rupture to surgery was 7.8 weeks (range 4-16 weeks). The mean gap was 44 mm (range 30-75 mm). Mean postoperative follow-up period was 62 months (range 56-84 months). At the last follow-up, mean AOFAS score was 93.6 (range 82-100) while VAS score was found as zero in all patients. No significant difference was detected in mean calf circumference and plantar flexion and dorsiflexion range of ankle between involved site and contralateral intact site (p=0.40; p=0.59 and p=0.68, respectively). One patient suffered from superficial skin infection which was treated successfully with antimicrobial therapy. There were no cases of deep-vein thrombosis, skin necrosis, or re-rupture. Conclusion: In neglected Achilles tendon rupture, primary repair and plantaris augmentation technique is associated with successful clinical and functional outcomes at mid-term. Keywords: Achilles; Tendon; Rupture; Neglected; Chronic; Plantaris