A modified operation for Achilles tendon ruptures

Abstract

Background: Treatment of Achilles tendon rupture has long been at the center of debate.

Hypothesis: A new technique in surgical Achilles tendon repair allows for more stability and earlier rehabilitation.

Study design: Case series; Level of evidence, 4.

Methods: One hundred Achilles tendon rupture patients (70 men, 30 women; age range, 16-54 years; mean age, 32 years) were treated by a newly modified method of repair. Twenty-one of these patients were high-level athletes, and 79 were recreational-level athletes. The average length of follow-up was 2.4 years (range, 1-6.3 years), and none of the ruptures included avulsion fractures. After adjusting the tendon to an adequate length using a Tsuge suture, each fibrous bundle was gathered in a longitudinal direction and fixed with a Bunnell-type suture. The same postoperative physical therapy protocol was applied to all patients: at 1 week, early full weightbearing with a walking cast was initiated, and at 2 weeks, patients began range of motion (ROM) exercises and were instructed to wear a hinged ankle-foot orthosis that permitted full plantar flexion but limited full dorsiflexion. From 6 weeks, patients started practicing double-legged heel raises.

Results: At an average of 10 weeks, ankle ROM was comparable to that of the nonoperated leg, and double-legged heel raises were achieved at an average of 7.6 weeks. On average, patients were able to do 20 continuous single-legged heel-raising motions (equivalent to manual muscle testing grade 5) at 15.4 weeks, and jogging started at 12.3 weeks. High-level athletes returned to their original sports level at an average of 5 months. Two reruptures (2%) were experienced, but no other complications occurred.

Conclusion: This surgical technique allows for strong repair stability and subsequent early weightbearing and ROM exercises.