Novel approach to repair of acute achilles tendon rupture: early recovery without postoperative fixation or orthosis

Abstract

Background: Immobilization or orthosis is required after conventional Achilles tendon surgery. Hypothesis This new Achilles tendon repair approach enables early rehabilitation without any postoperative immobilization or orthosis.

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

Methods: Twenty consecutive patients (14 men and 6 women; mean age, 43.4 years; range, 16-70 years) who had acute subcutaneous Achilles tendon rupture were treated by the new method, with an average follow-up of 2.9 years (range, 2-4.8 years). Among them, 15 injuries were sports-related and 5 were work-related. The authors applied a side-locking loop technique of their own design for the core suture, using braided polyblend suture thread, with peripheral cross-stitches added. The patients started active and passive ankle mobilization from the next day, partial weightbearing walking from 1 week, full-load walking from 4 weeks, and double-legged heel raises from 6 weeks after surgery.

Results: The range of motion recovery equal to the intact side averaged 3.2 weeks. Double-legged heel raises and 20 continuous single-legged heel raise exercises were possible at an average of 6.3 weeks and 9.9 weeks, respectively. T2-weighted magnetic resonance signal intensity recovered to equal that of the intact portion of the same tendon at 12 weeks. The patients resumed sports activities or heavy labor at an average of 14.4 weeks. The Achilles tendon rupture score averaged 98.3 at 24 weeks. There were no complications.

Conclusion: This new Achilles tendon repair approach enables early mobilization exercise without costly specialized orthosis or immobilization and allows an early return to normal life and sports activities, reducing the physical and economic burden on patients.