The Effectiveness of the Modified Side-Locking Loop Suture Technique with Early Accelerated Rehabilitation for Acute Achilles Tendon Rupture in Athletes

Abstract

Background/Objectives: An early accelerated rehabilitation is generally recommended after surgery for acute Achilles tendon ruptures (ATRs). The modified side-locking loop suture (MSLLS) is a surgical technique that provides high tensile strength to the repaired Achilles tendon and allows for a safe, early accelerated rehabilitation protocol without requiring postoperative immobilization. However, there are no reports investigating the clinical outcomes of the MSLLS technique with early accelerated rehabilitation for ATRs. To clarify the effectiveness of the MSLLS technique with an early accelerated rehabilitation protocol for ATR in athletes. Methods: We retrospectively analyzed 27 athletes (Tegner activity score ≥ 6) who underwent surgical treatment using the MSLLS technique for ATR between April 2017 and August 2022. All patients underwent an early accelerated rehabilitation protocol without immobilization. Outcome measures included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score taken preoperatively and one year postoperatively, the time required to perform 20 continuous double-leg heel raises (DHR) and single-leg heel raises (SHR), the time to return to the original sport, and the presence of any complications. Results: The mean AOFAS score significantly improved from 37.2 ± 9.7 preoperatively to 96.3 ± 5.3 one year postoperatively. The mean time to be able to perform 20 continuous DHR and SHR was 7.7 ± 1.2 weeks and 11.3 ± 1.6 weeks, respectively. All patients were able to return to their original sport at their pre-injury level in an average of 22.7 ± 3.7 weeks without complication. Conclusions: The MSLLS technique in conjunction with an early accelerated rehabilitation protocol for ATR in athletes produced satisfactory results, with all patients able to return to their original sport at their preinjury level without complication.

Keywords: Achilles tendon rupture; athletes; early accelerated rehabilitation; modified side-locking loop suture technique; operative treatment.

Figure 1

The illustration shows how to make two side-locking loop points for the proximal stump of the Achilles tendon using USP No. 5 braided polyblend suture thread. (A) First, the suture thread is passed perpendicularly to the tendon, approximately 3 cm from the proximal stump. (B) The suture is passed from behind the tendon to the front slightly proximal to the transverse suture (C) and then passed from the front of the tendon slightly distal to the transverse suture to the proximal end through the tendon, making the side-locking point. (D) Two side-locking points are created on the medial and lateral sides of the tendon.

Figure 2

(A) The sutures from the proximal and distal stumps are tied between the stumps using an antislip knot as a core suture, keeping the operated ankle in a neutral position. (B) After the core suture, a peripheral suture is made using the cross-stitch method with a USP No. 2-0 monofilament nylon suture.