title: Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast.
abstract: The aim of this study was to compare the clinical outcome for patients treated with walking cast immobilization and wrap early mobilization after surgical repair of acute Achilles tendon ruptures. A total of 39 consecutive patients with complete ruptures of the Achilles tendon were identified, treated, and functionally rehabilitated with either a walking cast or a wrap. Because the randomization was quasi-random, chi-square and t-tests were performed to compare the baseline characteristics. A statistically significant difference was present only for the injured side ( p<0.05). Therefore, groups were considered comparable for analysis of outcome. All patients were evaluated at an average follow-up of 6.7 years (range 5-8 years). Functional postoperative treatment with a wrap allowed a significantly shorter hospital stay ( p<0.05) as well as a shorter period to return to pre-injury sports level ( p<0.01) compared with treatment with a walking cast. According to the modified Rupp score, 91.3% of patients in the walking cast group had a good or excellent result, as did 93.8% in the wrap group ( p=0.9). Slight atrophy of the calf muscles was reported in 3 patients in the walking cast group (13.0%) and in 4 in the wrap group (25.0%). One re-rupture was reported in the walking cast group (4.3%). Functional treatment after surgical Achilles tendon repair is safe, and there is no increased risk of re-rupture or wound healing problems. Functional treatment with a wrap is preferable to treatment with a walking cast with respect to hospitalization time and return to sports.
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1105 AZ Amsterdam, The Netherlands. ginokerkhoffs@hotmail.com
authors.forename: G M M J
authors.initials: GM
authors.lastname: Kerkhoffs
authors.forename: P A A
authors.initials: PA
authors.lastname: Struijs
authors.forename: E L F B
authors.initials: EL
authors.lastname: Raaymakers
authors.forename: R K
authors.initials: RK
authors.lastname: Marti
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D001265:Athletic Injuries / Q000534:rehabilitation* / Q000601:surgery; D001458:Bandages; D002370:Casts, Surgical; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011184:Postoperative Period; D011336:Probability; D011446:Prospective Studies; D020127:Recovery of Function; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D012680:Sensitivity and Specificity; D016896:Treatment Outcome