Long-term results after functional nonoperative treatment of achilles tendon rupture.
BACKGROUND
Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness.


METHODS
The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury.


RESULTS
Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture.


CONCLUSIONS
Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.
Department of Trauma, Hannover Medical School, Hannover, Lower Saxony 30625, Germany. huefner.tobias@mh-hannover.de
Tobias M
TM
Hufner
Dirk B
DB
Brandes
Hajo
H
Thermann
Martinus
M
Richter
Karsten
K
Knobloch
Christian
C
Krettek
D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009983:Orthopedic Equipment; D010147:Pain Measurement; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012008:Recurrence; D012421:Rupture / Q000000981:diagnostic imaging / Q000534:rehabilitation; D012775:Shoes; D016896:Treatment Outcome; D014463:Ultrasonography