A modified operation for Achilles tendon ruptures.
BACKGROUND
Treatment of Achilles tendon rupture has long been at the center of debate.


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


METHODS
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.


CONCLUSIONS
This surgical technique allows for strong repair stability and subsequent early weightbearing and ROM exercises.
Uchiyama
Eiji
E
Kantoh Rosai Hospital, Kawasaki, Japan. eusports2007@kantoh.rofuku.go.jp
Nomura
Akiko
A
Takeda
Yasushi
Y
Hiranuma
Kenji
K
Iwaso
Hiroshi
H
D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000503:physiopathology; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D020127:Recovery of Function; D012008:Recurrence; D012421:Rupture / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D016474:Weight-Bearing