title: Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation.
abstract: BACKGROUND
  Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace.
  
  
  METHODS
  We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot.
  
  
  RESULTS
  Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks.
  
  
  CONCLUSIONS
  The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.affiliation: 2 Department of Orthopaedic Surgery, Shimane University School of Medicine, Izumo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Imade
authors.affiliation: 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Innami
authors.affiliation: 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kawano
authors.affiliation: 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*
keywords: Achilles tendon; accelerated rehabilitation; operation; suture