Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon

Abstract

Background: There has been considerable debate about the best treatment for acute rupture of the Achilles tendon. At our institution, a well-documented and structured program of nonoperative management of Achilles tendon rupture with use of casts and a removable orthosis was developed. Methods: We assessed the results in 140 consecutive patients with a complete rupture of the Achilles tendon who had been treated with our nonoperative regimen at our center between 1992 and 1998. Patients were evaluated on the basis of the subjective results and clinically with physiological testing. Results: Overall, 56% of our patients had an excellent result; 30%, good; 12%, fair; and 2%, poor. The overall complication rate was 8%, with three complete and five partial tendon reruptures, two deep vein thromboses, and one temporary dropfoot. Conclusions: The results of our nonoperative orthotic treatment were better overall than published results of operative repair of acute Achilles tendon rupture. Our patients were quite satisfied with their treatment. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Pulsed ultrasound treatment accelerates the repair of Achilles tendon rupture in rats

“…12 These resulted in good functional outcome, 13 low re-rupture rate, 11,13,14 and even faster healing rate than those managed by operative repair of acute Achilles tendon rupture. 14 Recently, there have been an increasing number of reports suggesting that therapeutic ultrasound promotes tendon healing after open repair. [15][16][17] Enwemeka and colleagues 16 suggested that the beneficial effects of ultrasound were more promising when it was applied at lower intensities.…”

“…2,10 Recently, functional bracing is used as an alternative for immobilization in conservative treatment, which allows early mobilization during rehabilitation. [11][12][13][14] The treatment protocols include 3-4 weeks of cast immobilization and 4-5 weeks of removable orthosis 11,13,14 or cast immobilization at the early phase of healing followed by the use of dosiflexion restricted orthosis, which allows early ankle movement. 12 These resulted in good functional outcome, 13 low re-rupture rate, 11,13,14 and even faster healing rate than those managed by operative repair of acute Achilles tendon rupture.…”

Suture percutanée des ruptures fraîches du tendon calcanéen

“…Ce résultat est sensiblement meilleur qu'en utilisant un traitement non chirurgical qui peut atteindre un taux de rerupture de 6 à 10 % [10][11][12].…”

Current Concepts Review: Acute Ruptures of the Achilles Tendon

“…Advances in nonoperative treatment have included both early weightbearing and functional bracing. 62,82,92 Advances in operative management have included suture technique, 48,60,93 percutaneous repair, 3,8,27,32,33,34,47,54,57,81,94 mini-open repair, 5,12,74 and accelerated postoperative rehabilitation. 14,59,60,66 Additionally, several recent meta-analyses and quantitative reviews have compared nonoperative and operative treatment.…”