End-to-End Operative Repair of Achilles Tendon Rupture

Abstract

We present the long-term results of operative repair in 23 consecutive patients with Achilles tendon ruptures, treated between 1984 and 1991, to evaluate our treatment method and determine the clinical causes of rupture. Fifty-four percent of ruptures occurred in people in their 30s; 90% occurred during participation in acceleration-deceleration sports. All but three patients were treated within 1 week of injury with open, operative, end-to-end repair of the Achilles tendon. The remaining three patients were treated more than 3 weeks after injury. All patients followed a standard postoperative regimen. Followup averaged 3.6 years (range, 1 to 7.5). Seventeen patients were available for Cybex analysis, and the remaining patients were interviewed personally or by telephone. Subjectively, patients were very satisfied with the results of treatment. Objectively, physical examination and Cybex testing to measure strength and endurance revealed results somewhat better than those previously reported with operative repair. No patient experienced a rerupture, although one attenuated repair was noted 9 months postoperatively. Only two minor wound problems were recorded. Long-term results revealed near-normal function when comparing the injured side with the uninjured side. Ninety-two percent of patients returned fully to their preinjury levels of activity.

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

“…After a mean follow-up of 4.8 years, most patients had no pain, were subjectively satisfied with the outcome, and had good or excellent results according to the anklehindfoot AOFAS score. These results compare favourably with those reported with both open and percutaneous endto-end suture [1,2,3,11,16,17,19]. Nyyssonen et al [13] retrospectively compared 39 repairs and 59 augmented reconstructions and found no differences in outcome.…”

“…Simple end-to-end suture is easier to perform and requires a less extensive dissection [16], but the poor quality of the tendon at the rupture site may compromise the strength of the repair. Surgical techniques have been developed to perform end-to-end suture of the Achilles tendon percutaneously [11,15,17,19], though the incidence of rerupture and sural nerve injury seems to be higher with percutaneous techniques [1,3,18].…”

“…However, several recent reports have favoured operative treatment in order to allow a faster recovery and minimize the rerupture rate. Surgical techniques include simple end-to-end suture [1,2,16,17,19] and several procedures for augmented reconstruction. [5,13,22] Augmented reconstruction, initially developed for chronic or neglected ruptures, is now also used for acute ruptures by some authors [22].…”

“…[5,13,22] Augmented reconstruction, initially developed for chronic or neglected ruptures, is now also used for acute ruptures by some authors [22]. Simple end-to-end suture is easier and can be performed through a more limited approach [2,16]. However, surgical augmentation may provide a stronger reconstruction, allow a more intensive rehabilitation program, and decrease the rerupture rate.…”

Unfavorable effect of knee immobilization on Achilles tendon healing in rabbits

“…Some investigators have asserted that immobilization of the knee joint is not necessary for treatment (Beskin et al 1987, Carden et al 1987, and recent treatment trends are towards immobilization of only the ankle (Cetti et al 1993, Rantanen et al 1993, Soldatis et al 1997. However, to our knowledge, no authors have explained why immobilization of the knee joint is not necessary for the treatment of Achilles tendon rupture.…”