Achilles tendon ruptures. A new method of repair, early range of motion, and functional rehabilitation.

Abstract

We prospectively treated 29 athletes who had Achilles tendon ruptures according to a functional rehabilitation protocol. The 25 male and 4 female patients had a mean age of 35 years (range, 19 to 56). The repair was performed with a Krackow suture of No. 2 nonabsorbable polyfilament. Patients began range-of-motion exercises 72 hours after surgery, used a posterior splint for 2 weeks, and then began ambulation in a hinged orthosis. Six weeks after surgery, use of the orthosis was discontinued, full weightbearing was allowed, and progressive resistance exercises were initiated. Isokinetic strength and endurance testing were performed at 3, 6, and 12 months after surgery. There were no reruptures. Two patients developed superficial wound infections that responded to debridement or local wound care. One patient suffered a pulmonary embolism. At 3 months' followup, isokinetic testing showed the mean functional deficits were 36% and 35% of the opposite leg at 60 and 120 deg/sec, respectively. By 6 months, the mean deficits were 2.9% and 2.3% at 60 and 120 deg/sec, respectively. All patients returned to preinjury activity levels at a mean of 4 months (range, 3 to 7) after repair. By 12 months, there were no significant differences in ankle motion, isokinetic strength, or endurance as compared with the uninvolved side.