Acute Achilles Tendon Repair Using a Mini-Dorsolateral Incision and Accelerated Rehabilitation (SS-51)

Abstract

Purpose: to assess the midterm clinical outcomes of acute Achilles tendon repairs using a mini-dorsolateral incision and the effectiveness of rapid rehabilitation. Introduction: There is no consensus as to the best surgical procedure for primary repair of an acute Achilles tendon rupture. Open techniques are associated with wound healing problems and both open and percutaneous methods have the potential for neurovascular damage. Prolonged immobilization of the repair leads to stiffness and calf atrophy. Standard rehabilitation protocols restrict weight bearing during the first 6 weeks, start biking and jogging at 12 weeks, and a full return to sports at 6 months. A more accelerated rehabilitation program would have many advantages. A consecutive series of acute (within 14 days of injury) Achilles tendon ruptures repaired using a mini-dorsolateral incision were reviewed at a minimum of 12 months follow up. Intra-articular pathology was documented and addressed. The technique used two modified, buried core sutures placed at each torn end of the Achilles tendon. Once approximated, a running whip-stitch reinforced the repair. Functional outcomes measured by ankle hindfoot scores and any adverse events were recorded. An accelerated postoperative rehabilitation protocol was followed. This program allowed immediate postoperative boot ambulation; biking, heel raises to neutral, and BAPS board at 6 weeks; treadmill at 8 weeks; jogging at 12 weeks; and a return to sports at 4 months when only 1 centimeter of atrophy was present. 15 patients (14 men; 1 woman) with an average age of 44 years (range, 32-60) were followed an average of 45 months (range, 14 to 72 months). Postoperative Ankle Hindfoot scores averaged 98.3 [39 pain; 49.6 function; 9.3 alignment]. All patients were able to do single toe raises. 8 of 15 demonstrated measureable atrophy and the average calf circumference loss was 1.0 cm compared to the unaffected side. The only postoperative complication was one case of superficial cellulitis was successfully treated with oral antibiotics. There were no sural nerve injuries, neuropraxias, wound break down, or re-ruptures at final follow-up. The repair of acute Achilles tendon ruptures through a minimal lateral incision provides excellent functional outcomes, avoided complications including sural nerve injury, and permits a return to sports as early as 4 months.