Achilles Rupture Repair Research Articles

The Best of Both Worlds

The minimal invasive surgery in Foot and Ankle is here to stay and its growth and strength is undeniable. During the 90s in the American continent, forefoot minimal invasive surgery was dominated by North American Podiatrist, during that time the now called “first generation MIS” for Hallux Valgus wasn´t well accepted by orthopedic foot and ankle surgeons. It was a controversial topic pointed out as a “blind with no fixation technique” that could not be predicted on its outcome. This was supported because of the lack of scientific studies regarding this MIS bunion´s correction and the fact that there were some publications and oral presentations putting it down because of its detrimental outcomes. In the 2000s and 2010s the orthopedic world started to look more seriously into this ideology and started to do a formal scientific work and resulted in this ultimate generation percutaneous Hallux Valgus correction with hardware fixation backed up with several papers with clinical and radiological outcomes. Proof of this is the threefold rise in publications on MIS that arouse from 10,127 in med nineties to 30,362 in 2015. At the same scenario, percutaneous metatarsal osteotomies that were done in despite of Metatarsophalangeal dislocation, found its contraindication on this new paradigm and must be done in an open fashion to reduce it when doing a percutaneous bunion, giving a place to hybrid surgery. Also Minimal Invasive Queilectomy for Hallux Rigidus yielded more second procedures than open surgery in some publications favoring this latter technique. Open surgery has been studied for many years reporting good to excellent outcomes in forefoot, midfoot, hindfoot and ankle. Wound Complications and faster recovery time are the main factors that pulled the indications for some open procedures to be done in a minimal invasive fashion like Achilles Rupture repair, arthroscopic ankle fusion, etc. But there are open techniques such as the Progressive collapsing foot deformity reconstruction, Cavus varus deformity reconstruction, tibial osteotomy for ankle deformities, tendon transfer for neurological pathologies, triple, or double arthrodesis, etc., that are mostly done with “traditional” surgery because of the power of addressing and fixing the problem that isolated minimal invasive procedures could not. Nevertheless, minimal invasive calcaneal osteotomy, arthroscopic arthrodesis, tendoscopy, arthroereisis, arthroscopic or percutaneous lateral ligament reconstruction are excellent complements for those open surgeries. Patient demands in cosmetic scars and very early return to more than moderate physical activity sometimes pushes the surgeon to choose a different procedure he or she are comfortable with, and this could jeopardize the results and elevates the complications possibility. The surgeon must decide on learning new techniques in the foot area that have more advantages for the patient benefit. The Foot and Ankle surgeon should be ready to consider both ways of thinking and being capable of performing either one procedure or sometimes both (hybrid surgery) accordingly to each one´s experience and expertise to be able to give the best resolution to mild, moderate or severe cases for the patients with the least risk of complications. It is our responsibility to evolve…

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Time to Surgery and Technique as Predictors of Complications after Surgical Treatment of Achilles Ruptures: A Retrospective Study

Category: Trauma; Ankle; Hindfoot; Sports Introduction/Purpose: Achilles tendon ruptures are challenging injuries and complications following Achilles repair surgery can lead to poor patient outcomes. The objective of this study was to determine if time to surgery and an open versus closed surgical technique were related to postoperative complications. We hypothesized that an increased time to surgery and an open surgical technique would correlate with an increase in complications. Methods: One hundred ninety-four patients at a single institution who underwent Achilles rupture repair surgery between October 2016 and November 2020 were included. All patients had a minimum follow-up of 3 months +- 14 days. A retrospective review was performed collecting data which included injury and treatment timepoints, surgical technique (open or percutaneous), and complications. Patients were separated into 3 categories based on time to surgery: acute (<2 weeks), sub-acute (2-6 weeks), and chronic (>6 weeks). Complications were categorized as minor (wounds and/or infections that resolved with outpatient care), major (wounds and/or infections requiring operative intervention), re-rupture, DVT, and all other complications. A Fisher's exact test was used to determine if there was a statistically significant relationship between time to surgery and post-surgical complications as well as surgical technique and post-surgical complications. Results: In total, 194 patients were included for analysis: 134 with an acute rupture (69%), 36 sub-acute (18.6%), and 24 chronic (12.4%). 45 complications were observed in 37 patients (19.0% of patients); 8 patients had a minor complication (4.1%), 8 major (4.1%), 7 re-ruptures (3.6%), 12 DVTs (6.2%), and 8 others (4.1%). 25 acute ruptures had complications (18.7%), 6 sub-acute (16.7%), and 6 chronic (25%). No statistical differences were determined between time to surgery or surgical technique and complications among groups. There was an increase in complications in the chronic group, the most notable being Achilles tendon re-rupture (P = 0.06). The mean re-rupture time from the date of original injury to surgery was 47 days (range 3-131 days), and mean time from surgery to re-rupture was 49 days (range 7-133 days). Conclusion: This study did not demonstrate any statistically significant relationship between time to surgery or open versus percutaneous surgical technique and post-surgical complications following operative treatment of Achilles ruptures. Though not statistically significant, complications and re-ruptures were more frequent in patients undergoing surgery >6 weeks following injury. These results suggest increased time to surgery may be a predictor of increased risk for postoperative complications following Achilles repair surgery, however further research including studies with larger patient populations is needed to support this determination.

Achilles Tendon Rupture Repairs: Clinical Outcomes of a Novel Technique

Category:Trauma; Ankle; SportsIntroduction/Purpose:Acute Achilles tendon rupture repair has undergone several changes in the past decade, aiming to minimize complications while maximizing clinical outcomes. Less invasive approaches have been associated with comparable results and decreased infection risk compared with traditional open techniques. Patient positioning during surgery also influences outcomes; prone positioning is associated with increased operative times as well as risk of neuropraxia and ophthalmologic injuries as compared to supine positioning. The Medial Mini-Open Supine (MMOS) Achilles Repair technique combines the benefits of supine positioning and mini-open techniques. This study compares 1-year clinical outcomes, operative times, and complication rates of patients undergoing repair with this novel technique to those treated with an open or mini-open approach with prone positioning.Methods:Patients undergoing operative acute Achilles rupture repair at our institution after February 2015 were included in this study. Patients were grouped by technique used: 1) open repair with prone positioning, 2) mini-open repair with prone positioning, or 3) the medial mini-open repair with supine positioning. Patients were followed for a minimum of 1 year postoperatively. Primary outcome measures include Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Physical Function, Pain Interference and Depression), Foot and Ankle Ability Measure (FAAM) assessments (ADLs and Sport) and Visual Analog Scale (VAS) pain scores. Secondary outcome measures include intraoperative times and complication rates. Statistical analysis to assess for significant differences between the groups was conducted using the Kruskal-Wallis test, Nemenyi test, ANOVA with posthoc Tukey test and chi-square test as was appropriate.Results:A total of 56 patients (Group 1: n=18, Group 2: n=14, Group 3: n=24) were included in this study. Average 1-year PROMIS Physical Function scores were 59.57 (+-12.9), 64.29 (+-13.96) and 63.03 (+-11.69) for Groups 1, 2 and 3 respectively.Average Pain Interference scores were 46.05 (+-17.65), 42.12 (+-8.75) and 42.48 (+-7.11). Depression score averages were 40.79 (+-7.61), 36.87 (+-9.35) and 39.81 (+-9.48) for Groups 1, 2 and 3, respectively. Differences between groups were not significant (p >0.05). Group 3 had statistically significant differences in total OR time compared to both Groups 1 and 2. The median difference was 33 min between Groups 1 and 3, and 35 min between Groups 2 and 3 (p<0.01) The majority of time savings arose from pre- incision setup and post-closure times. Differences in complication rates (5.5% (n=1), 14.3% (n=2), and 12.5% (n=3), for Groups 1, 2 and 3 respectively) were not statistically significant (p=0.73).Conclusion:The Medial Mini-Open Supine Achilles Repair technique shows promise as a viable option for acute Achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. Patient-reported outcomes at 1-year follow-up demonstrate comparable results with both open and mini-open prone techniques, without an increase in complication rates.

Safety and Efficacy of Achilles Repair Using the Mini-Open Approach in Supine Versus Prone Position: A Retrospective Study.

PurposeSurgical repair of the Achilles tendon is a common procedure in cases of acute rupture. Open Achilles tendon surgery with a traditional extensile approach is most often performed in the prone position, but this can lead to numerous complications. The mini-open approach for repair in the supine position may avoid the risks of the prone position. The purpose of this study is to compare perioperative outcomes and differences in cost between patients undergoing acute Achilles rupture repair with mini-open approach, incision of approximately 3 cm, in the supine position versus traditional approach in the prone position.MethodsPatients who underwent surgical repair of acute Achilles rupture at a single institution were retrospectively identified using Current Procedural Terminology (CPT) code 27650. Complication rates and the total cost charged to the insurance companies of both the supine and prone groups were calculated.ResultsA total of 80 patients were included for analysis, 26 supine and 54 prone. The difference in average total time in the operating room was statistically significant. The prone position took approximately 15% more time (118.7 minutes) compared to the supine position (100 minutes) (p = 0.001). While not statistically significant, the total cost for the supine group ($19,889) was less than the for the prone group ($21,722) (p = 0.153) Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and deep vein thrombosis (DVT) rate were also similar between the two groups. No patient in either group experienced re-rupture of the Achilles tendon within the first year of primary repair.ConclusionThe mini-open approach in the supine position may be advantageous in the repair of acute Achilles rupture in that it reduces total time in the operating room and total cost while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

Return to Driving After Foot and Ankle Surgery: A Novel Survey to Predict Passing Brake Reaction Time.

Introduction. Brake reaction time (BRT) is an accepted method for establishing recommendations for safe return to driving by the National Highway Traffic Safety Administration. Other than performing a BRT test in clinic, there is no established clinical tool to help physicians differentiate safe from unsafe drivers once patients reach general recovery milestones. The purpose is to present individual recommendations to the patient through a novel, validated survey evaluating safe return to driving after orthopaedic surgery of the right foot and ankle. Methods. A total of 171 patients undergoing 1 of 3 specific foot and ankle procedures were prospectively enrolled. A 4-question survey and BRT were completed 6 weeks postoperatively. The following questions were asked: (1) "I think my brake reaction time is slower than most drivers my age," (2) "I think my brake reaction time is faster than most drivers my age," (3) "I think my brake reaction time is about the same as most drivers my age," (4) "Based on what I think my brake reaction time is, I think I am ready to drive." Internal consistency was determined with Cronbach's α and item total correlation. External validity was determined by Spearman's correlation coefficient. A BRT less than 0.850 s was considered as a pass. Results. Of 171 patients, 162 (95%) with ages ranging from 21 to 83 years achieved a passing BRT by 7.6 weeks. After removing 1 question because of internal inconsistency, the optimal threshold for predicting passing BRT was 10/15 points or higher, which had 99% probability of success that a patient would pass the BRT (95% CI = 96%, 100%). Conclusion. This novel, 3-question driving readiness survey can accurately predict a passing BRT Achilles rupture repair, total ankle arthroplasty, and hallux valgus correction performed in the right foot and ankle as early as 6 weeks postoperatively.Level of Evidence: Level II: Comparative study.

Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study

Category:SportsIntroduction/Purpose:Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position.Methods:Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant.Results:A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups.Conclusion:The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

Return to Driving After Foot and Ankle Surgery

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Sports Introduction/Purpose: The time frame for safe return to driving is an important question amongst physicians and patients following orthopaedic surgery of the right lower extremity. There is no universally validated foot and ankle psychometric test that confirms patients’ ability to safely return to driving after surgery. The purpose of the study is to report a novel, validated survey that can be used to confirm safe return to driving after orthopaedic surgery of the right foot and ankle. Methods: Patients that had undergone right achilles rupture repair, total ankle arthroplasty, and hallux valgus correction by four fellowship-trained foot and ankle surgeons were prospectively included over a trial period of 4 months. A four-question survey (see Figure 1) was administered at the 6 week post-operative office visit. Breaking reaction time (BRT) was then assessed using the Reaction Time Tester, Model RT-2 S (Advanced Therapy Products, Glen Allen, VA). A passing BRT for safe return to driving was considered 0.850 seconds. Statistical analysis was performed and Cronbach’s alpha was calculated to determine validity of the survey relative to BRT results. One hundred and twenty-two patients were included with ages ranging from 21 to 76 years (average 45 years). Results: One hundred and nine (89%) of 122 patients achieved a braking time of 0.850 seconds or less. Using time-to-event analysis, 95% of patients passed at 7.6 weeks. With a “strongly agree” or “agree” response to question 4, the survey predicts a 96% certainty of passing the BRT. At first, validating the psychometric test across all three procedures resulting in a poor Cronbach’s a of 0.6. When question 3 was removed from statistical analysis, the Cronbach’s alpha was 0.76 and the psychometric test was validated for all studied procedures. Upon calculating a composite score from the 3-question survey, the optimum threshold for a passing braking time was at least 10 points resulting in a very good AUC score of 0.948. Conclusion: This novel, three-question driving readiness survey can accurately predict a passing breaking reaction test. This provides foot and ankle surgeons with a valuable tool to objectively determine if a patient can safely return to driving after achilles repair, total ankle arthroplasty, and hallux valgus correction. Further study is required to determine whether patients who come to clinic weeks before their standard post-operative follow up appointment with the belief that they are ready to drive also pass the BRT. Additional validation of the survey would be valuable across other foot and ankle procedures.

Evaluation of Brake Response Time Following Primary Achilles Tendon Repair Surgery

Category: Sports. Introduction/Purpose: Although surgical repair of Achilles tendon ruptures are common procedures, there are no studies investigating postoperative driving safety in these patients. Active contracture of the Gastroc-soleus-Achilles mechanism is required during a braking maneuver while driving. There is concern that these patients may be hesitant to rapidly apply braking pressure, putting themselves and others at potential risk. The purpose of this study was to evaluate postoperative brake response time (BRT) in right-sided Achilles rupture repair patients as a means to determine driving preparedness. BRT is defined as the time, in milliseconds, between presentation of a perceived hazardous stimulus and the application of pressure to the brake pedal in a driving simulator model. We hypothesized patients would demonstrate BRTs comparable to control subjects 6-week after repair. Methods: Following IRB approval, 50 right-sided acute primary Achilles rupture repair patients were prospectively identified and enrolled. All patients were managed with a standardized postoperative protocol. Exclusion criteria were age under 18, those not in possession of a valid driver’s license, those undergoing non standard open primary repair, and those declining to participate in the study. All patients were tested for their BRT utilizing a validated driving simulator at their 6-week postoperative follow-up appointment. Those patients that failed to achieve a safe brake response time less than 0.850 seconds were re-tested at weekly intervals until a safe breaking time was achieved. The passing brake response time of 0.850 seconds was determined from the published control data and from testing 20 healthy volunteers in the same simulator. At each testing, patients also filled out an AOFAS Ankle Hindfoot Scale, an Achilles Tendon Total Rupture Scale (ATRS) Questionnaire and a Driving Preparedness survey. Results: Each subject underwent 3 sequential drive-braking simulation tests, with their BRT being calculated as an average of the 3 times. At six weeks post repair the overall average BRT for all 50 patients was 0.658 seconds. 47 of the 50 patients (94%) demonstrated safe average BRT at their 6-week post operative testing of equal to or less than 0.850 seconds, with the remaining 3 patients achieving a safe BRT after 7 weeks. All 47 patients whose test demonstrated a safe BRT at 6 weeks responded in their survey that they “Agreed” or “Strongly Agreed” they were ready to drive at the time of testing. At six weeks post repair, the average AOFAS-AH score was 78.7/100, and the average ATRS score was 54.0. Conclusion: The present study revealed that 94% of primary right-sided acute Achilles tendon rupture repair patients were able to demonstrate a safe BRT comparable to those of healthy control subjects 6 weeks after their surgical procedure, and all by seven weeks following surgery. 100% of these patients also reported that after completing the test, they felt ready to return to driving. Therefore, we believe that it is reasonable to offer primary Achilles tendon repair patients an estimate of 6-weeks recovery time before driving.

Early Functional Treatment Versus Cast Immobilization in Tension After Achilles Rupture Repair

Background: There are no long-term prospective controlled trials comparing postoperative regimens after Achilles tendon rupture repair. Purpose: To compare ≥10-year outcomes of 2 postoperative regimens after Achilles tendon rupture repair: early weightbearing with early mobilization versus early weightbearing with early immobilization in tension. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 50 patients with acute Achilles tendon ruptures were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks (group 1) or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks (group 2). Patients were assessed at 3, 6, and 14 months and 11 years postoperatively. Results: There were 37 patients (74%) evaluated at a mean (±SD) of 11.0 ± 0.9 years. The mean Leppilahti score was 92.9 ± 5.6 in group 1 and 93.6 ± 7.2 in group 2 (P = .68). The mean isokinetic plantar flexion peak torque deficits or average work deficits in plantar flexion showed no differences between the groups with any angular velocity. Isokinetic strength changed minimally between 1 and 11 years compared with the unaffected ankle, but a mean deficit of 5% in peak torque and mean deficit of 8% in average work were still present after 11 years. On the contrary, isometric plantar flexion strength recovered significantly, with only a 2.4% difference at 11-year follow-up. Conclusion: After the 11-year follow-up, early mobilization and immobilization in tension after Achilles rupture repair resulted in similar clinical outcomes and isokinetic strengths. Regardless of patient satisfaction with the operative treatment, calf muscle strength did not recover normally even at 11-year follow-up.

Early functional treatment after Achilles rupture repair

Early functional treatment after Achilles rupture repair

Chronic Achilles Rupture Repair by Allograft With Bone Block Fixation

Chronic Achilles Rupture Repair by Allograft With Bone Block Fixation

Results of Accelerated Postoperative Rehabilitation Using Novel “Suture Frame” Repair of Achilles Tendon Rupture

The management of Achilles tendon rupture is a much-debated subject. In recent years, there has been much interest in early postoperative mobilization. We present the results of our Achilles tendon repair technique and accelerated rehabilitation program. The technique we propose uses the strength of a 1-loop polydioxanone “suture frame” to enable restoration of the tendon length, immediate positioning of the foot in a near-plantigrade position, and an accelerated rehabilitation program. We followed up 15 cases of Achilles tendon rupture treated with this technique. The initial follow-up was a review of case notes and a telephone questionnaire. All patients were subsequently invited for a clinical follow-up visit, and 11 patients (68.75%) attended. No cases of infection or repeat rupture occurred. The return to work (mean 5.6 weeks) and return to sport (mean 4.8 months) were relatively rapid. Regarding overall satisfaction on a scale of 0 to 10, the median was 9 (range 8 to 10). Of the 11 patients who attended the clinical follow-up visit, the mean American Orthopaedic Foot and Ankle Surgery ankle-hindfoot score was 94.5 points (range 83 to 100). The Achilles rupture repair scores (including isokinetic muscle strength) were good or excellent in all but 1 patient, whose result was fair. Of the 11 patients, 10 reported complete satisfaction with their outcome. Our technique with accelerated rehabilitation is safe and effective in the management of acute Achilles tendon rupture. It facilitates an early return to work and recreational sports, with excellent overall patient satisfaction.

A Simple Suture Technique for Achilles Rupture Repair

A Simple Suture Technique for Achilles Rupture Repair

Description de la force isocinétique de la cheville après réparation chirurgicale du tendon d’Achille (tendon calcanéen)

Objective To describe the isokinetic strength recovery of ankle flexors after Achilles rupture repair. Synthesis of facts The isokinetic strength of ankle flexors was measured in 18 sports subjects at four, six and 12 months after Achille tendon repair and according to tendon elongation and ankle steepness. The results shown a plantar flexors strength deficit is respectively of 27, 18 and 7% at four, six and 12 months postsurgery. In case of tendon elongation, the deficit was higher. In case of ankle steepness, a dorsal flexors deficit was also present. Conclusion The ankle isokinetic strength recovery makes gradually over 12 months after Achilles tendon repair.

Achilles Tendon Elongation after Rupture Repair

Background A few prospective controlled trials comparing early functional rehabilitation after Achilles tendon repair and non-operative immobilization have been reported. Hypotheses There is no difference in Achilles tendon elongation between early motion and immobilization after Achilles tendon repair. Tendon elongation does not correlate with the clinical outcome. Study Design Randomized clinical trial; Level of evidence, 2. Methods Fifty patients with acute Achilles tendon rupture were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks or immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks. Full weightbearing was allowed after 3 weeks in both groups. Standardized radiographs to measure previously placed radiographic markers were taken on the first day postoperatively and at 1, 3, 6, 12, 24 weeks postoperatively, with the final radiograph a mean of 60 (SD, 6.4) weeks postoperatively. The outcome was assessed at the 3-month and final checkups by the clinical scoring method described by Leppilahti et al and included subjective factors and objective factors. Results Tendon elongation occurred in both groups but was somewhat less in the early motion group (median 2 mm in the early motion group vs median 5 mm in the cast group a mean of 60 weeks postoperatively, P = .054). The elongation curves first rose and then slowly fell in both groups. The patients who had less elongation achieved a better clinical outcome (ρ= -.42, P = .017). Tendon elongation did not correlate significantly with age, body mass index, or isokinetic peak torques. Conclusion Achilles tendon elongation was somewhat less in the early motion group and correlated with the clinical outcome scores. We recommend early functional postoperative treatment after Achilles rupture repair.

Surgery for chronic Achilles tendinopathy. Review of 91 procedures over 10 years.

The authors reviewed 91 surgical procedures in 87 patients with chronic Achilles tendinopathy. There were 62 males and 25 females (mean age, 44.9 years). The average interval between surgery and review for the group was 4.2 years (range, 1 to 10 years). Twenty patients underwent peritenolysis, with a mean return-to-activity time of 7.7 weeks. Four patients with concomitant bony procedures had significantly longer return-to-activity times than 16 patients who underwent peritenolysis only. The mean return-to-activity time was 13.2 weeks in 15 patients who had Achilles debridement for mucoid degeneration, 14.4 weeks in 32 Achilles tendocalcinosis repair patients, 18.6 weeks in 24 patients who had retrocalcaneal exostectomy procedures, and 34.0 weeks in 5 patients who had chronic Achilles rupture repair. Athletic patients (n = 47) had significantly shorter return-to-activity times than active (n = 38) and sedentary (n = 6) patients. Males returned to activity faster than females. Runners returned to activity faster than other patients.

Early Functional Treatment versus Early Immobilization in Tension of the Musculotendinous Unit after Achilles Rupture Repair

Early Functional Treatment versus Early Immobilization in Tension of the Musculotendinous Unit after Achilles Rupture Repair

Relationship between calf muscle size and strength after achilles rupture repair.

The object was to study the relationships between calf muscle size and strength in 85 patients an average of 3.1 years after repair of achilles tendon rupture. The isokinetic calf muscle strength results were excellent or good for 73% of the patients, whereas calf muscle size was normal in only 30%. The average plantar flexion peak torque per unit muscle cross-sectional area was higher on the injured side than on the uninjured side. The average calf muscle cross-sectional area deficit was 15+/-9% (p<0.001) of that on the unaffected side, while the average plantar flexion peak torque deficit was speed-dependent, being 9+/-18%, 10+/-18 and 2+/-13% of that on the unaffected side at 30, 90, and 240 degrees/sec (p<0.001). The correlation between cross-sectional area and peak torque varied in the range 0.52-0.61 at 30, 90 and 240 degrees/sec (p<0.001).

Outcome and Prognostic Factors of Achilles Rupture Repair Using a New Scoring Method

A new clinical scoring system, including subjective assessment of symptoms and evaluation of ankle range of motion and isokinetic measurement of ankle plantar flexion and dorsiflexion strengths, is presented in 101 patients (86 men, 15 women) who had repair of a closed Achilles tendon rupture. Twenty-one patients were competitive athletes and 70 were recreational athletes. Eighty-one percent of the ruptures were related to sports, and 32% occurred while playing volleyball. Twenty-six patients had previous Achilles tendon symptoms. At followup, an average of 3.1 years after repair, the overall result scores were excellent in 34 cases, good in 46, fair in 17, and poor in four. Only age was a predictor of overall results. The isokinetic strength scores were excellent or good in 72 cases, fair in 18, and poor in 11. Presence of systemic diseases, activity level, previous Achilles tendon symptoms, and later return to physical exercise were predictors of strength results. Gender, body weight, height, period between rupture and operation, surgeon, rupture site, operative method, complications, and thickness, width, and area of the Achilles tendon at followup were not related significantly to the outcome.