New Surgery for Achilles Tendon Rupture
Rupture of the Achilles' tendon is a fairly common injury. The Achilles' attaches the calf muscle to the calcaneus (heel bone). Surgery to repair the injury may be needed. Rehab can be long and slow.
In this study, researchers from Japan report on the results of a modified method of Achilles' tendon repair. The goal was to allow early weight-bearing and faster return to daily activities.
All patients were active adults between the ages of 16 and 54 years. Both high-level and recreational athletes were included. Surgery was done to adjust the length of the tendon. It was then stitched back in place. A Tsuge suture was used with a figure-eight at one end and a single knot at the other end.
The position of the uninjured ankle was used to determine the appropriate tendon length of the ruptured tendon. Everyone followed the same rehab program:
Week one: The lower leg was immobilized in a cast.
Week two: A walking cast in a position of slight plantar-flexion (toes pointed downward) was
applied. Full weight-bearing was allowed.
Week three: Patients were switched to a hinged foot-orthosis (brace). The brace allowed full
plantar-flexion but a limited amount of dorsiflexion (toes moved up toward the knee). Active ankle range of motion exercises were begun.
Patients could take the orthosis off while sleeping by the end of the third week. By week five, the patients could walk with full weight-bearing without the orthosis. The following week, double-legged heel raises were added.
The brace was no longer needed during indoor activities by week four and could be taken off during outdoor activities after six to eight weeks. When the patient could raise up on the toes of one leg (on the injured side), then jogging and later running and jumping were allowed.
With this new method of Achilles' tendon repair, walking and full weight-bearing were achieved earlier (at two weeks) compared with a standard repair (six to eight weeks). Most athletes were able to return to full sports participation at the end of five months.
Eiji Uchiyama, MD, et al. A Modified Operation for Achilles Tendon ruptures. In The American Journal of Sprts Medicine. October 2007. Vol. 35. No.10. Pp. 1739-1743.