Early Return to Sports Possible After Achilles Tendon Rupture
Orthopedic surgeons from Japan report a new way to surgically repair acute Achilles tendon ruptures that keep athletes out of a cast and back on the playing field faster. They used a strong suture thread and a new suture technique that allowed patients to get back into action in three months.
The suture thread used was a high tensile strength, braided polyethylene-blend material. The technique they used was a side-locking loop that was easy to use and provided a secure repair of the torn tendon. The Achilles tendon is where the calf muscle attaches to the heel.
Tears or ruptures of this tendon usually occur from side-to-side (horizontal direction) rather than up and down (vertical). The authors used their new side-locking loop from the upper side of the tear and placed the knots for each suture between the locking loops, buried in the tendon. Photographs from the operation are provided to show how the repair is done. A schematic drawing also shows details of how to make the side-locking loop sutures. Step-by-step details of the operative technique were also given.
The surgeons used this new technique in a case series of 20 patients who had sports-related or work-related Achilles tendon tears. Patients ranged in ages from 16 to 70 and were followed for at least two years to see how well they did with this new surgical approach.
No one was placed in a cast, splint, ankle brace, or other form of immobilization following the procedure. The patients were given active range-of-motion exercises to do the day after the surgery. They were allowed to put weight on the foot by the end of the first week and used crutches to get around.
After four weeks, they progressed to full weight-bearing without crutches. And they were instructed to begin rising up on toes (both feet at the same time) six weeks after surgery. Muscle strengthening exercises were also added to the program at that time. By the end of 12 weeks, everyone was back to work or involved in sports at full participation and without any post-operative problems. By this time, they could also complete 20 single-toe rises (raising up on the toes of one foot without the support of the other leg).
The surgeons used MRIs taken at regular intervals after surgery (four weeks, eight weeks, and 12 weeks) to follow the progress of the healing tendon tissue. Their hope was that with early mobilization, tendon healing would be faster. And, in fact, that's exactly what they found. The benefits to patients who want to get back up on their feet quickly are obvious.
This new rigid suturing method gives a stronger suture and higher tensile strength to make recovery faster. Although many people can recover from this injury without surgery, for those who want or need a quick turnaround in function, this new surgical technique may be the answer. Severe ruptures with large defects in the tendon tissue may still require immobilization after surgery.
Since this study was a case series with a limited number of patients, more research is needed to confirm these findings and follow patients over time to see if there are any new issues or long-term problems. It will be necessary to compare patients treated this way with those who are immobilized before this technique can be recommended for use in acute Achilles tendon ruptures. The advantage of this new approach is clear: patients are able to recover faster, avoid the expense of an ankle brace, and experience an early return to normal activities, including sports.
Tadahiko Yotsumoto, MD, PhD, et al. Novel Approach to Repair of Acute Achilles Tendon Rupture. In The American Journal of Sports Medicine. February 2010. Vol. 38. No. 2. Pp. 287-292.