Early Active Motion and Weightbearing After Cross-Stitch Achilles Tendon Repair

Abstract

Twenty-two closed Achilles tendon ruptures caused by sports injuries in 22 patients (average age, 37.6 years) were repaired with Kirschmayer core suture and cross-stitch epitenon suture, and early active ankle motion with weightbearing was implemented after surgery. This study was undertaken to evaluate the effectiveness of the repair technique and rehabilitation protocol by assessing clinical results and magnetic resonance imaging findings. The follow-up period averaged 24.6 months. Twenty of the tendons (91%) healed without rerupture, and two tendons (9%) suffered a partial rerupture at 23 and 56 days, respectively. Active ankle extension reached from the minus range to 0 degree in an average of 9.7 days, and ankle motion recovered to normal in an average of 6.0 weeks. Full weightbearing without heel raising became possible in an average of 16.4 days, and heel raising with both legs became possible in an average of 7.3 weeks. The patients returned to full sports activity in 13.1 weeks. The interval until the area of high-intensity signal at the tendon repair site on T2-weighted magnetic resonance imaging scans became intermediate-intensity signal averaged 6.9 weeks, and the tendon repair site became low-intensity signal in an average of 12.6 weeks, demonstrating excellent tendon healing. Treatment employing Kirschmayer core suture and cross-stitch epitenon suture may help athletes return to sports activity in a shorter period than that allowed by previous methods of repair for Achilles tendon ruptures.

Enveloping bioabsorbable polyglycolide membrane and immobilization in achilles tendon repair: A comparative experimental study on rabbits

“…11 Moreover, large intratendinous lesion following operative repair of ruptured Achilles tendon has been associated with a poor outcome in patients during followup. 12 The potential benefits and adverse effects of immobilization versus early mobilization after Achilles tendon repair, 13,14 and after rejoining other tendons, 15,16 have been discussed in many scientific reports. However, no consensus has yet been reached on this matter, especially concerning the management of acute Achilles tendon ruptures.…”

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

“…A n Achilles tendon (AT) rupture is the most frequent tendon injury in the lower limb, with an incidence of 18 per 100 000 individuals each year, [1][2][3][4][5] most of whom are middle-aged [5][6][7] male amateur athletes. 1,8 Tendinous overload 6,9 and a nonuniform distribution of stress 10 promoted by neuromuscular imbalance 11 or pathologic muscular conditions 12 are mechanical factors that contribute to an AT rupture.…”

“…1,8 Tendinous overload 6,9 and a nonuniform distribution of stress 10 promoted by neuromuscular imbalance 11 or pathologic muscular conditions 12 are mechanical factors that contribute to an AT rupture. 6,9,10 Rupture directly compromises motor tasks that require propulsion and takeoff actions, such as gait, running, and jumping, 11,13,14 and appropriate rehabilitation is required to improve the alterations, such as strength loss, that frequently develop after AT surgery. that begin 4 weeks after AT repair represent the traditional rehabilitation model, which is standard practice.…”

“…The other begins with some degree of immobilization or non-weight bearing in the first 4 weeks after AT repair, normally via a rest period during the first 2 weeks after surgery. 21 Currently, managing AT rehabilitation after operative repair remains controversial 1,2,4,5,8,16,22 because of the unknown mechanical tolerances of different operative techniques 4,6 for preventing clinical failure 22 ; the comorbidities associated with traditional management, [3][4][5][6]8,14,16,22 such as muscle atrophy, adherences, delayed collagen remodeling, thromboembolism, and high rerupture rates [2][3][4][5][6]22,23 ; and the risks and complications that can occur during early rehabilitation, 3,4,6,15,21,22 such as tendinous elongation and early reruptures. 3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,…”

“…3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,[21][22][23] to promote better clinical outcomes than are typical with open or traditional rehabilitation programs. 3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks.…”