Results of tenorrhaphy with early rehabilitation for acute tear of Achilles tendon

Abstract

Background: For the treatment of acute Achilles tendon rupture, early rehabilitation after surgical repair is believed to be a useful method. The purpose of this study was to evaluate the outcome of open tenorrhaphy followed by early rehabilitation. Methods: A total of 112 patients who underwent open repair and early rehabilitation for acute Achilles tendon rupture from January 2003 to March 2015 were retrospectively reviewed. These 112 patients (80 men, 32 women) had an average age of 43.1 years (22-62 years), and the mean follow-up period was 91.8 months (12-171 months). A short leg cast was applied postoperatively for an average of 16.5 days (12-20 days). The mean duration of bracing was 6.9 weeks (6-8 weeks). Each patient was assessed based on range of motion, single heel raising test, calf circumference compared to the contralateral limb, ability to return to previous activity, the Arner-Lindholm scale, and the American orthopaedic foot and ankle society (AOFAS) hind foot scale. Isokinetic plantar flexion power was also checked. Results: All patients were fully satisfied (AOFAS ! 90) with the treatment results, and 96 patients were able to return to their previous athletic activities. As assessed by the Arner-Lindholm scale, 103 cases were rated as excellent and the other 9 cases were rated as good. At the 1-year follow-up period, single heel raise and hopping was possible in every patient. Compared to the contralateral side, 10 subjects (8.9%) had minor limitation of dorsiflexion motion, and an average of 1.6 cm calf circumference difference without functional disabilities. There were no major complications such as re-rupture, nerve injury, or infection. Conclusion: For acute Achilles tendon ruptures, open surgical repair with optimal length restoration, followed by earlier rehabilitation results in good functional outcomes and a successful return to preinjury levels of physical activity without major complications. Level of evidence: Level IV.

Early rehabilitation protocol after Achilles tendon tenorraphy: ultrasonography and elastosonography difference with immobilization in cast: an observational study.

“…This evidence is due to the use of However accelerated protocol seems to provide positive aspects: first off all, according to Huang et al [19] faster mobility of the ankle joint produced a better restoration of articular range of motion, with an improvement of local edema and to prevent stiffness and calf atrophy [20]. Moreover in previous literature [21] Regarding clinical and functional outcomes, Ryu et al [22] reported a case series of 112 patients treated with early rehabilitation for acute tear of Achilles tendons. All patients included in this study were fully satisfied, with an AOFAS score at 1 year follow up of 95.7.…”

Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

“…The reference sources report methodological discrepancies in the applied physiotherapy protocols for patients after the surgical suturing of the AT [46][47][48]. Physiotherapeutic procedures conducted up to 4 months after surgical suturing of the AT have already been described [49,50]. The applied postoperative protocol in this research included the types and number of exercises, series, and rest breaks [19].…”

Treatment of Acute Achilles Tendon Rupture

“…In their study, 40 out of 81 patients (49%) with acute Achilles tendon ruptures were unable to perform a single heel raise at 12 weeks after the injury. In a study by Ryu et al, 41) 87 of 112 patients with acute Achilles tendon ruptures had difficulty with a single heel raise at 3 months after open tenorrhaphy followed by early rehabilitation; however, all patients were able to raise the heel 6 months postoperatively.…”

“…McCormack and Bovard 52) noted a 10% to 30% calf strength deficit on the injured side compared to the uninjured side in their patients with acute Achilles tendon tears. Ryu et al 41) also reported that even in patients who were able to perform single heel raises and sports after operative repair of acute tears and early rehabilitation, the calf circumference decreased by an average of 1.6 cm on the injured side and the isokinetic flexion peak torque deficit at 30°/sec was 16% (range, 0% to 21%) on the injured side compared with the uninjured side.…”

“…In general, the ankle is initially maintained in plantar flexion position with gradual dorsiflexion. However, some authors recommend neutral ankle position immediately after surgery to allow for full weight bearing, 41) because rerupture occurs frequently in gradual dorsiflexion of the plantar-flexed ankle during rehabilitation. Ryu et al 41) reported there was no case of rerupture in the total 112 patients who started weight-bearing ambulation in neutral ankle position immediately after surgery.…”