Surgical repair of Achilles tendon ruptures

Abstract

We evaluated the surgical results of 42 consecutive patients with spontaneous rupture of the Achilles tendon treated from 1973 to 1984 to determine the causes of rupture and to evaluate our treatment methods. Patients were divided into early and late repair groups and their charts reviewed to determine common clinical features. A new method of repair with early functional range of motion exercises before casting was used and compared to other techniques in common use. Thirty-one patients were contacted for long-term followup (average, 4.7 years). Twenty-three of these patients returned for intensive reevaluation and Cybex testing. We found a high incidence of gout (14.3%) and previous steroid injections (7.1%) in our patients. Good results were obtained from the four surgical methods used. There were no reruptures and only 7% of the patients experienced minor wound problems. Patients treated with early functional range of motion exercises averaged 12.5 degrees more dorsiflexion at the time of cast removal and did not require adjunctive protective devices. Long-term results, however, revealed equilibration of range of motion and near normal function in all repair techniques with 88% of all patients returning to preinjury activity levels.

Therapeutic potential of mesenchymal stem cells to treat Achilles tendon injuries

“…Achilles tendon ruptures are common injuries in patients from 30 to 55 years of age and represent 35% of all tendon injuries, including more than 75% of those occurring during participation in sports activities (Beskin et al, 1987;Józsa et al, 1989). The annual incidence is 18 to 37 cases per 100,000 individuals, and they commonly result from indirect injuries caused by mechanisms that include forcible traction of the foot with the knee in extension and a sudden and unexpected dorsiflexion of the ankle or violent dorsiflexion with the foot in plantar flexion.…”

Unfavorable effect of knee immobilization on Achilles tendon healing in rabbits

“…Some investigators have asserted that immobilization of the knee joint is not necessary for treatment (Beskin et al 1987, Carden et al 1987, and recent treatment trends are towards immobilization of only the ankle (Cetti et al 1993, Rantanen et al 1993, Soldatis et al 1997. However, to our knowledge, no authors have explained why immobilization of the knee joint is not necessary for the treatment of Achilles tendon rupture.…”

Tendon and Ligament Tissue Engineering, Healing and Regenerative Medicine

“…Re-rupture rate of 3.5% in the operatively treated patients and 12.6% in the nonoperative patients has been reported previously [38]. Complications such as adhesions, altered sensation, and wound infection, however, were more common in operatively treated patients with 34.1% in the operative patients versus 2.1% in the non-operative patients [39].…”

“…The most common and easiest autograft to harvest is with the plantaris tendon, which is usually intact after a rupture and easily available through the same surgical wound. The tendon is cut from its insertion on the calcaneus and stretched or "fanned out" and can be placed over the rupture site with absorbable sutures [37][38][39].…”

“…Controversy regarding operative versus non-operative treatment exist in the treatment of tendon ruptures that focuses on re-rupture rates and wound complications related to surgery [15,[35][36][37][38]54]. Re-rupture rate of 3.5% in the operatively treated patients and 12.6% in the nonoperative patients has been reported previously [38].…”