Formal open repair of the achilles tendon

Abstract

Acute ruptures of the Achilles tendon are common injuries associated with trauma, male gender, obesity, and a history of injected corticosteroids. Although there is a significant increase in the incidence of Achilles tendon injuries over the last two decades, there is no consensus regarding the optimal management (operative vs. nonoperative) of acute ruptures of the Achilles tendon. This chapter describes the operative technique favored by the senior author as well as a physical therapy protocol that has resulted in excellent outcomes. A number of studies have shown that surgical repair results in less morbidity and improved function. For example, surgically repaired tendons are at lower risk of rerupture, and patients who elect surgery achieve normal push-off power. One randomized prospective study compared operative versus nonoperative treatment of acute ruptures of the Achilles tendon in 111 patients and demonstrated better results (resuming sports activities, fewer subjective complaints) in the operative group at 1 year follow-up, although there were fewer minor complications in the nonoperative group. Other advantages of surgical repair include decreased ankle stiffness and calf atrophy, fewer tendocutaneous adhesions, and a lower risk of thrombophlebitis. Open operative treatment of acute ruptures of the Achilles tendon is probably the method of choice for athletes and patients who wish to continue with high-demand physical activity. Two recent meta-analyses of randomized controlled trials showed that operative management has a reduced risk of rerupture compared with conservative measures, but was associated with an increased risk of complications including wound infections, delayed wound healing, adhesions, and disturbed sensations. © Springer Science+Business Media, LLC 2009.