Background: Controversy persists regarding the
ideal surgical technique for repair of a ruptured Achilles tendon.
We propose a limited open procedure with use of an instrument that
provides the advantage of an open repair but avoids the soft-tissue
problems with which open repair has been associated.
Methods: We first performed a cadaver study in order
to develop an instrument and a technique for a limited open repair
and then, using this procedure in conjunction with an early functional rehabilitation
protocol, we began a prospective multicenter study. We are reporting
on the first eighty-seven patients consecutively treated
with the new instrument and followed for an average of twenty-six
months (range, eighteen to forty-two months). All patients
were assessed clinically and with an enhanced American Orthopaedic
Foot and Ankle Society (AOFAS) rating score. In addition, all fifty
patients who had been followed for at least twenty-four months were
further evaluated with isokinetic dynamometry.
Results: Four patients were lost to follow-up
and one patient died, which left eighty-two patients for
evaluation. There were no problems with wound-healing, and there
were no infections. No patient noted a sensory disturbance in the
sural nerve distribution. All patients returned to their previous
professional or sporting activities. The mean AOFAS score was 96
points (range, 85 to 100 points). Isokinetic dynamometry showed
no significant difference in strength between the injured and uninjured
limbs of the fifty patients who were tested. Complications occurred
in three patients. Two of them were noncompliant and removed the
orthosis, so that the repair was disrupted by a new injury within
the first three weeks postoperatively. One patient fell twelve weeks
after the surgery and sustained a rerupture. All three new injuries
were repaired with an open surgical procedure.
Conclusions: This new procedure allows the surgeon
to precisely visualize and control the tendon ends while avoiding
excessive dissection and disturbance of local vascularity and minimizing nerve
and wound-healing problems. Such a technique, along with an early
functional rehabilitation program, allowed us to achieve a high
rate of successful results with minimal morbidity.