Tendon Resection and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair

Abstract

Category: Other. Introduction/Purpose: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon, itself, as well as the thin surrounding soft tissue. For management of an infected Achilles tendon following tendon repair, we first focused on complete debridement with tenectomy and then promoted scar healing of the Achilles tendon using functional management. Methods: We retrospectively reviewed all of the medical records of 15 patients with post-operative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, twenty two to 97 months). Tenectomy with radical debridement was performed, and the ankle was placed in a short leg splint for two weeks. The splint was then replaced with an ankle brace for the next four weeks. Partial weight-bearing walking was allowed immediately, and full weight-bearing walking was allowed two weeks postoperatively. We assessed the physical parameters such as range of motion, the calf circumference, capability of single heel raising, satisfactions and the Arner Lindholm scale were recorded. Laboratory test, post- operative ultrasonography and isokinetic plantar flexion power was also checked. Results: At the final follow-up, any sign of infection had disappeared without recurrence in all of the patients. Achilles tendon continuity recovered in all by scar healing. Compared to the contralateral side, there was no difference in the range of motion in eight patients. According to the Arner Lindholm scale, nine of fifteen cases were excellent and the other six cases were good. Their ability regarding single-heel rising on involved leg was achieved in ten patients. Eleven of 15 patients could return to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity within the tendon sheath was observed on the ultrasonographic examination or MRI. Conclusion: Tenectomy of infected Achilles tendon and radical debridement with vigorous rehabilitation is simple and successful management way for the postoperative infection following Achilles tendon repair.