Comparison of Early Functional Rehabilitation and Cast Immobilization after Minimally Invasive Repair of an Acute Achilles Tendon Rupture

Abstract

Category: Hindfoot Introduction/Purpose: The optimal treatment for acute Achilles tendon ruptures is still a subject of debate. Operative repair of an acute Achilles tendon rupture (ATR) reduces the risk of re-rupture and has therefore gained popularity as a standard treatment for ATR. There is ongoing controversy over the best surgical technique and postoperative treatment. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with minimally invasive repair and early functional rehabilitation with the outcomes of similar patients treated with cast immobilization. Methods: 41 patients were enrolled in this study. All included patients underwent minimally invasive surgery, after which a below-knee splint with the foot in 120 degrees of plantar flexion was applied for the first week. Patients were then divided to the cast immobilization group (IG) or to the functional group (FG). The ankle in the IG was immobilized in a fiberglass cast in 110 degrees of plantarflexion during next 1 week and in 100 degrees in next 1 week and neutral position with full weightbearing in weeks 3 to 4. From the second week, patients in the FG were mobilized, full weightbearing, in a CAM Walker boot with weekly removing heel wedges. (first wedge removed at 2 weeks, second wedge removed at 3 weeks, third at 4weeks) Data were collected during the outpatient checks at 6 weeks; 3 and 6 months; and 1 year. Results: There was no clinically important difference between groups with regard to heel height, range of motion, return to work or sports, calf circumference, VAS, AOFAS, ATRS except ROM difference at 6weeks and heel height at 3 months. Rerupture occurred in one patient in each group. Conclusion: The minimally invasive repair of ATR was a safe and reliable technique with good results. Early mobilization and weightbearing seemed to be as safe as more traditional postoperative immobilization with similar functional result and complications.