Achilles tendon ruptures: functional outcome of surgical repair with a "pull-out" wire

This is a retrospective review of 30 consecutive patients with acute Achilles tendon ruptures treated surgically by a single surgeon between 1992 and 1999. Repair was effected with a 26-gauge "pull-out" wire technique. A compressive dressing reinforced with plaster was employed to immobilize the ankle in neutral for 6 weeks. The hardware was removed 6 weeks postoperatively under local anesthesia. Intensive physical therapy was employed until ankle motion was symmetric and single heel raise was possible. Average follow-up was 4 years (range, 1-8 years). Nearly all patients (29/30) report satisfaction with their outcome. Most patients (29/30) had AOFAS Ankle-Hindfoot Scores greater than 90. Twenty-three (77%) returned to preoperative levels of athletic activities. Isometric testing documented 81% plantarflexion strength compared to the normal ankle at a mean of 32 months postoperatively. Five of eight women reported shoe wear difficulties related to the incision. There were no reruptures or deep infections. The "pull-out" wire technique is recommended for patients who wish to return to an active lifestyle. This method provides rigid approximation of tendon length, minimizes strangulation of tissue, repairs large gaps, and avoids late foreign-body reactions.