Percutaneous repair of Achilles tendon rupture. Immobilization versus functional postoperative treatment

Between 1987 and 1992, 48 patients with ruptured Achilles tendons were operated on using a standardized microinvasive technique; 30 patients underwent functional postoperative treatment, whereas 18 underwent conventional cast immobilization. Validated tests and a specially designed instrument for measuring strength and endurance were used for followup examinations. Patients undergoing functional postoperative treatment were hospitalized for shorter periods and lost fewer days from work than those in the cast group. Tests of ankle mobility showed more pronounced limitations of plantar flexion in cast immobilized versus functionally treated patients. Patients in the cast group also did less well on maximal one leg tiptoeing. Percutaneous Achilles tendon repair with functional postoperative treatment and early full weightbearing was associated with significantly less severe limitations of calf muscle work by the injured leg than postoperative cast immobilization. The rerupture rate was no higher than after cast immobilization, but lower than after open surgical repair or conservative functional treatment alone. Unlike those undergoing conservative functional treatment, patients need not wear special boots at night or be observed by ultrasound studies at regular intervals. Because the procedure can be done on an outpatient basis and because patients lose significantly fewer days from work than those immobilized in a cast, cast immobilization after Achilles tendon suture repair is no longer justified.