INDICATIONS FOR AND LIMITATIONS OF NONOPE RATIVE TREATMENT OF ACUTE ACHILLES-TENDON RUPTURES WITH EARLY MOBILIZATION

According to sonographic criteria, 55 patients underwent surgical trea tment with mobilisation in a lower leg plaster or conservative treatme nt with early mobilisation in heel pad (3 cm) shoes when an acute Achi lles tendon rupture (ATR) was diagnosed. The follow-up period in 51 pa tients was 2.4 years (operated group = 28 patients, conservative group = 23 patients) with clinical examination and testing of isokinetic mu scle strength in knee joint flexion. After surgical treatment, minor w ound infections occurred in 10.6 %. Reruptures occurred in 13 % of the conservative group. Following conservative treatment, the rate of str ess-related achillodynia was significantly higher (P = 0.019). In the operated group mean isokinetic muscle strength was 13.7 % lower than i n the uninvolved leg and decreased significantly with non-operative tr eatment to 75.3 % (P = 0.012). We recommend surgical treatment of acut e ATR. The indications for conservative treatment depend on the extent of the rupture (measured by ultrasound in the equinus position), the desired level of daily activity and the patient's degree of compliance .