Achilles tendon shortening in cases of elongation following conservative treatment of Achilles tendon rupture.

Introduction: Is operative shortening of the achilles tendon an adequate th erapy in cases of elongation following conservative treatment of achilles t endon rupture? Methods: From 11/89 to 12/97, 12 patients underwent achilles tendon shortening (9 mate, 3 female, average age 43 years). All patients h ad an elongated tendon following conservative treatment of achilles tendon rupture. We were able to examine 8 patients (67%) after the operation. The average follow-up period was 35 (7-103) months with an average span between the primary trauma and surgery of 22 (8-45) months. Results: Prior to surg ery, all patients complained of weakness, gait disturbance and limitation o f activity. At follow-up a subjective weakness of the plantar flexion remai ned in five and an objective weakness in all patients. We found a decrease of the isometric plantar flexion strength to 52% of the non-operated lower extremity while the maximum calf circumference was only 5% decreased. Only two patients reported of a gait disturbance and activity limitation whereas three patients were free of complaints, Using a modified Trillat score (1 967), 7 patients rated good or very good (1 poor). Conclusions: Achilles te ndon shortening in case of elongation following conservative treatment of a chilles tendon rupture helps to decrease gait disturbance and limitation of activity whereas a lack of the isometric plantar flexion strength persists . In our opinion an early decision for achilles tendon shortening might pre vent this deficit.