A. Buchgraber et Hh. Passler, PERCUTANEOUS REPAIR OF ACHILLES-TENDON RUPTURE - IMMOBILIZATION VERSUS FUNCTIONAL POSTOPERATIVE TREATMENT, Clinical orthopaedics and related research, (341), 1997, pp. 113-122
Between 1987 and 1992, 38 patients with ruptured Achilles tendons were
operated on using a standardized microinvasive technique; 30 patients
underwent functional postoperative treatment, whereas 18 underwent co
nventional cast immobilization, Validated tests and a specially design
ed instrument for measuring strength and endurance were used for follo
wup examinations, Patients undergoing functional postoperative treatme
nt were hospitalized for shorter periods and lost fewer days from work
than those in the cast group, Tests of ankle mobility showed more pro
nounced limitations of plantar flexion in cast immobilized versus func
tionally treated patients, Patients in the cast group also did less we
ll on maximal one leg tiptoeing. Percutaneous Achilles tendon repair w
ith functional postoperative treatment and early full weightbearing wa
s associated with significantly less severe limitations of calf muscle
work by the injured leg than postoperative cast immobilization, The r
erupture rate was no higher than after cast immobilization, but lower
than after open surgical repair or conservative functional treatment a
lone, Unlike those undergoing conservative functional treatment, patie
nts 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 fr
om work than those immobilized in a cast, cast immobilization after Ac
hilles tendon suture repair is no longer justified.