PRIMARY REPAIR WITHOUT AUGMENTATION FOR EARLY NEGLECTED ACHILLES-TENDON RUPTURES IN THE RECREATIONAL ATHLETE

From 1987 to 1994, the senior author performed 41 Achilles tendon repa irs. We identified 11 patients during this period (age, 35.3 years; ra nge, 26-60 years) who fit the criterion for neglected Achilles tendon rupture (repair greater than or equal to 4 weeks and less than or equa l to 12 weeks from injury), All patients underwent proximal release of the gastrocsoleus complex, imbrication of the early fibrous scar with out excision of any local tissue, and primary repair of the tendinous ends with two No. 5 Ticron sutures (5R, 6L), Several (three to five) N o. 0 Vicryl sutures were used to augment the repair, The ankle was pla ced in a 20 degrees plantarflexion nonweightbearing short leg cast for 3 weeks, All skin closures were primary, At 3 weeks, weightbearing as tolerated was initiated in a short leg cast, The cast was discontinue d at 6 weeks, and physical therapy was initiated, consisting of range of motion exercises and closed kinetic exercises, progressing to funct ional exercises as swelling, strength, and pain allowed. Minimal follo w-up was 18 months (mean, 3.5 years; range, 1.5-5.8 years), There have been no subsequent ruptures to date, All patients returned to a prein jury level of activity at a mean of 5.8 months (range, 2.5-9 months), Total range of motion was not different (P > 0.05) between the involve d (67 degrees) and uninvolved (74 degrees) ankle, Plantarflexion loss of strength in the involved ankle was the same (98.4%, 88.1%, and 87.6 % respectively, involved to uninvolved) as that seen after acute repai r at all speeds tested. Visual analog pain scale (0 to 10) revealed a mean score of 0.7 (range, 0-2) during activities of daily living;Ind 1 .0 (range, 0-3) during sports activity, The subjective and objective o utcome was similar (P > 0.05) to that seen after an acute repair by th e same surgeon. There were no complications including skin sloughs or nerve damage, We believe this is the first article to report the resul ts after primary repair without augmentation for the neglected Achille s tendon rupture, We conclude that this approach can result in excelle nt clinical and functional outcome, a low rate of subsequent rupture, and a high rate of return to sports in the recreational athlete whose repair is performed between 4 and 12 weeks after injury.