Speaker: Repair, rehabilitate Achilles tendon ruptures early
WAILEA, Hawaii — With one opportunity to restore Achilles tension after an Achilles tendon rupture, surgeons in the United States will repair these injuries as soon as possible, according to a presenter at Orthopedics Today Hawaii.
“If you catch that patient literally the moment they injure their Achilles and you put them in a plantar flexed cast or boot and you run them through functional rehab, you can still have a good outcome; but oftentimes, that is not the case,” Andrew Hsu, MD, said in his presentation.
He noted patients with Achilles tendon ruptures do not need to undergo an MRI, which can delay surgery, unless they have a more complicated injury, such as preexisting tendinosis, the physician cannot feel the defect, or patients have combined insertional or mid-substance tears.
Hsu also noted Achilles tendon ruptures should be treated with minimal dissection and maximal strength. Although Hsu noted there is nothing wrong with use of traditional open Krackow sutures, he added the back of the ankle has poor healing potential.
“When things go south, things go really, really south,” Hsu said. “It’s not just put on a little Neosporin and antibiotics. We can talk about free flaps, below the knee amputations, really, really disastrous complications when you have incisions on the back of the ankle that go wrong.”
However, minimally invasive techniques can minimize the amount of dissection on the paratenon and the skin, and lead to smaller wounds and better outcomes, according to Hsu.
Variability in suture knots can also present issues, which Hsu said may be resolved with a knotless system that “could bridge the area of disruption across the Achilles tendon and dock it straight into the bone, similar to the idea of the internal brace of how do we back up our repair so we can get people moving.”
Finally, Hsu noted patients should be mobilized early and undergo rehabilitation as fast as possible.
“Ideally, [patients are] doing plantar flexion range of motion day one, weight-bearing day 1 to reorganize the collagen,” Hsu said. “If you look at people in a cast, their calf muscle atrophies to the size of their biceps, basically, by the time they’re out of the cast. For every day in the cast, [there are] 2 to 3 days of rehabilitation. Think about how much time that eats up for an already difficult injury.”