Clinical Tip: Achilles Tendon Repair with Accelerated Rehabilitation Program

The management of acute Achilles tendon ruptures is much-debated. Conservative management has been advocated by some who reported that strength and function were similar whether the rupture was treated by operative or nonoperative methods.6,11 However, others have recommended operative treatment, because they found lower rerupture rates and improved power after repair.1,3,4 Various techniques of Achilles tendon repair are used. The classic method of repair uses a Kessler stitch that may be reinforced with the plantaris tendon, which is released proximally and passed in a loop proximal and distal to the Achilles rupture. Many other modifications and variations have been described, including fanning out and tacking the plantaris tendon over the repair;6 using a ‘rotation flap’ of proximal Achilles tendon and gastrocnemius;9 and using a ‘dynamic loop suture’ of peroneus brevis tendon to itself.13 Numerous suture techniques also have been described.5 Percutaneous repair was first described in the 1970s10 and has recently attracted renewed interest. Advocates of this technique cite improved cosmesis, fewer wound complications,7 and the possibility of repair with local anesthesia as advantages. However, rerupture rates have been found to be higher than with open techniques.2 More recently, ‘‘mini-open’’ techniques have been used.12 Despite the variety of operative techniques, postoperative management and