![]() The secondary aim was to assess whether the repair of the AT as in an “anatomical reconstruction” technique resulted in superior objective outcomes compared to the traditional repair technique. Derived from the available literature, our main hypothesis was that there will still be end-range isokinetic plantarflexion deficits which will further reflect into the dynamic performance testing like heel rise and gait analysis. The aim of the present study was to evaluate midterm functional performance after AT repair. non-surgical treatment seem to have a significant advantage in the average patient. Neither rehabilitation scheme (accelerated vs. In terms of patients’ satisfaction, AT rupture is associated with a highly acceptable outcome averaging midterm Achilles Tendon Rupture Scores (ATRS) above 85/100. Going beyond the traditional Kessler’s suture-type repair, this has been stated to be respecting the original, twisted anatomy, resisting the asymmetric loading of the tendon, and it dedicates special attention to the integration and pretensioning of the soleus muscle. Apart from traditional Kessler’s suture-type repairs which is a mere adaptation of the ruptured ends, a reconstructive technique of the ruptured AT was first established by Segesser et al. Only the rate of major complications like necrosis has been shown to be less in percutaneous repair, while re-rupture rates and sural nerve irritation may be increased. The differences, especially in early and midterm functional performance, have not shown significant differences between these techniques, and there is only a paucity of studies comparing different techniques. When deciding to perform surgical repair after acute AT rupture, there are several surgical techniques: Open repair using variations of end-to-end Kessler suture, augmented repairs, different techniques of mini-open or percutaneous repair, and anatomical reconstruction have been described. Especially in an athletic population, it is necessary to maintain the end-range plantarflexion strength in order to allow for the full range of performance as for example during sprinting and jumping. In a clinical setting, this end-range deficit is often evaluated by heel-rise height and heel-rise work, which has been shown to correlate with patient-reported outcome (PRO) and physical performance. However, also in surgical treatment there is a relevant postoperative deficit in plantarflexion strength ranging from 12 to 30%. Regarding lower leg performance, it was recently shown that soleus atrophy is more common in non-surgical treatment resulting in greater strength deficits, especially in end-range plantarflexion. Summarizing the latest evidence, there is a strong tendency toward surgical treatment with accelerated rehabilitation in the young athlete, due to a quicker return to sports, less muscle atrophy, and improved functional performance coupled with a lower risk of re-rupture. Few recent randomized controlled studies have compared surgical to nonoperative treatment and also conservative to accelerated rehabilitation. With the Achilles tendon (AT) ruptures showing a steady increase in incidence over the past decades, there is ongoing debate on the optimal treatment algorithm. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. 29.9%, p 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. ResultsĪt an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. conventional repair = CR) were compared in a subanalysis. Two different surgical techniques (anatomical repair = AR vs. This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. The aim of this study was to assess the functional performance at midterm following open surgical repair. Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture.
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