The operative treatment of Achilles tendon injuries.

Twenty cases of Achilles tendon injury treated surgically at the University of Virginia Medical Center from 1970 to 1979 were reviewed and reevaluated with up to 9 years of follow-up. Three treatment groups were identified: Group I--primary repair of a lacerated Achilles tendon; Group II--primary repair of an acutely ruptured Achilles tendon; and Group III--subacute repair of Achilles tendon rupture (performed more than 72 hours after injury). Acute repairs were performed by end-to-end suture. In subacute cases the anastomosis was reinforced with one or 2 flaps from the gastrocnemius tendon. Strenuous exercise accounted for nearly all the cases of acute tendon rupture. Surgical complications and overall functional results were determined for each treatment group. Open repair provides excellent results when applied to lacerations. A good-to-excellent overall result can be expected for patients with acute ruptures and primary repair, but an awareness of the possible postoperative complications is necessary. Achilles tendon ruptures that go unrecognized for more than 72 hours are best treated conservatively.