Speck M, Klaue K
Department of Orthopaedic Surgery, University of Berne, Inselspital, Switzerland.
Am J Sports Med. 1998 Nov-Dec;26(6):789-93. doi: 10.1177/03635465980260060901.
We prospectively evaluated the clinical outcomes of 20 patients (mean age, 42.8 years) with early full weightbearing and functional treatment after surgical repair of acute Achilles tendon rupture according to a prospective intra- and postoperative protocol. All patients underwent open repair using a Kessler-type suture and simple apposition sutures. The postoperative regimen included a plantigrade splint for 24 hours and 6 weeks of early full weightbearing in a removable walker. All patients were evaluated with clinical and ultrasound examination and according to a new scoring system at 3, 6, and 12 months after repair. After 3 months, the score averaged 73 of 100 points; after 6 months, 86; and after 1 year, 94. All patients reached the same level of sports activities as preoperatively and demonstrated no significant difference in ankle mobility and isokinetic strength. There were no reruptures. One patient had a deep venous thrombosis 3 weeks after the operation after having prematurely stopped thromboprophylaxis. We believe that early careful ankle mobilization and full weightbearing in a removable walker after primary Achilles tendon repair does not increase the risk of rerupture. An accelerated rehabilitation program improves early foot function with excellent recovery of plantar flexion strength and amplitude.
我们根据一项前瞻性的术前和术后方案，对20例急性跟腱断裂手术修复后早期完全负重及功能治疗的患者（平均年龄42.8岁）的临床结果进行了前瞻性评估。所有患者均采用凯斯勒（Kessler）式缝合和简单对位缝合进行开放修复。术后方案包括使用平足夹板固定24小时，并在可移动步行器中进行6周的早期完全负重。在修复后3个月、6个月和12个月时，对所有患者进行临床和超声检查，并根据一种新的评分系统进行评估。3个月后，评分平均为100分中的73分；6个月后为86分；1年后为94分。所有患者恢复到了术前相同的体育活动水平，踝关节活动度和等速肌力均无显著差异。没有再次断裂的情况。1例患者在过早停止血栓预防措施后，术后3周发生了深静脉血栓形成。我们认为，初次跟腱修复后在可移动步行器中进行早期仔细的踝关节活动和完全负重不会增加再次断裂的风险。加速康复计划可改善早期足部功能，跖屈力量和幅度恢复良好。
