The best management for acute rupture of the Achilles tendon remains controversial. An unacceptably high re-rupture rate following conservative management has been quoted as a reason for surgical management, however, many of these studies do not stand up to critical scrutiny. Since 1989 I have personally treated over 1600 consecutive patients with acute rupture of the tendo-achilles using a conservative functional management protocol. This protocol was developed in the light of experience over a number of years. I will present an independent review of 1044 consecutive patients presenting to my tendo-achilles clinic between 1996 and 2008. After examination, 975 patients were found to have an acute tendon rupture, the rest being gastrocnemius muscle tears, painful Achilles tendonopathy or mis-referrals. Of these 975 patients 29 were late presenters in whom the tendon ends did not approximate well on plantar flexion. These patients were therefore treated surgically. One patient was too obese to be included in the standard protocol, although he was still treated conservatively. With a minimum follow up of two years, the overall re-rupture rate was 2.9%. The re-rupture rate using this management protocol is similar to or better than the published operative re-rupture rates. The protocol, complications and outcome will be discussed and I recommend a well defined and tested non operative functional management protocol for treatment of acute tendo-achilles rupture. This protocol is suitable for all ages including those with significant sporting demands. It is essential that patients have assessment and follow up carried out by a senior and experienced surgeon

Introduction: The acute rupture of Achilles tendon is injury with absolute indication for operation. Rupture of the Achilles tendon is only in rare instances due exclusively to an accident. Commonly, the site of rupture reveals marked fraying and degenerative lesions. Therefore, the pathologic tissue must be excised and often a large defect is created. Different procedures have been described to repair this defect. Methods: In our department, between June 1995–June 1997 we have use the operation described by Lange to bridge the defect in 15 acute rupture of Achilles tendon. This procedure consists in turning down a fascia flap from the gastroknernius to bridge the gap and end-to-end suture. In 13 patients the plantaris tendon has been used as a reinforcing membrane. In 2 cases we didn’t found it. We didn’t have any postoperative complications. After care a long -leg cast is applied with sufficient equinus of the foot and flexion of the knee for 6 weeks. For 6 weeks more a short leg cast was applied with the foot in neutral position and weight hearing was slowly resumed. Results: All the patients were reviewed between 6m and 2y. (F.U. 14m) and pain, range of motion, power, and functional level were evaluated. We had 2 far results and 1 poor but -no rerupture. The gap that we were obliged to repair was between 3cm–8cm. Discussion: We believe that this procedure, described for neglected rupture, is a method that we can recommend for acute rupture of degenerative Achilles tendon

Aim. To determine the effects of knee and ankle position on tendo Achilles (TA) gap distance in patients with acute rupture using ultrasound. Methods. Twenty seven patients with twenty-eight acute complete TA ruptures confirmed on ultrasound were recruited within a week of injury. The mean age at presentation was 42 years (range 23-80 years). Ultrasound measurements included location of the rupture and the gap distance between the superficial tendon edges with the ankle in neutral and knee extended. The gap distance was sequentially measured with the foot in maximum equinus and 0°, 30°, 60° and 90° of knee flexion. Results. The mean distance of the rupture from the enthesis was 52mm (range: 40-76mm). The mean gap distance with the ankle in neutral and knee extended was 11.4mm (95%CI: 9.9, 12.9). This reduced to 4.8mm (95%CI: 3.3, 6.4) when the foot was in maximum equinus, 3.8mm (95%CI: 2.5, 5.1) with 30° knee flexion, 2.6mm (95%CI: 1.7, 3.6) with 60° knee flexion and 1.5mm (95% CI: 0.8, 2.2) with 90° knee flexion. Expressing the reduction in gap distance with each successive position as a percentage of the gap distance with the knee extended and ankle in neutral revealed a mean reduction of 58.9%, 66.9%, 77.1% and 85.9% with maximum equinus and 0°, 30°, 60° and 90° of knee flexion respectively. The difference in gap distance between each of these positions was statistically significant (p<0.05). Discussion. Maximum equinus alone significantly reduces the gap distance in acute TA rupture. Increasing knee flexion demonstrates a lesser effect throughout the initial 90° arc suggesting apposition is encouraged by use of a below knee maximum equinus cast permitting full knee flexion

A consensus for the best treatment for acute Achilles tendon ruptures has not yet been reached. Non-operative functional treatment using ankle foot orthosis has shown a reduction in re-rupture rate. This study aims to compare operative, cast immobilisation and functional treatment with cam- walker for acute Achilles tendon ruptures.

A retrospective review of medical records of patients with acute Achilles tendon rupture between 1999–2770 was carried out. Open repairs were carried out in the surgical group. In the cam- walker group, patients were immobilised in equines backslab for 2 weeks and then transferred to cam- walker with 3 heel-wedges giving plantar flexion of 20–30 degrees. One wedge was removed weekly after 4 weeks. After 6 weeks, patients removed the cam-walker at night. After 10 weeks, they mobilised in a shoe with a raise. After 12 weeks, the cam-walker was removed. There were 56 patients reviewed of whom 20 were treated operatively, 23 were treated non- operatively in a cast and 13 were treated functionally in a cam-walker. The average age of operative group was 39 years with average post operative immobilisation in a cast of 7.4 weeks. 15% had major complications with 2 DVTs and 1 re-rupture and 45% minor complications with 4 wound infections, 3 sural nerve damage and 2 patients complained of pain. The average age of non-operative group in a cast was 46 years with average immobilisation of 8 weeks. 12% had minor complications with 2 DVTs, 1 re-rupture and 12% healing complications with 1 non- healing and 2 delayed healing.

The average age of functional group treated with cam- walker was 44.5 years. They were immobilised in a cast for 2.5 weeks and cam-walker for 9 weeks. There were 35% major complications with 3 DVTs and no re-ruptures. 2 DVTs were treated and 1 DVT spontaneously resolved.

Metz et al. (2007) conducted a similar study and found that 34% of surgically treated patients suffered from complications other than rerupture. The main advantage they found with conservative treatment is the elimination of wound complications and intra-operative sural nerve damage. This retrospective review shows that surgical treatment provides a lower re-rupture rate but higher complication rate. A prospective study is currently underway to look at re-rupture rates and functional outcome after non-operative functional treatment with cam-walker.

Introduction: We reviewed the complications and recovery of patients treated for Achilles tendon rupture by percutaneous repair, open repair, and non-operative management in a tertiary referral centre between 2001 and 2003.

Materials and Methods: We identified patients who underwent Achilles tendon rupture repair by percutaneous or open methods from the logbooks of Consultants and the operating theatre register. We used plaster room records were also used to identify patients who received non-operative treatment. We collated demographic and management details, and compared them with published rates relating to average age range, demographic, and management details.

Results: In the 20 patients who underwent open repair, one (4.8%) patient sustained a re-rupture, four (19%) sustained minor complications, and one (4.8%) had a major complication. In the 31 patients who underwent percutaneous repair, one (3.2%) patient sustained a major complication, six (19.4%) patients experienced minor wound complications, and there were no re-ruptures. In the 12 patients who underwent conservative management, re-ruptures occurred in one patient (8.3%), minor complications occurred in five patients (41.7%), and there were no major complications. The median recovery time in the open, percutaneous and conservative groups was 25 weeks, 26 weeks and 18.5 weeks respectively.

Discussion and Conclusion: In our setting, percutaneous repair is the most successful management method, with no re-ruptures and very few complications. Although conservative management produced the highest rate of complications, each patient will have different needs due to their age, occupation or level of sporting activity. Ultimately, the decision of the management regime used probably lies with the patient.

Aims

We performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes.

Introduction

The dichotomy between surgical repair and conservative management of acute Achilles tendon ruptures has been eliminated through appropriate functional management. The orthoses used within functional management however, remains variable. Functional treatment works on the premise that the ankle/hindfoot is positioned in sufficient equinus to allow for early weight-bearing on a ‘shortened’ Achilles tendon. Our aim in this study was to test if 2 common walking orthoses achieved a satisfactory equinus position of the hindfoot.

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing

Introduction and Objectives: Acute ruptures of the Achilles tendon are often treated surgically. The minimally-invasive technique of end-to-end suture has gained popularity in recent years. However, the use of reinforcing tendinous plasties can yield a more solid reconstruction, permit an earlier rehabilitation programme, and reduce the risk of re-rupture. The goal of this study is to determine the long-term results and complications of repairs using reinforcing plasties in the treatment of acute ruptures of the Achilles tendon. Materials and Methods: Between 1995 and 2001, a total of 56 consecutive Achilles tendon ruptures were repaired using end-to-end suture and primary tendinous reinforcement. Average patient age was 35 years (range: 23–75), and 87% were males. Average time of postoperative immobilization was 4 weeks, and average time to discharge was 6 weeks. Average follow-up time was 4.7 years (range: 2–8 years). Results: At the end of the follow-up period, 51 patients (89%) showed normal ankle function and had returned to their normal pre-injury activities. There were no complete re-ruptures. One patient presented with a partial traumatic re-rupture of the central area of the tendon, which did not require surgical treatment. There were 2 cases of deep infection, 10 patients with surgical wound problems, and 2 patients with transient paresthesia in the sural nerve area. Discussion and Conclusions: Reconstruction of acute ruptures of the Achilles tendon using tendinous plasty for reinforcement gives satisfactory results in a high percentage of patients, permitting earlier rehabilitation with very low risk of subsequent re-rupture. However, the procedure is associated with a high rate of cutaneous complications and infection

PURPOSE: We describe the results of 64 patients who underwent treatment for acute distal biceps tendon rupture using a single incision and suture anchors. The purpose of the study is to evaluate if this method is reliable and if it can reduse the risk of ectopic bone formation or synostosis. Methods: 64 patients underwent surgical repair for acute rupture of the distal biceps tendon, using suture anchors and a single incision. All performed by 1 surgeon. We had 63 male and 1 female with a mean age of 48 years (range 30–59). Our operative technique consisted of an “S”-shaped anterior incision centered over the antecubital fossa. After identification and protection of the lateral antebrachial cutaneous nerve, we exposed and mobilized the ruptured biceps tendon. The distal portion of the tendon was debrided and the radial tuberosity gently decorticated. A 4 stranded suture was then inserted into the tuberosity. The tendon was advanced to bone and the sutures were tied using the modification of Kessler’s technique, holding the elbow in 90° of flexion. The post-op protocol was a posterior splint for 10 days (in 90° of flexion and 20° of supination), a dynamic hinged-extension block brace in 45° for 3 weeks and progressive advancement to full extension in 3 more weeks. Strengthening exercises were permitted after 3 months. Results: All acute tears (< 3 weeks) were repaired anatomically. The follow-up period was 39 months (range 18m – 11years). Objective data consisted of ROM (range of motion) of the elbow, flexion and supination strength were measured by a BTE Work Stimulator. The ROM was normal in 54 patients, 10 patients lacked 10° of extension. 51 patients returned to their pre-injury level of activity and within 6 months returned to work. All patients reported pain relief and good recovery of strength and were completely satisfied of the outcome. There were no implant failures, nerve palsies or heterotopic bone formation. Conclusions: Use of a single incision repair with bone suture anchors provides secure fixation of distal biceps tendon to the radius with minimal volar dissection wich is associated with a minimum risk of synostosis and posterior interosseous nerve injuries. This method is reliable for acute ruptures. Return to normal strength and range of motion can be expected if tendon repair is performed before 3 weeks. The advantages of this method are less dissection for re-attachment of the tendon, less nerve injuries and no ectopic bone formation or synostosis

To evaluate the clinical outcome of arthroscopic treatment of ACL with an Achilles tendon allograft in patient with acute rupture. 22 patients, between 2003 and 2006, with acute rupture of ACL, were treated with an Achilles tendon allograft. The mean age was 26 years. Patients were evaluated before and after surgery and at the latest follow-up with Noulis-Lahmann test and Pivot shift test. We also used IKDC score, Lysholm score and one leg stance test and functional reach test. Patients were also evaluated with Cybex II + and with plain radiographies. The mean follow-up time was 3.5 years. 90% of the patients had a negative pivot shift test and 95% of the patients had a score at Noulis-Lahmann test +1. The mean value of IKDC score was 88 (62–100) and the mean time of Lysholm score was 91 (75–100). Until the latest follow-up there were no clinical sighs of inflammation or graft rejection. Radiologic evaluation revealed no sign of tunnel enlargement. We believe that the use of a fresh-frozen allograft in the treatment of acute ACL ruptures is an effective procedure for the restoration of ligamentous stability of the knee

Acute achilles tendon ruptures are increasing in incidence and occur in 18 per 100 000 people per year, however there remains a lack of consensus on the best treatment of acute ruptures. Randomised studies comparing operative versus non-operative treatment show operative treatment to have a significantly lower re-rupture rate, but these studies have generally used non-weight bearing casts in the non-operative group. Recent series utilizing more aggressive non-operative protocols with early weight-bearing have noted a far lower incidence of re-rupture, with rates approaching those of operative management. Weight bearing casts may also have the advantages of convenience and an earlier return to work, and the purpose of this study was to compare outcomes of traditional casts versus Bohler-iron equipped weight-bearing casts in the treatment of acute Achilles tendon ruptures. 83 patients with acute Achilles tendon ruptures were recruited from three Auckland centres over a 2 year period. Patients were randomised within one week of injury to receive either a weight-bearing cast with a Bohler iron or a traditional non weight-bearing cast. A set treatment protocol was used, with a total cast time of eight weeks. Patients underwent detailed muscle dynamometry testing at 6 months, with further follow up at 1 year and at study completion. Primary outcomes assessed were patient satisfaction, time to return to work, and overall re-rupture rates. Secondary outcomes included return to sports, ankle pain and stiffness, footwear restrictions, and patient satisfaction. There were no significant differences in patient demographics or activity levels prior to treatment. At follow up, 1 patient (2%) in the Bohler iron group and 2 patients (5%) in the non weight bearing group sustained re-ruptures (p=0.62). There was a trend toward an earlier return to work in the weight-bearing group, with 58% versus 43% returning to work within 4 weeks, but the difference was not significant. 63% of patients in the weight bearing group reported freedom from pain at 12 months compared to 51 % in the non weight bearing group. There were no statistically significant differences in Leppilahti scores, patient satisfaction, or return to sports between groups. Weight-bearing casts in the non-operative treatment of Achilles tendon ruptures appear to offer outcomes that are at least equivalent to outcomes of non-weight bearing casts. The overall rerupture rate in this study is low, supporting the continued use of initial non-operative management in the treatment of acute ruptures

Background. We prospectively studied achilles tendon acute rupture cases operated over 2 years and reviewed the causes, treatment options, outcome and complications. Our Aim of the study was to look at the different suture materials used and to observe for their complications. Method. Fifty-three (53) consecutive patients who came to our hospital with acute Achilles rupture were included. We prospectively collected their data, including medical history, causes, mode of treatment and complications. We followed them up to 6 months to measure their outcome using Boyden score and observe any complications. Results. We randomised the fifty-three (53) patients into two groups according to admitting consultant. Out of fifty three 53 Achilles tendon ruptures nineteen 19 were repaired using Polyester (Ethibond) and thirty four 34 were repaired using Polydiaxonone (PDS). There were 6 surgical infections of the operative site and one DVT. Conclusion. In majority of patients the functional outcome results were good to excellent according to Boyden score. We observed that all of them who got infection were repaired using non-absorbable polyester (ethibond). We also observed that DVT prophylaxis should be regularly given in the patients

Achilles tendon (AT) rupture may lead to complaints of heel pain. In forefoot ulcer patients AT lengthening is used to transfer pressure from forefoot to the heel. The primary aim was to investigate if AT was longer or associated with changes in pedobaric measurements, in particular heel pressure, on the injured leg 4–5 years after the injury. Methods. We invited all participants from an RCT (n=56) of conservatively treated AT Rupture (ATR) with or without early weight-bearing (early-WB, non-WB). 37 patients participated, 19 from early-WB (1 re-rupture (RR)), and 18 from non-WB (2 RR). Time from injury to follow up was 4,5 years (4,1 to 5,1). AT length was measured using ultrasound with a validated protocol. Foot pressure mapping (FPM) was measured barefoot, using an EMED platform (novel, Germany), with 5 trials for each foot. Statistics. T-test for limb to limb comparisons and linear regression for correlations was applied. Results. We found no differences in any of the variables between the early-WB and non-WB groups. Compared to the uninjured limb, the Achilles tendon was an average of 1.8 (1.2–2.3) cm longer on the injured limb (p<0.001). When comparing the ratio of the medial (1–2 ray) to lateral (3–5 ray) forefoot mean peak pressure, we found no difference between the injured and healthy limb (p=0.26). Mean heel peak pressure was not different from the injured to the healthy leg (difference was 3,9 (−1,7 – 9,45) p=0,17). Heel lift-off was delayed in the injured limb by 2% (0.4%–4.4%) of the total roll over process (ROP) (p= 0.02). Achilles tendon length could not be linked to either heels lift-off or mean peak pressure of the heel using linear regression (p 0.27 to 0.78). Conclusion. Conservatively treated Achilles tendon ruptures were approximately 1.8 cm longer. A subtle change in the time of heel rise could be detected on the injured limb, but contrary to our expectations AT length did not correlate to time of heel lift or mean heel peak pressure. This is in contrast to the common practice in diabetics, where the Achilles tendon is elongated to relieve pressure from the forefoot – a mechanism we cannot observe from elongation of the tendon after acute rupture, treated conservatively - though this study is underpowered

Aims

Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation.

Introduction:. The treatment of acute rupture of the tendo-achilles remains controversial. There is good evidence to suggest that outcomes are the same for both operative and non-operative treatment when a functional rehabilitation program is utilised. However, debate continues as to whether the radiological gap-size between the proximal and distal remnants of the tendon has an influence on the suitability for non-operative management. Methods:. All adult patients who attended the emergency department with a clinically suspected tendo-achilles rupture were place in a plantarflexed cast, and underwent MRI scanning to confirm the diagnosis. They were then counselled on the risks and benefits of operative versus non-operative treatment. Patients opting for non-operative treatment were asked to take part in the study and treated using a functional rehabilitation programme. Gap sizes were determined using a standardised protocol by a single musculoskeletal radiologist blinded to the clinical outcomes. Results:. A total of 69 patients have been recruited into the study, 40 have complete their one year review. There were two re-ruptures. The average age was 42.4 years (range 19–70). The average gap size recorded by MRI was 40.4mm (range 6–110). The average ATRS score was 80 (range 17–100) and the single limb heel raise percentage of contralateral side was 64.8% (range 4–115). The Spearman rank correlation coefficient comparing gap size and ATRS score was 0.272 (p=0.045) and for gap size and strength was 0.158 (p=0.165). Conclusion:. This study shows a weak positive correlation between MRI measured gap size of the ruptured tendo-achilles and the Achilles tendon Total Rupture Score at one year. No correlation could be demonstrated between gap size and strength at one year. These results suggest that the MRI measured gap size is unimportant in predicting outcome and hence suitability for non-operative treatment of tendo-achilles rupture using functional rehabilitation

Evidence-based orthopaedic surgery emphasizes the need to properly design and perform high-quality randomized controlled trials to minimize bias and to truly ensure the effectiveness of orthopaedic interventions. The currently available best evidence suggests to load and move the Achilles tendon after an open or percutaneous repair for an acute rupture. Following repair of the torn AT, patients are immobilized with their ankle in gravity equines. They are encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and discharged home on the day of the procedure. All patients are given an appointment for review 2 weeks postoperatively, when they receive a single cast change, with the ankle accommodated in a removable anterior splint in a plantigrade position, secured to the lower leg and foot with Velcro straps. Removal of the foot straps under supervision of a physiotherapist allowes the ankle to be plantar flexed fully but not dorsiflexed. These exercises are performed against manual resistance. At 6 weeks postoperatively, the anterior splint is removed, and the patient referred to physiotherapy for active mobilization. At 12 weeks postoperatively, patients are assessed as to whether they are able to undertake more vigorous physiotherapy, and encouraged to gradually return to their normal activities. Progressive activities are incorporated as strength allowed, with the aim to return to unrestricted activities 6 months following surgery

Background: Acute traumatic rupture of the Tendo-Achilles is a common problem. Review of the published literature shows a conflict between surgical and non-surgical management. Primarily, surgical treatment has repeatedly been shown to have a lower re-rupture rate compared with conservative treatment. However, it is associated with a higher rate of other complications, principally infective soft tissue complications. Debate concerning the method and duration of conservative treatment regimens also remains. Methods: We aimed to assess the effect of knee position on the gap in acute tendo-Achilles ruptures. Our null hypothesis was there is no difference in tendon gap with variation of knee position. Patients with a history and examination consistent with an acute rupture were collected prospectively. They were imaged by the same consultant musculoskeletal consultant radiologist using ultrasound. Tendon gap was measured with the foot in neutral and full tolerable equinus with the knee both flexed to 90° and fully extended. A pilot study of 10 patients was used to provide data for a power calculation and consequently a total of 25 patients were recruited. Results: All patients had their clinical diagnosis confirmed and tendon gap measured in each of the 4 positions. A paired t-test was used to compare mean differences between each position. This confirmed there was no significant difference in the tendon gap with the knee flexed or extended providing the foot is in full equinus. This may have considerable implications on the rationale behind conservative treatment and splinting of acute tendo-Achilles ruptures

Aim: To study the results of a percutaneous suture technique for the management of acute ruptures of the Achilles’ tendon. Method: Ten patients with acute Achilles’ tendon rupture were entered into the study. We utilised a percutaneous surgical technique and functional post-operative regime described in the current literature. Results: All were recreational sports people with an average age of 42.9 years. At an average follow-up of six months there were no re-ruptures, no wound complications, no sural nerve injuries, and no episodes of deep vein thrombosis. No patient had any discomfort during normal walking. In comparison to the uninjured side, there was still a mild reduction in calf circumference but minimal deficits in endurance, strength or range of motion. Conclusions: The technique was easily performed and overall the treatment appeared to have very high patient acceptance and low morbidity. The well described benefits of early mobilisation were evident