Postoperative rehabilitation after percutaneous Achilles tendon repair : early functional therapy versus cast immobilization

PURPOSE: To report a comparative study on postoperative management following percutaneous repair of acute Achilles tendon ruptures. METHODS: One hundred and three patients with percutaneous repair after acute Achilles tendon rupture were prospectively entered in our departmental database. Before July 1999, 15 patients were treated postoperatively with below-knee cast immobilization; after July 1999, patients underwent early functional therapy using a special shoe. Patients were seen at 6 weeks, 12 weeks, and 12 months after surgery. Matched pairs were selected based upon gender, age, weight, height, body mass index, and the side involved. The total number of patients consisted of 14 matched pairs. Compared outcomes included clinical evaluation, time away from work, and time before return to sports. RESULTS: Fifteen patients had an objective force reduction compared to the nonoperated side (9 cast group; 6 shoe group). The mean Achilles tendon score was 81 points in the cast group and 88 points in the shoe group. Patients in the cast group had a significantly (p = 0.042) longer time before return to work (67 days) compared to those in the shoe group (37 days). CONCLUSION: Early mobilization in a special shoe is preferable to postoperative immobilization after percutaneous Achilles tendon repair. It provides a good clinical outcome and shortens the time for return to work and sports.