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Achilles Tendon Rupture: Non Operative Treatment


- See: Achilles Tendonitis

- Discussion:
    - indications:
         - may be indicated in older patients w/ minimally displaced ruptures;
         - note that younger patients w/ expectations of participating in sports such as basketball may not be good candidates for non
                  operative rx;
         - atheletes should not expect to resume full activities for one year;
    - managment:
         - short leg cast strategy:
                - SLC is applied w/ ankle in plantar flexion;
                      - some surgeons place the cast in gravity equinus where as other surgeons place the ankle in maximal equinus;
                - w/ time the cast is brought out of equinus over 8-10 weeks;
                - walking is allowed (in the cast) at 4-6 weeks;
                - as an alternative, consider using functional brace starting in 45 deg of flexion;
                      - the functional brace prevents ankle dorsiflexion but allows ankle plantar flexion;
                - following casting, a 2 cm heel lift is worn for an additional 2-4 months;
          - long leg cast:
                - some orthopaedists have recommended an initial long leg cast in gravity equinus for 6 weeks, followed by a SLC for 4
    - expected outcome: non operative vs operative outcomes:
          - expect a re-rupture rate from 4% to 33% (avg 18%);
          - decrease in strength and endurance of 30%;
          - 83% of surgical patients vs 69 % immobilization patients returned to the preinjury level of activity;
          - 93 % of surgical patients were satisfied with the results of treatment vs 66% of immobilized patients;
          - poor results w/ non operative treatment occur when the ankle is casted in neutral position (leads to relative lengthening
                     of the tendon);
          - even w/ initial positioning of the ankle in equinus, non operative treatment cannot be expect to restore the correct length
                     of tendon

Effects of immobilization on Achilles tendon healing in a rat model.

Functional bracing for rupture of the Achilles tendon. Clincial results and analysis of ground reaction forces and temporal data.

Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study.   

Review of the operative treatment of Achilles tendon rupture.  

Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon.

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: a multicenter randomized trial using accelerated functional rehabilitation

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