More sutures mean quicker tendon recovery

NEW YORK (Reuters Health) - A new technique for repairing Achilles tendon ruptures that uses several sutures to reconnect the tendon, rather than just one, allows patients to start bearing weight on their injured leg within a week, Japanese researchers report. Most people in their study recovered full range of motion in 17 weeks.

Standard Achilles tendon repair surgery involves using a single suture to reconnect the ruptured ends, after which the injured leg is immobilized for several weeks to allow scar tissue to form and stabilize the repair site, the researchers explain in The American Journal of Sports Medicine. With this method, the bunched tendon can form a "lump" that can delay a patient's return to normal range of motion.

More recently developed techniques use several sutures to make a stronger repair so that extended immobilization isn't necessary, which can help patients recover more quickly, Dr. Eiji Uchiyama of Kantoh Rosai Hospital in Kawasaki and colleagues point out.

Uchiyama and colleagues tested one such strategy in 100 patients with Achilles tendon rupture, 21 of whom were elite athletes. The rest were recreational athletes. All were followed for an average of 2.4 years.

Patients wore a cast for two weeks, but were allowed to begin full weight bearing with a walking cast at one week. After two weeks they began performing "range of motion" exercises. Within 7.6 weeks, on average, the patients were able to perform double legged heel raises, while they could perform single legged heel raises by 12 weeks. Once a patient could do single heel raises he or she was allowed to jog, and when patients did 20 single heel raises in a row, they were permitted to jump on one leg and do activities requiring them to move in several directions.

By 10 weeks, on average, the ankle in a patient's repaired leg had the same range of motion as the ankle that hadn't been operated on. Ninety-two percent of patients recovered full range of motion by 17 weeks. The elite athletes were back at their original level of training four to five months after the surgery.

"Bearing weight on the operated leg not only leads to quicker return to daily activities but also trains the muscles on the operated side and prevents articular [joint] cartilage deterioration," the researchers note.

Their technique, they conclude, allows "earlier functional recovery and a quicker return to sports."

SOURCE: The American Journal of Sports Medicine, October 2007.