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Aim: To study the effects of early weight bearing following acute repair of ruptured Achilles tendon., Methods: Using a comparative longitudinal study design, following repair of an Achilles tendon rupture, patients in Group 1 were immobilised with their ankle in gravity equinus, were encouraged to weight bear on the operated limb as soon as possible to full weight bearing, and received a single a cast change at 2 weeks, when the ankle was immobilised in a plantigrade position. Patients in Group 2 were immobilised with their ankle in full equinus, and received a cast change at 2 weeks, when the ankle was immobilised in mid equinus, and at 4 weeks, when the ankle was immobilised in a plantigrade position. They were advised to weight bear 4 weeks from the operation., Results: Patients in Group 1 attended less outpatient visits, completely discarded their crutches at an average of 2.5 weeks from the operation (Group 2: average of 5.7 weeks from the operation), (p=0.013), and a greater proportion of them were satisfied with the results of surgery. At ultrasound scan, the average thickness of the repaired tendon was 12.1 mm (SD 2), with no difference in the thickness of the ruptured tendon regardless of the method of postoperative management. There was no significant difference in isometric strength between the two groups of patients., Conclusion: Early weight bearing with the ankle plantigrade is not detrimental to the outcome of repair following rupture of the Achilles tendon.

Purpose: To study the effects of early weightbearing and ankle mobilization after acute repair of ruptured Achilles tendon., Study Design: Comparative longitudinal study., Methods: Patients in group 1 were postoperatively immobilized with their ankle in gravity equinus, they were encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and they received a single cast change at 2 weeks, with the ankle accommodated in an anterior splint in a plantigrade position, allowing the ankle to be plantar flexed fully but not dorsiflexed above neutral. Patients in group 2 were immobilized with their ankle in full equinus with a cast change at 2 weeks, when the ankle was immobilized in mid equinus, and at 4 weeks, when the ankle was immobilized in a plantigrade position, and they were advised to bear weight., Results: Patients in group 1 attended fewer outpatient visits, completely discarded their crutches at an average of 2.5 weeks, and more were satisfied with the results of surgery. At ultrasonography, the average thickness of the repaired tendon was 12.1 mm, with no difference in the thickness of the ruptured tendon regardless of postoperative management. There was no significant difference in isometric strength between the two groups., Conclusions: Early weightbearing with the ankle plantigrade is not detrimental to the outcome of repair after acute rupture of the Achilles tendon and shortens the time needed for rehabilitation. However, strength deficit and muscle atrophy are not prevented.

Purpose: To assess the long-term ultrasonographic appearance of rupture of the Achilles tendon., Subjects and Methods: We examined 70 patients at an average of 63 months (range 10-120 months) after rupture of the Achilles tendon. We assessed the patient's contralateral tendon and also performed ultrasonography on the Achilles tendon of 70 age- and sex-matched controls. We recorded the maximum transverse anteroposterior diameter, the presence of intratendinous alterations, and the presence of intratendinous calcification., Results: The average maximum anteroposterior diameter of the ruptured tendon was 11.7 mm (SD = 2.10). The patients' normal tendons measured an average of 5.4 mm (SD = 0.9), and there was an average measure of 4.9 mm (SD = 0.5) (p = 0.0001) in the controls. There was no difference in the maximum anteroposterior diameter of the ruptured tendon depending on the method of treatment (conservative, open repair, percutaneous repair). Seventeen patients exhibited areas of hypoechogenicity in their ruptured tendon, two patients had areas of hypoechogenicity in their unruptured contralateral tendon, and 10 patients had calcification in their ruptured tendon., Conclusion: The anteroposterior diameter of the ruptured tendon was significantly greater than the nonruptured contralateral. However, when compared with a group of individually age- and sex-matched controls, the patients' contralateral tendons had significantly greater maximum anteroposterior diameter and had a greater prevalence of intratendinous alterations. This difference may represent a background of subclinical tendinopathy that may predispose to rupture.

Objective: To ascertain whether there is an association between tendinopathic and ruptured Achilles tendons, hypothesizing that the histopathological aspects of tendinosis in tendinopathic tendons are less advanced than those found in ruptured Achilles tendons., Methods: This was a comparative cohort study at a university teaching hospital. Histological examination was performed using hematoxylin and eosin and alcian blue/periodic acid-Schiff stained slides. The slides were interpreted using a semiquantitative grading scale assessing fiber structure, fiber arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, hyalinization, and glycosaminoglycan. We calculated a pathology score giving up to three marks for each of the above variables, with 0 being normal and 3 being maximally abnormal. All the histology slides were assessed twice in a blinded manner, the agreement between two readings ranging from 0.170 to 0.750 (kappa statistics)., Results: We studied biopsy samples from the Achilles tendon of patients undergoing open repair for a subcutaneous rupture of their Achilles tendon (N = 35; average age (+/- SD), 48.4 +/- 16.9 yr; range, 26-80), biopsy specimens from the Achilles tendon of patients undergoing exploration for Achilles tendinopathy (N = 13; average age, 35.7 +/- 12.9 yr; range, 18-67) and specimens of Achilles tendons from individuals with no known tendon pathology (N = 16; average age, 65 +/- 19.1 yr; range, 46-82). The highest mean score of ruptured tendons was significantly greater than that of tendinopathic tendons (17.4 +/- 4.9 vs 10.5 +/- 6.1, P < 0.001), and highest mean score of tendinopathic tendons was greater that that of control tendons (10.5 +/- 6.1 vs 5.9 +/- 7.3) (P < 0.001)., Conclusion: Ruptured and tendinopathic tendons are histologically significantly more degenerated than control tendons. The general pattern of degeneration was common to the ruptured and tendinopathic tendons, but there was a statistically significant greater degree of degeneration in the ruptured tendons. It is therefore possible that there is a common, as yet unidentified, pathological mechanism that has acted on both of these tendon populations.

Achilles tendinopathy is often treated surgically after failure of nonoperative management, but results are not uniformly excellent. We critically assessed the methods of 26 studies that reported surgical outcomes of patients with this condition. Using 10 previously published criteria, and blinded to study outcomes, we derived a "methodology score" (0 to 100) for each study. This score was highly reproducible (r = 0.99, P < 0.01). Scores were generally low concerning the type of study, subject selection process, and outcome measures, which indicates methods deficiency in the way the study was designed, performed, and analyzed. We found a negative correlation between reported success rate and overall methods scores (r = -0.53, P < 0.01), and a positive correlation between year of publication and overall methods score (r = 0.70, P < 0.01). Study methods may influence reported surgical outcome, and we suggest guidelines for improving study design in this area of clinical research. We acknowledge that study methods have improved over the course of the past 20 years.