[Sports fitness after functional conservative versus surgical treatment of acute Achilles tendon ruptures].

Acute Achilles tendon ruptures are mostly related to recreational activities. Therefore, these patients intend to return to sports as soon as possible with no functional deficiency. This is the first study, comparing functional results after functional treatment to those after surgery. According to sonographic examinations of the tendon gap, primary functional treatment with heel supported shoes or surgery were suggested. Between 2/1991 and 12/1992, 22 patients with acute Achilles tendon rupture were treated without operation (group 1) and in 10 patient the rupture was sutured (group 2). 6 months later, 27 patients underwent standardized clinical examination: one leg standing for one minute, measurement of the circumference of the calf. The actual activities were assigned to Tegner Activity Score. 19 patients had isokinetic cybex testing with 60 degrees/s. There were 3 re-ruptures in group 1 and no comparable complications in group 2. At this time, clinical examination and Tegner Activity Score showed no relevant differences. Force of flexion was 30.4% lowered in group 1 and 2.4% in group 2. Additional training of the calf muscles improved the results after 6 weeks in group 1. We concluded that individual management of acute Achilles tendon rupture is possible according to sonographic tendon gap. Functional treatment is effective, but the rate of re-ruptures has to be reduced by careful selection of patients (rupture gap < or = 2 mm, high cooperation).