Summary

Open repair of acute Achilles tendon ruptures followed up by a prolonged period of non-weight bearing cast immobilization post-operatively allows 100% of athletes to return to their normal training after 35 weeks, 95% play their first match after 42 weeks, while 88% return to performance after 50 weeks with no complications or re-ruptures.

Abstract

Objective

Provide an overview of the return to sport (RTS) outcomes after open primary Achilles tendon repair in elite athletes.

Methods

Elite athletes who underwent open Achilles tendon repair for a primary Achilles tendon rupture were retrospectively reviewed. Post-operatively patients received non-weight bearing cast immobilization for 6 weeks, weight bearing cast immobilization for 2 weeks and a walking boot for 4 weeks. Primary outcome measures included the self-reported return to performance (RTP) rate and the time to self-reported RTP. Additional RTS outcome measures were the time to return to sport-specific training, time to return to normal training (RTT), time to training without restrictions, time to first match, time to first match without restrictions. Further outcomes evaluated were the complication and re-rupture rate.

Results

Fourteen athletes were included with a median age of 22.5 years (IQR 17.1 - 25.5), resulting in 17 cases with a median follow-up period of 5.2 years (IQR 3.5 – 7.6). Athletes started sport-specific training at 25,5 (IQR 20,5-32,3) weeks post-operatively, returned to normal training at 35 (IQR 24,6-40) and had their first unrestricted training 38 (IQR 29-41,6) post-operatively. Athletes played their first match after 42 (IQR 35,3 – 48,8) weeks with their first full match coming at 45 (IQR 40,5 – 50,9) weeks coinciding with the first unrestricted match at 45,4 (IQR 40,5 – 52,1) weeks. The median time to RTP was 50.2 (IQR 42 - 52.2) weeks. One patients did not return to their pre-injury level of sport due to the index Achilles tendon rupture, one athlete due to a contralateral Achilles tendon rupture and one patient due to a recurrent retrocalcaneal bursitis. No major complications including re-ruptures, sural nerve injuries or wound infections were observed. Three athletes suffered a contralateral Achilles tendon rupture with the injury occurring at median of 2.3 years after open primary Achilles tendon repair.

Conclusion

Open repair of acute Achilles tendon ruptures followed up by a prolonged period of non-weight bearing cast immobilization post-operatively allows 100% of athletes to return to their normal training after 35 weeks, 95% play their first match after 42 weeks, while 88% return to performance after 50 weeks with no complications or re-ruptures. Additionally, after open Achilles tendon repair, an extensive period of non-weight bearing cast immobilization may be beneficial to reducing the re-rupture rate.