Management of open achilles tendon injury: Primary repair and early mobilization

Abstract

Background: Achilles tendon injuries have progressive increase worldwide in the last few decades. This is attributable to increase in both competitive and recreational sports. In most of the literature written on Achilles tendon injuries there were rarely any information about open Achilles tendon lacerations. In fact, Achilles tendon injuries were erroneous equated to Achilles tendon ruptures and subsequently the management.
Objective: To show that primary repair of open Achilles tendon lacerations (or incisions) and early postoperative mobilization in carefully selected patients may give excellent results.
Methods: This was a prospective study that took place at the Plastic Surgery Unit of Irrua Specialist Teaching Hospital, Edo State, Nigeria over a period of 5 years. There were 52 cases of open Achilles tendon injuries that presented but only 12 of them, with lacerations or incisions, had primary repair and early postoperative mobilization. The study was between February 2010 and January 2015. The exclusion criteria included: (i) Achilles tendon injuries like avulsions and crush injuries; (ii) Patients that presented later than six hours of injury; (iii) Patients who had other system injuries or co-morbidity. The following data were collected which include biodata, side involved, the aetiology and complications and then analyzed.
Results: There were 12 cases that fit into this study. There were 5 males (41.7%) and 7 females (58.3%) with male: female ratio of about 2.5:1. The average age was 37.6 years (range 6-60 years). Forty one point seven percent of them were within the paediatric age group of 0-15 years while the rest were adults. The most common aetiology was motorbike spoke. Nine (75%) of the injuries were on the left side. Two patients had infection which resolved with oral antibiotics.
Conclusion: Literature on open Achilles tendon injuries are sparse, however it is an important subset of Achilles tendon injuries. Primary repair and early post-operative mobilization in open uncomplicated Achilles tendon lacerations or incisions gives excellent results.

Key words: Open, Achilles tendon, Lacerations, Primary repair, Complications