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Delayed weight bearing (>6 wks)
6%
63/999
Gastrocnemius fascial flap augmentation
3%
29/999
Biological augmentation
4%
42/999
Early functional rehabilitation protocol
85%
845/999
Percutaneous repair technique
1%
13/999
Select Answer to see Preferred Response
Utilization of an early functional rehabilitation protocol is most likely to decrease Achilles tendon re-rupture after surgical intervention. Several studies have demonstrated no significant difference in functional outcomes, or the rate of re-rupture, in patients with Achilles tendon ruptures who are treated operatively or nonoperatively when an early functional rehabilitation protocol is utilized. Specifically, in cases where operative repair is chosen, early functional rehabilitation is thought to decrease time to normal walking and stiffness, while improving patient quality of life. While the definition of early rehabilitation varies slightly, most protocols involve beginning weight bearing in a walking boot around 2 weeks after surgery with a focus on ankle range of motion exercises during this period. Percutaneous repair, fascial flap augmentation, and biologic augmentation have not been shown to decrease the rate of re-rupture after Achilles repair. Soroceanu et al. investigated surgical versus nonsurgical treatment of acute Achilles tendon ruptures in a meta-analysis of randomized trials. They reported that when functional rehabilitation with an early range of motion was employed, re-rupture rates were equal for surgical and nonsurgical patients, while surgery was associated with an absolute risk increase for complications other than re-rupture. They highlighted that conservative treatment should be considered at centers using functional rehabilitation protocols and that surgical repair is preferred at centers that do not employ early functional rehabilitation. Gwynne-Jones et al. compared the outcomes of patients with acute Achilles tendon rupture who underwent operative or nonoperative treatment while using an identical functional bracing protocol. They reported a significantly lower re-rupture rate and re-operation rate in the surgical group. They highlighted that functional early bracing as part of nonoperative treatment can result in lower re-rupture rates in patients over 40, especially in females. Kadakia et al. reviewed acute Achilles tendon ruptures and provided recommendations for treatment. They note early functional rehabilitation may improve patient outcomes after Achilles tendon repair. They go on to discuss specific intraoperative techniques which do not appear to alter re-rupture rates, including percutaneous repair, PRP augmentation, and gastrocnemius fascial flap augmentation. Incorrect Answers: Answer 1: Delayed weight-bearing >6 weeks may promote stiffness and poorer functional outcomes, without improvement in re-rupture rates. Answer 2: Augmentation of acute Achilles repair with gastrocnemius fascial turndown flap has not been shown to decrease rates of re-rupture with Achilles tendon repairs. Answer 3: At this time, biologic augmentation has not been shown to decrease rates of Achilles tendon re-rupture. Answer 5: There is no significant difference in the rate of re-rupture when an open repair is performed compared to percutaneous repair.
3.3
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