[Surgical treatment of ruptures of the Achilles tendon. Apropos of 42 cases treated by Bosworth's technique]. / Traitement chirurgical des ruptures du tendon d'Achille. A propos de 42 cas traités selon la technique de Bosworth.

ABSTRACT

PURPOSE OF THE STUDY There is no consensus on the treatment of acute ruptures of the Achilles tendon. We have chosen surgical technique with early muscle stimulation. This study analyses possibilities of functional recovery and complications in Athletes. MATERIALS AND METHODS: Between 1983 and 1994, we treated surgically 42 Athletes who had Achilles tendon ruptures with early musculo-tendinous stimulation. The 39 male and 4 female patients had a mean age of 41 years (range, 15 to 70). We have always used Bosworth's technique with gastrocnemius flap procedure. Immediately after surgery, weightbearing with below-the-knee cast was initiated for 6 weeks followed by rehabilitation. RESULTS: There was no local major complication, deep vein thrombosis or pulmonary embolism. Only one patient suffered from a traumatic rerupture one month after surgery. Mean value of the calf atrophy was less than 1 cm. 93 per cent of patients returned to previous activity levels and 78.5 per cent of patients returned to their usual sport activity. DISCUSSION: Like this study recent results confirm the low complication and recurrence rate of the surgical treatment. Percutaneous technique and conservative treatments seem to be worse for rerupture and sportive functional recovery. Early muscle stimulation decrease morbidity and calf atrophy. Our protocol with weightbearing in ankle neutral position reduces calf atrophy. CONCLUSION: A rigid and stable reconstruction, allowing early weightbearing without equinus position seems to be a rational treatment for Achilles tendon rupture in athletes.