Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures

OBJECTIVES: We evaluated the long-term results of acute Achilles tendon ruptures treated with primary end-to-end repair with the Krackow technique combined with augmentation using the plantaris tendon. METHODS: Thirty-six patients (31 males, 5 females; mean age 34 years; range 21 to 42 years) underwent primary surgical repair for acute Achilles tendon ruptures. Most of the patients (31/36) were involved in regular sportive activities. Surgery included end-to-end repair with the Krackow technique (locking-loop) combined with plantaris tendon augmentation. All the patients received a standardized progressive postoperative rehabilitation program. The results were evaluated with respect to time to return to work and preinjury activity levels and by a scoring system covering objective and subjective parameters. The mean follow-up was 54 months (range 28 to 78 months). RESULTS: At surgery, 34 patients (94.4%) and two patients (5.6%) were found to have complete and partial ruptures, respectively. The mean operation time was 50 minutes (range 40 to 70 minutes). The patients returned to work after a mean of eight weeks (range 6 to 9 weeks) and to preinjury sportive activities after a mean of 17 weeks (range 14 to 20 weeks). The overall mean scoring was good (88 out of 100) at the end of a year follow-up. Early or late complications included superficial wound infections in five patients and partial rupture recurrence in one patient. CONCLUSION: Our results showed that the Krackow technique combined with plantaris tendon augmentation and a rehabilitation protocol aiming early motion enabled physiological tendon healing