Management of Acute Achilles Tendon Rupture Using the Krackow and Tendon-Bundle Techniques

ABSTRACT: Background: Acute Achilles tendon rupture is a severe injury of the lower extremities; however, optimal treatment options are not yet available. This study aimed to investigate the surgical method and clinical effect of the Krackow and tendon-bundle techniques for managing acute Achilles tendon rupture. Methods: This retrospective case series study analyzed 17 cases of acute Achilles tendon rupture at the Beijing Jishuitan Hospital from December 2012 to January 2020. There were 16 men and one woman, aged 27–45 years, with an average of 39.6 years. Thirteen patients were injured while playing basketball or badminton, and 4 patients were injured while participating in a football match or other sports. All injuries were repaired using the Krackow and tendon-bundle techniques. Postoperative evaluation indicators included active range of motion during ankle plantar flexion and dorsiflexion, height of single foot heel lifting, Amer-Lindholm Achilles tendon function score, and American Orthopedic Foot and Ankle Society (AOFAS) score. Results: The patients were followed-up for 6–45 months (average, 18.9 months). There was no re-rupture of the Achilles tendon, wound infection, or sural nerve injury. At the final follow-up, the affected and contralateral sides exhibited plantar flexion of 42.1 ± 4.4 ° and 43.8 ± 2.8 °, dorsiflexion of 15.8 ± 2.9 ° and 16.6 ± 2.9 °, respectively, and one foot exhibited a heel lifting height of 7.2 ± 1.0 cm and 7.5 ± 0.9 cm, respectively. There was no significant difference between the affected and contralateral sides (P>0.05). At the final follow-up, the Amer-Lindholm Achilles tendon function score was excellent in 94.1% (16/17) of the patients and good in 5.9% (1/17) of the patients. The AOFAS scores ranged from 90 to 100, with an average of 96.4 ± 3.7. Conclusion: Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends, and thus it is an effective repair method for closed Achilles tendon injury