The mainstay of treatment for Achilles tendon ruptures in the past has been open direct repair of the tendon ends. The literature over the last five years or so, especially in Europe, has clearly shown that there is no advantage to this older style direct repair technique as compared to
non-operative treatment, with bracing and physiotherapy.
This new information has caused a substantial alteration in practice in the United Kingdom and Scandinavia where it is unusual for surgical treatment to be undertaken for an acute Achilles tear. I have adopted and modified a new technique put forward by Dr Gordon Ramsey from Scotland involving internal bracing. This new technique allows the Achilles tendon to be repaired directly to bone. This has a far stronger initial repair than does end-to-end tendon reconstruction, which has very little overall strength. It allows rapid weight bearing and mobilization and a much more rapid recovery.
Internal bracing seems to be the way to the future and is a technique that is practised extensively in this clinic. It has application not only in relation to the Achilles, being very useful for management of acute medial collateral tears, for instance. The principle of internal bracing involves the use of fibre tape or another very strong inert suture material being placed over the top of a tendon or ligament tear. The internal brace is securely attached to bone and bypasses the defect in the tendon, allowing the tendon to heal rapidly with a controlled and reduced force across it. It also allows the tendon or ligament to heal with no change in its length, preserving strength in the musculotendinous complex.
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