Primary Repair of Severed Tendoachilles Ensured Better Outcome

Abstract

Background: Achilles tendon rupture, a prevalent musculoskeletal injury, significantly impairs mobility and function. Primary surgical repair ensures anatomical restoration and minimizes rerupture compared to conservative management. Objective: To evaluate the functional and clinical outcomes of immediate primary repair of acute open tendoachilles injuries using the Modified Kessler technique with postoperative functional rehabilitation. Methods: This prospective cohort study was conducted at Rajshahi Medical College Hospital (January–December 2020) involving 50 patients (38 males, 12 females; mean age 30.02 ± 7.7 years). All underwent primary repair within 6 hours using non-absorbable Prolene sutures. Functional outcomes were assessed at 16 weeks using Juhana Leppilahti Modified Scoring System. Statistical analyses included chi-square tests, Student’s t-tests, and 95% confidence intervals (CI), with significance at p<0.05. Results: A total number of 50 patients, 90% (n=45) stood on tiptoe unsupported, 8% (n=4) required support, and 2% (n=1) failed due to wound gap. Ankle motion remained normal in 70% (n=35), mildly restricted (≤10°) in 26% (n=13), and severely restricted (>10°) in 4% (n=2). Mean delay of repair was 6.12 ± 2.36 hours. Mean calf circumference reduction was 1.4 ± 0.7 cm (p=0.031). Plantarflexion power recovery achieved ≥90% in 88% of patients, with mean torque 27.8 ± 3.1 Nm. Complications included superficial skin infection 8% (n=4), swelling 8% (n=4), hypertrophic scar 4% (n=2), wound gap 2% (n=1). Functional outcome grading: excellent 56%, good 32%, fair 8%, poor 4%. Overall satisfactory outcome: 88% (95% CI, 79–97%, p=0.001). Gender, infection status, and timing of surgery were significantly associated with functional outcome (p<0.05). Conclusion: Early primary repair of acute Achilles tendon injuries provides superior functional recovery, reduced rerupture risk, and statistically significant outcomes when performed within the golden 6-hour window.