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The return to sport after an achilles tendon rupture

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The rupture of the Achilles tendon in athletes, is a rare event that usually occurs during the 3rd decade in athletes and 4th among the sedentary. The break often occurs when an eccentric effort (Work together a muscle elongation instead of the normal shortening) as a startup, acceleration or landing from a jump.
The risk of tendon rupture is even greater than the tendon tissue is injured and / or constraints that sports are important. The break quite often following an increased physical activity or change training

The rupture of the Achilles tendon is supported or orthopedically (plaster resin) or surgically. There are no recommendations on treatment to offer, and each case will be discussed with the physician and surgeon sport.

Surgery may be based on the case and habit of the surgeon:

- Classic with an opening in the skin and direct suture repair of tendon by tendon edge to edge like the picture below.

surgical technique for the repair of block-breaking classic Achilles tendon surgical suture chirurgiedusport.jpg

- Percutaneous by setting up the harpoon, then telescoping tendon ends and locking system button

Rehabilitation, aimed at recovering a good joint mobility and good strength of the sural triceps, should definitely consider the surgeon's instructions is divided into three phases:

1 st phase postoperative period that occurs tendon healing. The ankle is immobilized about 6 weeks (sometimes equinus during the first three weeks and then at right angles). Patients are sometimes not capitalized, particularly after percutaneous suture, but must walk between two crutches during the same period. During this first phase, rehabilitation is very limited and merely limit the atrophy of the limb.

2nd phase recovery of mobility of the ankle and calf muscle strength in order to restore normal operation and to make possible the resumption of daily and professional activity. This work must be gradual and supervised by experienced professionals in order to avoid straining too early and too significantly tendon.
Crutches are phased out over two to three weeks at the beginning of this phase. The resumption of the march is accompanied by a more or less painful lameness and may require the help of a cane or a heel to relieve the Achilles tendon. At this stage, the physio can help in a rehabilitation pool and on bicycle and treadmill respecting the rule of not pain.

3rd stage: preparation for the resumption of sport should be gradual and - at best - framed so as not to exceed las functional abilities of the athlete.
It will begin at 3 months of operation, the resumption of jogging to jog in the axis and without acceleration. Over the next month will be phased lateral movements and changes of direction and acceleration and jumps.

The main complication of the treatment of Achilles tendon ruptures (surgery or plaster) is the iterative tendon rupture. Pay particular attention during the first weeks after removal of the cast. During this period, the callus tendon remains very fragile and under stress all the more strong that there is a calf muscle-tendon retraction common to the output of the asset. It will therefore be particularly careful as you will not have recovered enough mobility dorsiflexion.

Doctor Charles AISENBERG. - 6 juillet 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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