Repair of the Achilles tendon sleeve avulsion: quantitative and functional evaluation of a transcalcaneal suture technique.

The clinical characteristics of patients with a nonbony avulsion of the Achilles tendon from its calcaneal insertion (Achilles "sleeve" avulsions) along with the results of operative treatment via a transcalcaneal suture repair technique are presented. Analysis of functional outcome was measured by the AOFAS ankle/hindfoot score and quantitative peak strength by Cybex testing. The results of AOFAS ankle/hindfoot scoring demonstrated no statistically significant difference in AOFAS ankle/hindfoot score between the operative limb and the control (unaffected) limb (mean values = 98.83 vs. 96.67, respectively, p = .5232, unpaired Student t test). Cybex testing for peak strength generated during plantarflexion was performed on all operative limbs and compared to the matching control (unaffected) limb. Cybex testing results demonstrated no statistically significant difference in maximum peak strength between the operative limb and the matched control (unaffected) limb (mean values: 43 ft-lbs vs. 46 ft-lbs, respectively, p = .2818, paired Student t test). All patients were satisfied with their result. This technique was successful in repairing Achilles sleeve avulsions in a variety of patients, ranging from professional and recreational athletes to lower-demand patients with diabetes, allowing them to return to work and full recreational activities. Based on our data, we conclude that the transcalcaneal suture repair technique for the Achilles tendon sleeve avulsion is a reliable reconstruction technique for these otherwise difficult-to-repair osseous-tendinous disruptions at the Achilles tendon insertion.