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paul

how does a ruptured achilles tendon heal without surgery?

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i ruptured my achilles earlier this year. surgery was discouraged. my leg was put in plaster (initially in the equinus position) for 11 weeks. it is now healed. but what actually happened? how did the two ends 'knit' together (if 'knit' is the correct word?)?

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It's because the 'rupture' wasn't a complete break, otherwise surgery definitely would have been required. It was more likely that only a portion of the tendon tore, and healed back together while your leg was inactive.

 

Mokele

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thanks mokele, but it was a full rupture. there is debate as to whether surgery is advisable even with full ruptures (as it can lead to infection, and conservative treatment is almost as effective).

 

my leg's fine. i'm curious though, about the 'knitting' process; what actually takes place? do the cells themselves rupture as a result of the accident? or is it a break in the bond between cells? how do cells bond together anyway? and how do they 're-bond' following rupture?

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Ahh, there's not much cellular material in tendon at all - it's mostly just collagen protein, with a handful of cells around to heal it from minor stuff. In the case of a complete rupture, without surgery, it would probably entirely depend upon your leg remaining immobile.

 

It's basically the same process and a bone break - the cells inhabiting the area go into overdrive and start laying down new collagen at each end of the rupture, and eventually they meet up. Like bone, tendon does remodel itself, so once the ends are fused, the union will be 'cleaned up' by the cells (removing stray fibers of collagen that aren't in the right orientation, etc).

 

Mokele

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i have a question about achilles tendon surgical repair.

 

what are the chances of some how tearing the inner stitches doing some rehab about 5 weeks post op? and how can i tell if i did that. i have no swelling and i am still able to do the reps w/o any issues

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Honestly, I have no idea. If you have any concerns, though, I'd bring them up ASAP with your physical therapist (I'm assuming you have one, due to the nature of the injury).

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tendon tissues are avascular so full recovery will take a long time. when you tear or rupture tendons the collagen fibers that grow back will never be as strong. for example: Achilles tendon collagen fibers are type 1 and when torn, only type 3 will grow back, nowhere near as strong (info from memory, correct if wrong!)

so, be careful when doing anything high impact and make sure you rehab properly!

good luck =]

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