Dual-Incision Achilles Tendon Repair Using Krackow Sutures With Over-the-Top Knot Placement for Early Rehabilitation Without Immobilization: A Retrospective Case Series.

Background: Early functional rehabilitation after Achilles tendon repair has gained increasing attention; however, most protocols still incorporate postoperative immobilization. Sufficient initial fixation strength may allow safe early mobilization without external immobilization. Methods: This retrospective case series evaluated patients who underwent dual-incision Achilles tendon repair using a Krackow locking stitch with over-the-top knot placement. Thirty-eight patients were included, and functional outcomes were analyzed in 35 patients with at least 12 months of follow-up. The rehabilitation protocol permitted early mobilization without routine postoperative immobilization. Clinical outcomes, including return to activity, gait recovery, and complications, were assessed with a mean follow-up of 33.4 ± 20.6 months. Results: The cohort included 38 patients (24 males and 14 females) with a mean age of 51.8 ± 17.0 years. The mean time from injury to surgery was 5.5 ± 3.6 days. The median preinjury and postoperative Tegner Activity Scale scores were 7 and 6, respectively (range, 3-8). Among the 35 patients with at least 12 months of follow-up, 33 maintained their preinjury activity level, whereas 2 demonstrated a decrease of 1 point in TAS. Median time to step-to gait was 10 days, and median time to independent ambulation was 30 days. Postoperative complications occurred in 3 patients (7.9%), all of which were superficial surgical site infections. No reruptures or sural nerve injuries were observed (0/38; 95% CI, 0%-9.3%). Conclusion: Dual-incision Achilles tendon repair using a Krackow locking stitch with over-the-top knot placement was associated with early functional rehabilitation without routine postoperative immobilization in this case series. Preservation of the paratenon and relocation of the knot away from the repair interface may confer biological and mechanical advantages. Level of Evidence: Level IV, retrospective case series.