scholarly journals The Achilles tendon Total Rupture Score is a responsive primary outcome measure: an evaluation of the Dutch version including minimally important change

2020 ◽  
Vol 28 (10) ◽  
pp. 3330-3338
Author(s):  
Olivier C. Dams ◽  
Inge H. F. Reininga ◽  
Johannes Zwerver ◽  
Ronald L. Diercks ◽  
Inge van den Akker-Scheek
Keyword(s):  
Achilles Tendon ◽  
Roc Analysis ◽  
Longitudinal Research ◽  
Achilles Tendon Rupture ◽  
Important Change ◽  
Receiver Operating Curve ◽  
Global Rating ◽  
Dutch Version ◽  
Level Of Evidence ◽  
Minimally Important Change

Abstract Purpose Aim of this study was to evaluate the responsiveness of the Dutch version of the Achilles tendon Total Rupture Score (ATRS-NL). Methods Patients (N = 47) completed the ATRS-NL at 3 and 6 months after Achilles tendon rupture (ATR). Additionally, they filled out the Euroqol-5D-5L (EQ-5D-5L) and Global Rating of Change Score (GRoC). Effect sizes (ES) and standardized response means (SRM) were calculated. The anchor-based method for determining the minimally important change (MIC) was used. GRoC and improvement on the items mobility and usual activities on the EQ-5D-5L served as external criteria. The scores on these anchors were used to categorize patients’ physical functioning as improved or unchanged between 3 and 6 months after ATR. Receiver operating curve (ROC) analysis was performed, with the calculation of the area under the ROC curve (AUC) and the estimation of MIC values using the optimal cut-off points. Results There was a large change (ES: 1.58) and good responsiveness (SRM: 1.19) of the ATRS-NL between 3 and 6 months after ATR. Using ROC analysis, the MIC values ranged from 13.5 to 28.5 for reporting improvement on EQ-5D-5L mobility and GRoC, respectively. The AUC of improvement on mobility and improvement on GRoC were > 0.70. Conclusion The ATRS-NL showed good responsiveness in ATR patients between 3 and 6 months after injury. Use of this questionnaire is recommended in clinical follow-up and longitudinal research of ATR patients. MIC values of 13.5 and 28.5 are recommended to consider ATR patients as improved and greatly improved between 3 and 6 months after ATR. Level of evidence II.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Deep venous thrombosis after Achilles tendon rupture is associated with poor patient-reported outcome

2020 ◽  
Vol 28 (10) ◽  
pp. 3309-3317
Author(s):  
Simon Svedman ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Surgical Techniques ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Reported

Abstract Purpose The aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization. Methods A cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation). Results The total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71–79 vs 80–87; p < 0.01). Sixty-seven percent (95% CI 57–77%) of the patients devoid of DVT reported a good outcome (ATRS > 80) compared to 51% (95% CI 41–61%) of the patients sustaining a DVT (p < 0.05). Quality of life displayed significantly better outcome in the non-DVT versus DVT patients (mean = 75 (95% CI 71–79) vs. mean = 68 (95% CI 64–72); p < 0.05). A significant difference in total concentric work was observed between non-DVT and DVT patients (median = 1.9 kJ (IQR = 0.9 kJ) vs. median = 1.6 kJ (IQR = 1.0 kJ); p < 0.01). Conclusion Sustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR. Level of evidence III.

scholarly journals Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988767
Author(s):  
Lu Bai ◽  
Siyao Guan ◽  
Tian You ◽  
Wentao Zhang ◽  
Peng Chen
Keyword(s):  
Retrospective Study ◽  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Hamstring Graft ◽  
Early Recovery ◽  
Level Of Evidence ◽  
Type 3

Background: Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon. Purpose: To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively. Results: The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group ( t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups. Conclusion: Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

Retrospective Analysis of Mini-Open Repair Versus Open Repair for Acute Achilles Tendon Ruptures

2012 ◽  
Vol 6 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Erin E. Klein ◽  
Lowell Weil ◽  
Jeffrey R. Baker ◽  
Lowell Scott Weil ◽  
Wenjay Sung ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Surgical Intervention ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Tendon Ruptures ◽  
Return To Activity ◽  
Mini Open

Purpose: Debate exists over optimal treatment for acute Achilles tendon ruptures. Recent literature suggests the mini-open technique may provide the reliability of the open repair with the decreased complication rate of non-operative treatment. This retrospective review compares acute tendon ruptures treated with one of two techniques: open repair (TO) or mini-open repair (MOA). Methods & Results: Records were reviewed and 34 patients were found to meet the inclusion criteria for open or mini-open repair of an acute Achilles tendon rupture with follow up of at least 12 months. TO (n=16) and MOA (n=18) had no statistically significant differences in age at time of injury [TO: 41 + 2.5 years (range 20 – 68); MOA: 46 + 2.5 years (range 33 – 73)] or time between injury and surgical repair [TO: 15 + 2 days (range 2 – 30); MOA: 15 + 2 days (range 2 – 30)]. Post-operative VISA-A scores were 82 + 10 (range 42 – 98) and 92 + 5 (range 66 – 100) for TO and MOA, respectively. Significant differences were found in the time between surgical intervention and beginning of rehabilitation [TO: Post op day 37 + 5 (range 21 – 46); MOA: Post op day 19 + 2 (range 7 – 32)] and the time between surgical intervention and full return to activity [TO: Post op month 7 + 1 (range 4 – 11); MOA: Post op month 5 + 0.6 (range 4 – 11)]. Conclusion: These results suggest that the mini-open repair provides acceptable surgical outcomes while optimizing patient function after Achilles tendon repair. Level of Evidence: Therapeutic, Level III: Retrospective Comparative

scholarly journals Achilles tendon detachment after local infiltration of corticosteroids

2021 ◽  
Vol 15 (1) ◽  
pp. 73-76
Author(s):  
Jorge Del Vecchio ◽  
Eric Dealbera ◽  
Jorge Batista ◽  
Mauricio Ghioldi ◽  
Lucas Chemes
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Imaging Studies ◽  
Level Of Evidence ◽  
Local Infiltration ◽  
Achilles Tendinosis ◽  
Retrocalcaneal Bursitis ◽  
Retrocalcaneal Bursa ◽  
Haglund Deformity

Complete disinsertion of the Achilles tendon is relatively rare but is an injury of considerable clinical significance. A 50-year-old non-smoking man presented with complete disinsertion of the Achilles tendon due to an indirect low-energy trauma shortly after administration of local corticosteroid injections (LCI) for treatment of deep retrocalcaneal bursitis. Imaging studies showed complete disinsertion of the Achilles tendon as well as severe Haglund syndrome and retrocalcaneal bursitis. The tendon was repaired, and the Haglund deformity and retrocalcaneal bursa were then resected. Although Achilles tendon rupture is a frequent complication after LCI, to date, no cases of disinsertion have been published. Surgeons must be aware of this issue, especially in patients with previous insertional calcific Achilles tendinosis and Haglund syndrome. Level of Evidence V; Therapeutic Studies; Expert Opinion.

scholarly journals Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

2021 ◽  
pp. 107110072110385
Author(s):  
Nicola Maffulli ◽  
Nikolaos Gougoulias ◽  
Gayle D. Maffulli ◽  
Francesco Oliva ◽  
Filippo Migliorini
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Achilles Tendon Rupture ◽  
Rehabilitation Program ◽  
Calf Circumference ◽  
Level Of Evidence ◽  
Traditional Group ◽  
Percutaneous Repair ◽  
Patient Reported ◽  
Group 1

Background: Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after percutaneous surgical repair. Methods: Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. Results: At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. Conclusion: Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study. Level of Evidence: Level II, prospective comparative study.

Performance of the Achilles Tendon Total Rupture Score Over Time in a Large National Database: Development of an Instruction Manual for Accurate Use

2020 ◽  
Vol 48 (6) ◽  
pp. 1423-1429 ◽  
Author(s):  
Maria Swennergren Hansen ◽  
Katarina Nilsson Helander ◽  
Jón Karlsson ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
National Database ◽  
Future Research ◽  
Item Score ◽  
Level Of Evidence ◽  
Instruction Manual ◽  
Patient Reported ◽  
The Difference

Background: The Achilles tendon Total Rupture Score (ATRS) is a commonly used patient-reported outcome measure for patients with an acute Achilles tendon rupture. The score consists of 10 questions, the last 3 of which include activities that some patients cannot or do not do. No instruction manual has been developed for the ATRS. Hypothesis/Purpose: The purpose was to evaluate the ATRS at 4, 12, and 24 months after a rupture. The hypothesis was that the results at 4 months would be inconsistent when compared with the results at 1 year and 2 years. We also aimed to develop a manual that explains how to use the ATRS. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: This was a mixed-methods study. The first section was a registry study, where prospectively collected data were analyzed. Data were collected 4, 12, and 24 months after rupture. The original score based on 10 items was compared with a score based on the first 7 items adjusted to the same scale as the original score. Density plots and scatterplots were made and differences between the scores were tested using the Mann-Whitney U test. The second section of the study consisted of discussions among the authors, which resulted in a manual for the ATRS. Results: In total, 2790 complete ATRSs were included. The 7-item score significantly overestimated the value of the 10-item score at all time points ( P < .001), but only at 4 months was the difference clinically relevant (9.7 points). Conclusion: When the ATRS is used for short-term evaluation, there is a risk of results being inconsistent because of the last 3 questions. A manual explaining how to use the ATRS was therefore developed. We recommend that the full ATRS together with the manual should be used in future research rather than eliminating the 3 last questions.

Percutaneous versus Open Repair of the Ruptured Achilles Tendon

2005 ◽  
Vol 33 (9) ◽  
pp. 1369-1379 ◽  
Author(s):  
Andrej Čretnik ◽  
Miloš Kosanović ◽  
Vladimir Smrkolj
Keyword(s):  
Achilles Tendon ◽  
Local Anesthesia ◽  
Tendon Rupture ◽  
Open Repair ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Functional Results ◽  
Level Of Evidence ◽  
Significant Difference ◽  
American Orthopaedic

Background Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains. Purpose To compare the results of percutaneous and open Achilles tendon repair. Study Design Cohort study; Level of evidence, 2. Methods The results of 132 consecutive patients with acute complete Achilles tendon rupture who were operated on exclusively with modified percutaneous repair under local anesthesia from 1991 to 1997 and followed up for at least 2 years were compared to the results of 105 consecutive patients who were operated on exclusively with open repair under general or spinal anesthesia in the same period. Results There were significantly fewer major complications in the group of percutaneous repairs in comparison with the group of open repairs (4.5% vs 12.4%; P = .03), particularly necrosis (0% vs 5.6%; P = .019), and a lower total number of complications (9.7% vs 21%; P = .013). There were slightly more reruptures (3.7% vs 2.8%; P = .680) and sural nerve disturbances (4.5% vs 2.8%; P = .487) in the group of percutaneous repairs, with no statistically significant difference. Functional assessment using the American Orthopaedic Foot and Ankle Society scale and the Holz score showed no statistically significant difference. Conclusion The results of the study support the choice of (modified) percutaneous suturing under local anesthesia as the method that brings comparable functional results to open repair, with a significantly lower rate of complications.

scholarly journals Jigless knotless internal brace technique for acute Achilles tendon rupture: a case series study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Po-Yen Ko ◽  
Ming-Tung Huang ◽  
Chia-Lung Li ◽  
Wei-Ren Su ◽  
I-Ming Jou ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Case Series ◽  
Level Of Evidence ◽  
Case Series Study ◽  
Internal Brace ◽  
Preoperative Exercise ◽  
American Orthopaedic ◽  
Invasive Techniques

Abstract Purpose To mitigate the risk of poor wound healing and of infection associated with the open repair of Achilles tendon midsubstance ruptures, minimally invasive techniques have been developed. We report our preliminary results after reviewing our “jigless knotless internal brace technique.” Methods Patients were placed in prone position and a transverse 3-cm incision was made proximal to the palpable ruptured end. The proximal ruptured end was pulled out, gently debrided, and sutured using Krackow locking loops. Percutaneous sutures were crisscrossed through the distal tendon stump and looped around the Krackow sutures over the proximal stump. The ipsilateral Krackow sutures and the contralateral crisscrossed sutures were subcutaneously passed through two mini-incisions over the posterior calcaneus tuberosity and seated at the tuberosity with two 4.5-mm knotless suture anchors. All patients underwent the same post-operative rehabilitation protocol and regular follow-ups for at least 1 year. Results We recruited 10 patients (mean age, 37.3 years) who scored 100 points on the American Orthopaedic Foot and Ankle Society (AOFAS) scale, and who returned to their preoperative exercise levels 1-year post-operatively with no complications. Conclusion Our method is simple, effective, and requires no special tools. It might be a reliable option for Achilles tendon repair. Level of evidence III

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