scholarly journals Achilles tendon ruptures during summer show the lowest incidence, but exhibit an increased risk of re-rupture

2020 ◽  
Vol 28 (12) ◽  
pp. 3978-3986
Author(s):  
I. A. Saarensilta ◽  
G. Edman ◽  
P. W. Ackermann
Keyword(s):  
Adverse Events ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Surgical Techniques ◽  
Patient Reported Outcome ◽  
Injury Mechanism ◽  
Increased Risk ◽  
Patient Reported ◽  
Operative Complications

Abstract Purpose Achilles tendon rupture (ATR) is a common injury. The knowledge of seasonal factors´ impact is incomplete, but may provide means for preventive approaches for Achilles tendon related morbidity. The aim of this study was to investigate seasonal variations in ATR incidence in relation to injury mechanism, adverse events including risk of re-rupture, and patient-reported outcome in adults in Stockholm, Sweden. Methods In total, 349 patients with unilateral acute Achilles tendon rupture, prospectively treated with standardized surgical techniques, were retrospectively assessed. Date of injury was assigned to one of the four internationally defined meteorological seasons in the northern hemisphere. Injury mechanism and the rate of adverse events; deep venous thrombosis, infection and re-rupture in relation to per-operative complications. Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score. Results ATR incidence was significantly highest during winter and spring, and lowest during summer (p < 0.05). The most common sporting activities associated with ATR were badminton, floorball and soccer (> 50%). The rate of soccer-related ATR was highest during summer (p < 0.05). Patients sustaining an ATR during summer, compared to other seasons, exhibited more per-operative complications (p < 0.05), a significantly higher risk of re-rupture (p < 0.05) and a lower rate of good outcome (n.s.). The risk of other adverse events after ATR did not differ between the seasons. Conclusion Winter and spring are the high risk seasons for sports-related ATR and the risk sports are badminton, soccer and floorball. The reason for the higher risk of re-rupture after ATR repair during summer should be further investigated. Level of evidence III.

scholarly journals Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture

2018 ◽  
Vol 46 (12) ◽  
pp. 2929-2934 ◽  
Author(s):  
Simon Svedman ◽  
Robin Juthberg ◽  
Gunnar Edman ◽  
Paul W. Ackermann
Keyword(s):  
Patient Outcome ◽  
Adverse Events ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
Treatment Protocols ◽  
Good Outcome ◽  
Patient Reported

Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols; however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred twenty-eight patients with ATR who were treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on availability of the operating theater, and neither surgeon nor patient could influence the TTS. Patients were assigned to 1 of 3 groups: short TTS (<48 hours), intermediate TTS (48-72 hours), and long TTS (>72 hours). Patient-reported outcome at 1 year was assessed with the validated Achilles tendon Total Rupture Score, with scores higher than 80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (perioperative and postoperative) and deep venous thrombosis were assessed. Results: Short TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared with 44% (95% CI, 33%-56%) of the patients with long TTS ( P = .002), with the intermediate TTS group in between, 63% (95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS, 1.4% (95% CI, 1%-4%) compared with those with intermediate TTS, 11% (95% CI, 2%-21%) ( P = .035) and those with long TTS, 14.8% (95% CI, 7%-23%) ( P = .003). The risk of sustaining a deep venous thrombosis was not statistically significantly different among the 3 groups ( P = .15). Conclusion: Patients with acute ATR undergoing operation within 48 hours after injury had better outcomes and a lower number of adverse events compared with patients undergoing operation after 72 hours. These results align with evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols. Registration: NTC01317160 (ClinicalTrials.gov identifier).

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 Influence of Achilles tendon rupture site on surgical repair outcomes

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110076
Author(s):  
Shengxuan Cao ◽  
Zhaolin Teng ◽  
Chen Wang ◽  
Qian Zhou ◽  
Xu Wang ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Medical Records ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Weak Negative Correlation ◽  
The Common ◽  
The Mean ◽  
Rupture Site

Purpose: This study aims to measure the distance between the common site of Achilles tendon rupture and calcaneal insertion through ultrasound and to compare the outcomes between proximal and distal rupture groups. Methods: We investigated the electronic medical records of 117 patients and preoperative ultrasound describing the rupture site. Among 88 patients, we compared the patient-reported outcome and re-rupture rate of proximal and distal rupture groups. Results: The mean rupture site of the 117 included subjects was 4.5 ± 1.3 cm. The rupture site had a weak negative correlation with body mass index ( ρ = −0.230, P = 0.013). Furthermore, 77% of the patients with distal rupture reported good outcome (Achilles Tendon Rupture Score > 80) compared to 56% of the patients with proximal rupture ( P = 0.041). Conclusion: Patients with proximal rupture had less satisfactory postoperative outcomes than those with distal rupture.

Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management

2020 ◽  
Vol 102-B (7) ◽  
pp. 933-940 ◽  
Author(s):  
Julian F. Maempel ◽  
Nicholas D. Clement ◽  
Neil R. Wickramasinghe ◽  
Andrew D. Duckworth ◽  
John F. Keating
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome Measures ◽  
Nonoperative Treatment ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Long Term Follow Up

Aims The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial. Methods PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7). Results There was no statistically significant difference between operatively and nonoperatively treated patients, in SMFA Dysfunction Index (median 1.56 (interquartile range (IQR) 0 to 5.51) vs 1.47 (IQR 0 to 5.15); p = 0.289), SMFA Bother Index (2.08 (IQR 0 to 12.50) vs 0.00 (IQR 0 to 6.25); p = 0.074), ATRS (94 (IQR 86 to 100) vs 95 (IQR 81 to 100); p = 0.313), EQ-5D-5L (1 (IQR 0.75 to 1) vs 1 (IQR 0.84 to 1); p = 0.137) or EQ-5D health today visual analogue score (85 (IQR 72.5 to 95) vs 85 (IQR 8 to 95); p = 0.367). There was no statistically significant difference between operative and nonoperative groups in terms of satisfaction (84% vs 100%; p = 0.119) or willingness to recommend treatment to friends or family (79% vs 87%; p = 0.255). Four nonoperative patients and two in the operative group sustained a re-rupture (p = 0.306). Conclusion Both patient groups reported good results at long-term follow-up. The findings give no evidence of superior long-term patient reported outcomes (as measured by the SMFA) for surgical treatment over nonoperative treatment. There was no demonstrable difference in other patient reported outcome measures, satisfaction, or re-rupture rates at long-term follow-up. Cite this article: Bone Joint J 2020;102-B(7):933–940.

Does size of tendon gap affect patient-reported outcome following Achilles tendon rupture treated with functional rehabilitation?

2020 ◽  
Vol 102-B (11) ◽  
pp. 1535-1541 ◽  
Author(s):  
Mohamed Yassin ◽  
Richard Myatt ◽  
William Thomas ◽  
Vatsal Gupta ◽  
Tagrit Hoque ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Gap Size ◽  
Functional Rehabilitation ◽  
Patient Reported ◽  
Dynamic Ultrasound ◽  
The Mean

Aims Functional rehabilitation has become an increasingly popular treatment for Achilles tendon rupture (ATR), providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications. Limited evidence exists on whether gap size should affect patient selection for this treatment option. The aim of this study was to assess if size of gap between ruptured tendon ends affects patient-reported outcome following ATR treated with functional rehabilitation. Methods Analysis of prospectively collected data on all 131 patients diagnosed with ATR at Royal Berkshire Hospital, UK, from August 2016 to January 2019 and managed non-operatively was performed. Diagnosis was confirmed on all patients by dynamic ultrasound scanning and gap size measured with ankle in full plantarflexion. Functional rehabilitation using an established protocol was the preferred treatment. All non-operatively treated patients with completed Achilles Tendon Rupture Scores (ATRS) at a minimum of 12 months following injury were included. Results In all, 82 patients with completed ATRS were included in the analysis. Their mean age was 51 years (standard deviation (SD) 14). The mean ATRS was 76 (SD 19) at a mean follow-up of 20 months (SD 11) following injury. Gap inversely affected ATRS with a Pearson’s correlation of -0.30 (p = 0.008). Mean ATRS was lower with gaps > 5 mm compared with ≤ 5 mm (73 (SD 21) vs 82 (SD 16); p = 0.031). Mean ATRS was lowest (70 (SD 23)) with gaps > 10 mm, with significant differences in perceived strength and pain. The overall re-rupture rate was two out of 131 (1.5%). Conclusion Increasing gap size predicts lower patient-reported outcome, as measured by ATRS. Tendon gap > 5 mm may be a useful predictor in physically demanding individuals, and tendon gap > 10 mm for those with low physical demand. Further studies that control for gap size when comparing non-operative and operative treatment are required to assess if these patients may benefit from surgery, particularly when balanced against the surgical risks. Cite this article: Bone Joint J 2020;102-B(11):1535–1541.

scholarly journals Achilles Tendon Rupture Repairs: A Case Series Reporting Clinical Outcomes of a Novel Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Caroline Williams ◽  
Christopher P. Miller ◽  
John Y. Kwon
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Patient Positioning ◽  
Measurement Information ◽  
Repair Technique ◽  
Patient Reported ◽  
Mini Open

Category: Trauma; Ankle; Sports Introduction/Purpose: Achilles tendon rupture repair has undergone several changes in the last ten years, aiming to minimize complications while maximizing clinical and functional outcomes. Selecting a less invasive approach instead of traditional open incision has shown through various studies to generate excellent results and significantly reduce post-operative infections. Choice of patient positioning during operative repair has also shown to be of great impact, with prone positioning being associated with elevated surgical times and anesthetic requirements, thus secondary affecting clinical outcomes. Other complications associated with prone positioning include neuropraxia and increased risk of iatrogenic ophthalmologic insults as compared to the supine position. This case report evaluates clinical outcomes of patients following treatment of Achilles rupture with a novel Medial Mini- Open Supine Achilles Repair Technique. Methods: Patients were selected for case series inclusion after undergoing novel Medial Mini-Open Supine Achilles Repair Technique for acute achilles rupture. Retrospective medical record review for demographic, perioperative and functional data was completed for each patient, with means, range and standard deviations calculated when appropriate. Patients were then followed postoperatively to monitor recovery. At a final follow up visit scheduled no sooner than six months post operatively, outcomes were assessed with three separate Patient-Reported Outcomes Measurement Information System (PROMIS) surveys; Physical Function, Pain Interference and Depression. Two separate Foot and Ankle Ability Measure (FAAM) assessments, ADLs and Sport, were also completed. Patients were also assessed for physical pain/discomfort using the Visual Analog Scale (VAS). Results: Eighteen patients were included in this study; fifteen male, three female. Mean age was 37.5 years (+-12, range= 20-68). Mean duration of surgery was 31.0 minutes (+- 7.0). Follow up duration averaged 11.8 months (range 6.0-13.5). All patients completed three Patient-Reported Outcomes Measurement Information System (PROMIS) studies and two Foot and Ankle Ability Measure (FAAM) surveys. Mean score for the PROMIS Physical Function survey was 52.3 (+-11.5), for Pain Interference, mean= 50.0 (+-7.30), and for Depression, mean=39.5 (+- 6.96). FAAM Sport survey showed a mean=71.3 (+-29.4), with ADLs form responses showing a mean of 90.7 (+-12.7). All patients reported 0/10 pain on Visual Analog Scale (VAS), and overall satisfaction with their outcomes. Conclusion: In reviewing data collected thus far, the Medial Mini-Open Supine Achilles Repair technique shows promise to serve as a viable option for achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. No complications have been reported at this time; patients have demonstrated excellent outcomes in physical exam in postoperative clinic visits. All patients have expressed satisfaction with their results at final visit.

Risk Factors for Failed Nonoperative Treatment and Rerupture in Acute Achilles Tendon Rupture

2018 ◽  
Vol 39 (6) ◽  
pp. 694-703 ◽  
Author(s):  
Aleksi Reito ◽  
Hanna-Liina Logren ◽  
Katri Ahonen ◽  
Heikki Nurmi ◽  
Juha Paloneva
Keyword(s):  
Risk Factors ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Factors Associated ◽  
Increased Risk ◽  
Male Patients

Background: Nonoperative treatment is feasible in most patients with acute Achilles tendon rupture. Risk factors associated with failed nonoperative treatment are poorly understood. We investigated risk factors associated with rerupture after nonoperative treatment and otherwise failed nonoperative treatment of Achilles tendon rupture. Methods: All patients diagnosed with acute Achilles tendon rupture between January 2009 and June 2016 and who underwent 8 weeks of nonoperative treatment with functional rehabilitation were included in the study. Patients with rerupture or otherwise failed nonoperative treatment were identified retrospectively. Time to rerupture and association of age, sex, time from injury, diabetes, and visits to the physiotherapist for cases of reruptures and otherwise failed nonoperative treatment were investigated. A total of 210 patients were included in the study. Results: Fifteen patients sustained a rerupture. Rerupture incidence was 7.1%. Incidence of late reruptures, those occurring after return to daily activities at 12 weeks, was 1.9%. Six patients had otherwise failed nonoperative treatment. Median time to rerupture was 23 days (6 to 61) after the end of the treatment. The incidence of all-cause failure was 10.0%. Male gender was associated with reruptures ( P = .013) and failed nonoperative treatment for any reason ( P = .029). Conclusion: It is important to highlight the increased risk of rerupture in male patients during the first month after the end of the nonoperative treatment. Age alone, even in male patients, was a poor indication for operative treatment since it did not predict early failure. Further studies will hopefully clarify the influence of activity level on the risk of rerupture. Level of Evidence: Level IV, retrospective case series.

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