Effects of early rehabilitation following operative repair of Achilles tendon rupture (PEDro synthesis)

Background: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of—and specific risk factors associated with—postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. Methods: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. Results: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. Conclusion: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. Level of Evidence: Level III, retrospective comparative series.

Download Full-text

Results of tenorrhaphy with early rehabilitation for acute tear of Achilles tendon

Journal of Orthopaedic Surgery ◽

10.1177/2309499018802483 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901880248 ◽

Cited By ~ 2

Author(s):

Chang Hyun Ryu ◽

Ho Seong Lee ◽

Sang Gyo Seo ◽

Ho Yeon Kim

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Surgical Repair ◽

Plantar Flexion ◽

Achilles Tendon Rupture ◽

Early Rehabilitation ◽

Calf Circumference ◽

Major Complications ◽

The Mean

Background: For the treatment of acute Achilles tendon rupture, early rehabilitation after surgical repair is believed to be a useful method. The purpose of this study was to evaluate the outcome of open tenorrhaphy followed by early rehabilitation. Methods: A total of 112 patients who underwent open repair and early rehabilitation for acute Achilles tendon rupture from January 2003 to March 2015 were retrospectively reviewed. These 112 patients (80 men, 32 women) had an average age of 43.1 years (22–62 years), and the mean follow-up period was 91.8 months (12–171 months). A short leg cast was applied postoperatively for an average of 16.5 days (12–20 days). The mean duration of bracing was 6.9 weeks (6–8 weeks). Each patient was assessed based on range of motion, single heel raising test, calf circumference compared to the contralateral limb, ability to return to previous activity, the Arner–Lindholm scale, and the American orthopaedic foot and ankle society (AOFAS) hind foot scale. Isokinetic plantar flexion power was also checked. Results: All patients were fully satisfied (AOFAS ≥ 90) with the treatment results, and 96 patients were able to return to their previous athletic activities. As assessed by the Arner–Lindholm scale, 103 cases were rated as excellent and the other 9 cases were rated as good. At the 1-year follow-up period, single heel raise and hopping was possible in every patient. Compared to the contralateral side, 10 subjects (8.9%) had minor limitation of dorsiflexion motion, and an average of 1.6 cm calf circumference difference without functional disabilities. There were no major complications such as re-rupture, nerve injury, or infection. Conclusion: For acute Achilles tendon ruptures, open surgical repair with optimal length restoration, followed by earlier rehabilitation results in good functional outcomes and a successful return to pre-injury levels of physical activity without major complications. Level of evidence: Level IV.

Download Full-text

Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Foot & Ankle Orthopaedics ◽

10.1177/2473011420965967 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096596

Author(s):

Daniel Carpenter ◽

Katherine Dederer ◽

Paul Weinhold ◽

Joshua N. Tennant

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Return To Sport ◽

Biomechanical Analysis ◽

Absorbable Suture ◽

Operative Repair ◽

Repair Technique ◽

Achilles Tendon Repair

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120909556 ◽

2020 ◽

Vol 8 (3) ◽

pp. 232596712090955 ◽

Cited By ~ 4

Author(s):

Michael R. Carmont ◽

Jennifer A. Zellers ◽

Annelie Brorsson ◽

Katarina Nilsson-Helander ◽

Jón Karlsson ◽

...

Keyword(s):

Achilles Tendon ◽

Multiple Regression ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Stepwise Multiple Regression ◽

Secondary Outcome ◽

Outcome Variable ◽

Operative Repair ◽

Rise Height ◽

Tegner Score

Background: Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose: To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair. Study Design: Cohort study; Level of evidence, 3. Methods: From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI. Results: A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was –4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI ( R 2 = 0.19; P < .001; n = 120). Conclusion: Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.

Download Full-text

Treatment of Chronic Achilles Tendon Rupture with Triple Bundle Suturing Technique and Early Rehabilitation: Early Results

Techniques in Orthopaedics ◽

10.1097/01.bto.0000226226.40883.43 ◽

2006 ◽

Vol 21 (2) ◽

pp. 134-142 ◽

Cited By ~ 1

Author(s):

Arturo C. Ca??ete ◽

Harem P. Deiparine

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Early Rehabilitation ◽

Early Results ◽

Suturing Technique

Download Full-text

End-to-End Operative Repair of Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/036354659702500118 ◽

1997 ◽

Vol 25 (1) ◽

pp. 90-95 ◽

Cited By ~ 64

Author(s):

Jeffery J. Soldatis ◽

Donald B. Goodfellow ◽

John H. Wilber

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Operative Repair ◽

End To End

Download Full-text

Surgical Versus Nonsurgical Treatment for Acute Achilles Tendon Rupture A Systematic Review/Meta-Analysis

QJM ◽

10.1093/qjmed/hcaa059 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O A Elshazly ◽

A F Mohamed ◽

Y R A Mohamed

Keyword(s):

Systematic Review ◽

Achilles Tendon ◽

Tendon Rupture ◽

Meta Analysis ◽

Achilles Tendon Rupture ◽

Surgical Techniques ◽

Cochrane Library ◽

Wound Complications ◽

Rupture Rate ◽

Operative Repair

Abstract Background and Introduction Tendon Achilles injury affects 31.17 per 100000 per year, it has major impact on quality of life of affected patients, mostly active young patients. Different management options exist ranging from conservative treatment, to operative repair either open or percutaneous repair.no consensus has been reached on which treatment modality is preferred for each patient .in this study we systematically reviewed the literature for available evidence regarding management of tendon Achilles rupture. Aim of the Study to compare the two methods for treating Acute Achilles tendon rupture in a systematic review with meta-analysis and evaluate the functional outcomes of each methods. The objective is to perform a systematic review of overlapping meta-analysis regarding surgical versus non-surgical management of Acute Achilles tendon rupture to assist the decision makers in selecting their decision and provide intervention recommendations by the best available evidence. Methods This systematic review consisted of 5 studies, including a systematic search of the literature (PubMed, SCOPUS, and The Cochrane Library), selection of studies, extraction of study characteristics, assessment of methodological quality and bias. and extraction of data on clinical outcomes and their comparisons between different surgical groups. Results a total of 9 studies were included, 822 patients were extracted from the included studies. Of the 822 patients, 415 (50.4%) had undergone surgical intervention and 407 (49.6%) had received non-surgical treatment. The minimum follow-up duration was 12 months. The left Achilles tendon was relatively more prone to rupture. The interval from injury to treatment was within 2 to 14 days. Five 5 different surgical techniques were used; end to end, modified Kessler, augmented repair, Krackow type and interrupted circumferential stitch. Operative repair was found to significantly decrease rupture rate (risk ratio of 0.36, 95% CI 0.21-0.64; P = 0.0005) with higher risk of wound complications. No statistically significant difference between the two groups in functional outcome scores and range of motion. Conclusion We conclude that surgical technique lowers the risk of re-rupture rate but associated with higher complication rate which can be reduced by using the minimally invasive techniques. Multicenter randomized clinical trials are needed to obtain a high-quality level of evidence for the comparison between the different modified surgical techniques and the gap effect on making different decision of managements.

Download Full-text