Long-Term Results After Functional Nonoperative Treatment of Achilles Tendon Rupture

2006 ◽  
Vol 27 (3) ◽  
pp. 167-171 ◽  
Author(s):  
Tobias M. Hufner ◽  
Dirk B. Brandes ◽  
Hajo Thermann ◽  
Martinus Richter ◽  
Karsten Knobloch ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Treatment Protocol ◽  
Nonoperative Treatment ◽  
Long Term Results ◽  
Neutral Position ◽  
Return To Sports ◽  
Sports Activity ◽  
Tendon Ruptures

Background: Nonoperative treatment of complete Achilles tendon ruptures generally involves a long period of cast immobilization and is associated with frequent reruptures. Functional nonoperative treatment of complete Achilles tendon ruptures involves the use of a high-shaft boot with a 3-cm hindfoot elevation, in which physical therapy is begun after 3 weeks of wear. We reviewed our long-term results with this treatment protocol to determine its effectiveness. Methods: The indications for nonoperative treatment, defined by ultrasound, were a distance of 10 mm or less between the tendon ends with the ankle in neutral position and complete apposition of the tendon ends in 20 degrees of plantarflexion. From 1990 to 1996, 168 patients were treated; 125 (74%) were available for followup at a mean of 5.5 (2 to 12.7) years after the injury. Results: Good or excellent results were achieved in 92 (73.5%) with complete rehabilitation and return to sports activity at their pre-injury levels. Satisfactory (9%) and poor results (17.5%) were due to pain in the Achilles tendon region, a lengthened Achilles tendon, markedly reduced strength, or a marked reduction of calf size in 25 patients (76%). Eight patients (6.4%) sustained a rerupture. Conclusions: Functional nonoperative treatment achieved good results in patients who had precise sonographic evaluation and who were compliant. As a result of our study, we modified our protocol: (1) a repeat ultrasound examination is done by an experienced sonographer 2 to 5 days after the first to confirm the indications for nonoperative treatment, (2) the use of the 3-cm hindfoot elevation is extended from 6 to 8 weeks to provide a longer protection of the tendon, and (3) patients then wear shoes with 1-cm hindfoot elevation for another 3 months.

Acute Achilles Tendon Rupture in Badminton Players

1998 ◽  
Vol 26 (3) ◽  
pp. 467-470 ◽  
Author(s):  
Martin Fahlström ◽  
Ulf Björnstig ◽  
Ronny Lorentzon
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Specific Treatment ◽  
Treated Group ◽  
Activity Level ◽  
University Hospital ◽  
Long Term Results ◽  
Postoperative Rehabilitation ◽  
Sports Activity ◽  
Tendon Ruptures

All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon ruptures.

scholarly journals Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

2021 ◽  
Vol 9 (4) ◽  
pp. 465-470
Author(s):  
Saad Andaloussi
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Skin Wound ◽  
Plantaris Tendon ◽  
First Case ◽  
Tendon Ruptures ◽  
Post Traumatic

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

Operative versus nonoperative treatment of acute Achilles tendon ruptures: Long-term study

2017 ◽  
Vol 23 ◽  
pp. 142
Author(s):  
D. Pascoal ◽  
M.S. Santos Silva ◽  
J. Rosa ◽  
M. Marques ◽  
B. Correia ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Nonoperative Treatment ◽  
Term Study ◽  
Long Term Study ◽  
Tendon Ruptures

scholarly journals Subcutaneous Achilles tendon rupture in an eighty-year-old female with an absence of risk factors

2010 ◽  
Vol 2 (1) ◽  
pp. 11
Author(s):  
Motoki Sonohata ◽  
Tsutomu Okamoto ◽  
Kazuyoshi Uchihashi ◽  
Tsutomu Motooka ◽  
Hirofumi Tanaka ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Case Reports ◽  
Achilles Tendon Rupture ◽  
Treatment Protocol ◽  
The Elderly ◽  
Clinical Results ◽  
Level Of Activity ◽  
Healthy Female ◽  
Tendon Ruptures

Achilles tendon ruptures rarely occur in patients over 80 years of age. However, it is unclear what treatment, surgical or conservative, is suitable for such an Achilles tendon rupture in the elderly. In addition, the clinical results of an Achilles tendon rupture in the elderly are disappointing. We report here the case of a subcutaneous Achilles tendon rupture in an eighty-year-old, healthy female, who returned to her previous level of activity following surgical treatment. Additional case reports of other instances of successful treatment are needed to help establish the optimal treatment protocol for an Achilles tendon rupture in the elderly.

scholarly journals Is Early Controlled Motion and Weightbearing Recommended for Nonoperatively Treated Acute Achilles Tendon Rupture? A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110246
Author(s):  
Yi-jun Zhang ◽  
Xiao Long ◽  
Jing-yu Du ◽  
Quan Wang ◽  
Xiang-jin Lin
Keyword(s):  
Systematic Review ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Meta Analysis ◽  
Achilles Tendon Rupture ◽  
Risk Of Bias ◽  
Return To Sports ◽  
Sports Activity ◽  
Number Of Patients ◽  
Controlled Motion

Background: There is disagreement as to whether early controlled motion and weightbearing confer a beneficial effect for nonoperatively treated acute Achilles tendon rupture (ATR) compared with immobilization and late weightbearing. Purpose: To conduct a meta-analysis of randomized controlled trials (RCTs) to determine whether early controlled motion and weightbearing results in different outcomes compared with immobilization and late weightbearing for nonoperatively treated patients with acute ATR. Study Design: Systematic review; Level of evidence, 1. Methods: We conducted a search in the PubMed, Web of Science, and EMBASE databases for relevant RCTs in humans from January 1981 to August 2020. The primary outcome was the Achilles Tendon Total Rupture Score (ATRS) at 1-year follow-up. The secondary outcomes were the rerupture rate, return to sports activity and work, and the heel-rise work (limb symmetry index [LSI]). Study quality was assessed using the Cochrane Collaboration risk of bias tool. Results: Included were 7 RCTs involving 424 participants (n = 215 treated with early controlled motion and weightbearing [early group], n = 209 treated with immobilization and late weightbearing [late group]). The quality assessment indicated a low risk of bias in all included RCTs. There was no difference between the early and late groups regarding the ATRS (mean difference [MD], -0.220; 95% CI, -4.489 to 4.049; P = .920). Likewise, we found no difference between the 2 groups in terms of the rerupture rate (odds ratio [OR], 1.107; 95% CI, 0.552 to 2.219; P = .775), the number of patients who returned to sports (OR, 0.766; 95% CI, 0.438 to 1.341; P = .351) and returned to work (OR, 0.706; 95% CI, 0.397 to 1.253; P = .234), the time to return to work (MD, -2.802 days; 95% CI, -6.525 to 0.921 days; P = .140), or the heel-rise work LSI (MD, -0.135; 95% CI, -6.243 to 5.973; P = .965). Conclusion: No significant differences were found between early controlled motion and weightbearing compared with immobilization and late weightbearing regarding the ATRS, the rerupture rate, return to sports activity and work, and the heel-rise work in nonoperatively treated patients with acute ATR.

scholarly journals Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith Versus Tenolig

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1073
Author(s):  
Carlo Biz ◽  
Mariachiara Cerchiaro ◽  
Elisa Belluzzi ◽  
Nicola Luigi Bragazzi ◽  
Giacomo De Guttry ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Return To Sport ◽  
Functional Results ◽  
Return To Sports ◽  
Recreational Athletes ◽  
Sport Activities ◽  
Long Term Follow Up

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical–functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical–functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle–Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical–functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

scholarly journals Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture—A Pilot Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2370
Author(s):  
Łukasz Paczesny ◽  
Jan Zabrzyński ◽  
Marcin Domżalski ◽  
Maciej Gagat ◽  
Miron Termanowski ◽  
...  
Keyword(s):  
High Resolution ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Long Term Results ◽  
Sonographic Guidance

Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.

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.

scholarly journals Percutaneous Repair for the Treatment of Rupture of the Achilles Tendon: A Study of 20 Cases

2015 ◽  
Vol 2 (2) ◽  
pp. 51-59
Author(s):  
Gautam D Salunkhe
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Asia Pacific ◽  
Long Term Results ◽  
Percutaneous Technique ◽  
Percutaneous Repair ◽  
Acute Rupture ◽  
A Minor

ABSTRACT Background Despite many techniques used for repair of the ruptured Achilles tendon, uncertainty of healing of the surgical wound remains a problem. This mainly determines the success of the surgery. The long-term results generally result in healing of the rupture, but poor healing of the wound occurs repeatedly. This causes apprehension in advising surgery over a conservative approach. Objectives To study the outcome of 20 cases of acute rupture of the Achilles tendon treated by the percutaneous technique. Materials and methods From March 2004 to March 2012, 20 cases of acute Achilles tendon rupture were treated by percutaneous repair by the method of Ma and Griffith. Modifications were used in distal end and delayed repairs. Immobilization was used after surgery. Postoperative complications were observed, and results assessed using the Leppilahti score after 6 months. Follow-up was done for 2 years. Results Percutaneous repair had significantly good results in 95% cases. There were two cases of sural nerve hypoesthesia, which was a minor problem and in no way hampered the longterm result. There were no re-ruptures. Patient satisfaction was high in terms of final result and cosmesis. Conclusion Percutaneous repair is a safe and reliable method for repair of the Achilles tendon rupture. It has a minor complication rate, and is advisable over open surgery. How to cite this article Salunkhe GD. Percutaneous Repair for the Treatment of Rupture of the Achilles tendon: A Study of 20 Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):51-59.

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