Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture

Background: There is controversy whether nonoperative or operative treatment for Achilles tendon rupture is superior. It is unknown if patients with acute Achilles tendon rupture return to previous sports activity. The purpose of this study was to assess 5-year return to sport and subjective satisfaction, minimum 1-year functional outcomes, and complications in patients following nonoperative treatment of Achilles tendon rupture with early weightbearing rehabilitation. Methods: An institutional review board–approved, retrospective observational study involving 89 patients was performed. Out of 114 consecutive patients, 89 (78%) responded to questionnaires for sports activity. Nonoperative treatment consisted of an equinus cast and rehabilitation boot that enabled early weightbearing. Sports activity at 1-year and 5-year follow-up was compared to the prerupture status. Based on the prerupture Tegner Activity Scale (TAS), patients were divided into low-level (<6) and high-level (≥6) activity groups. Clinical assessment at minimum 1-year follow-up was performed with the Thermann score. Mean clinical follow-up was 34 ± 23 months. Results: Overall, >70% of the patients returned to their previous sports activity level after a nonoperative early weightbearing treatment. Return-to-sport rate was significantly ( P = .029) higher for patients in the low-level activity group (91%) compared to patients (67%) in the high-level activity group at 5-year follow-up. Subjective satisfaction with treatment was good in both groups (93% and 96%, respectively). The mean Thermann score did not differ between the 2 groups at 1-year follow-up. There were 11 reruptures, 5 deep venous thromboses, and 1 case of complex regional pain syndrome. Conclusion: Nonoperative treatment for Achilles tendon rupture yielded good functional outcome and high patient satisfaction. For patients with a high preinjury activity level, return to previous sporting level (assessed by TAS) was possible in 67% of the patients compared to >90% of patients with low preinjury activity level. Level of Evidence: Level III, retrospective comparative series

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Return-To-Sport at 5-Year Follow-Up after Non-Operative Treatment of Acute Achilles Tendon Rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00043 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0004

Author(s):

Fabian Krause ◽

Andreas Schwinghammer ◽

Till Lerch ◽

Timo Schmid ◽

Timo Ecker ◽

...

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Return To Sport ◽

Activity Level ◽

Sports Activity ◽

Activity Group

Category: Sports Introduction/Purpose: There is a controversy if non-operative or operative treatment for acute Achilles tendon rupture is superior. It is unknown, if young and active patients with acute Achilles tendon rupture, return to previous sports activity level after treatment with standardized non-operative immediate full weight-bearing protocol. The purpose of this was to assess (1) the return-to-sport rate and subjective satisfaction in patients with different activity levels before the rupture, at 1-year, and at 5-year follow-up, (2) the clinical outcome at 1-year follow-up, and (3) re-ruptures and complications. Methods: Out of 171 consecutive patients that were treated nonoperatively, 114 patients were available for 1-year follow-up. Eighty-nine patients responded to questionnaires for sports activity. Non-operative treatment consisted of a combination of an equinus cast and rehabilitation boot, that enables immediate full weight-bearing and early functional rehabilitation. Clinical 1-year follow-up and follow-up with questionnaires at 1-year and 5-year follow-up were evaluated to calculate Tegner Activity Scale (TAS), and Activity Rating Scale (ARS) and were compared to the status before the rupture. Based on the TAS before the rupture, patients were divided into a low-level activity (<5) and high-level activity (>5) group and the return-to-sport rate was compared between those two groups.Clinical assessment at minimum 1-year follow-up included testing of plantarflexion strength and endurance, calf circumference, and subjective parameters to calculate a modified Thermann score. Mean clinical follow-up was 34 ± 23 months (range 12-88 months). Results: (1) A significantly higher proportion (91%) of the patients in the low-level activity group returned to their previous TA at 5-year follow-up compared to patients (67%) in the high-level activity group (p=0.029). A higher proportion (91%) of the patients in the low-level activity group returned to their previous ARS Score at 5-year follow-up compared to patients (82%) in the high- level activity group (p=0,115). (2) The mean Thermann score was not significantly different between the two activity groups at minimum 1-year follow-up: 84 ±12 (range, 41-100) and 82 ±12 (range, 44 -100). (3) There were a total of 17 complications. There were 9,6% reruptures (8 with and 3 without an adequate trauma), 5 deep venous thromboses, 1 complex regional pain syndrome at 1 year follow-up. Conclusion: After 17 years of prospective evaluation, our non-operative treatment protocol for acute rupture of the Achilles tendon leads to good functional outcome, high patient satisfaction and high return-to-sport rate. Most patients return to their previous sports activity level after a standardized nonoperative early full-weightbearing treatment protocol for acute Achilles tendon rupture. Even for patients with a high activity level return to pre-rupture sports level activity was possible in two third of the patients. The re-rupture rate with immediate weight bearing is low and comparable to other non-operative treatment methods.

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

Foot & Ankle International ◽

10.1177/1071100717754042 ◽

2018 ◽

Vol 39 (6) ◽

pp. 694-703 ◽

Cited By ~ 7

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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Symptomatic Venous Thromboembolism After Achilles Tendon Rupture: A Nationwide Danish Cohort Study of 28,546 Patients With Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/0363546519876054 ◽

2019 ◽

Vol 47 (13) ◽

pp. 3229-3237 ◽

Cited By ~ 3

Author(s):

Melissa Hornbæk Pedersen ◽

Liv Riisager Wahlsten ◽

Henrik Grønborg ◽

Gunnar Hilmar Gislason ◽

Michael Mørk Petersen ◽

...

Keyword(s):

Risk Factors ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Nonoperative Treatment ◽

Incidence Rates ◽

Factors Associated ◽

Increased Risk ◽

Male Sex

Background: Venous thromboembolism (VTE) is a well-known complication of Achilles tendon rupture (ATR) and carries a high risk of morbidity and mortality. Although routine thromboprophylaxis for patients with ATR is not recommended, sparse knowledge is available regarding risk factors associated with VTE in patients with ATR. Purpose: To use Danish nationwide registers to identify incidence rates for symptomatic VTE and risk factors associated with increased risk of developing VTE in patients with ATR. Study Design: Cohort study; Level of evidence, 3. Methods: By crosslinking nationwide registers, we identified all patients with diagnosed ATR in Denmark from 1997 to 2015. We stratified patients into 4 groups by age and treatment modality (ie, operative vs nonoperative treatment). The main outcome was VTE within 180 days. We calculated crude incidence rates and considered age, sex, year, comorbidities, and medications as risk factors for VTE in Poisson regression models. Results: We identified 28,546 patients with ATR, of whom 389 (1.36%) were hospitalized with VTE during the follow-up period: 278 due to deep vein thromboses and 138 due to pulmonary embolism. Incidence rates were highest during the first month and ranged from 4.6 to 14.6 events per 100 person-years. VTEs were most frequent among nonoperatively treated patients aged ≥50 years. In Poisson regression analyses, having had VTE beforehand was associated with an increased risk of VTE, as was male sex in the nonoperative treatment group aged ≥50 years; among women <50 years of age, hormonal contraceptives led to a 4- to 6-fold higher risk of VTE compared with patients in the same group without the equivalent risk factor. Conclusion: In this nationwide cohort of patients with ATR, 1.36% developed symptomatic VTE during follow-up. Hormonal contraception, previous VTE, older age group, and male sex increased the risk of VTE. Taken together, the results of the present study suggest that focus on risk stratification and initiatives to prevent VTE might be warranted. A randomized controlled trial could answer this question.

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Activity level recovery after acute Achilles tendon rupture surgically repaired: a series of 29 patients with a mean follow-up of 46 months

Muscles Ligaments and Tendons Journal ◽

10.11138/mltj/2017.7.1.069 ◽

2017 ◽

Vol 7 (1) ◽

pp. 69 ◽

Cited By ~ 4

Author(s):

R Zayni

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Activity Level

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Activity level recovery after acute Achilles tendon rupture surgically repaired: a series of 29 patients with a mean follow-up of 46 months

Muscles Ligaments and Tendons Journal ◽

10.32098/mltj.01.2017.10 ◽

2019 ◽

Vol 07 (01) ◽

pp. 69

Author(s):

R. Zayni ◽

R. Coursier ◽

M. Zakaria ◽

J.-F. Desrousseaux ◽

D. Cordonnier ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Activity Level

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Rehabilitation after surgical repair of acute Achilles tendon rupture: Functional outcome with a Follow-Up of 6 months.

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2020.09.003 ◽

2020 ◽

Author(s):

Anna E. Röell ◽

Tim K. Timmers ◽

Denise J.C. van der Ven ◽

Ger D.J. van Olden

Keyword(s):

Achilles Tendon ◽

Functional Outcome ◽

Tendon Rupture ◽

Surgical Repair ◽

Achilles Tendon Rupture

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

Foot & Ankle Orthopaedics ◽

10.1177/24730114211003541 ◽

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.

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