Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

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Value of Supine Positioning in Repair of Achilles Tendon Ruptures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00407 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0040

Author(s):

Ryan Rogero ◽

David Beck ◽

Kristen Nicholson ◽

Rachel Shakked ◽

David Pedowitz ◽

...

Keyword(s):

Achilles Tendon ◽

Operating Room ◽

Functional Outcomes ◽

Short Form ◽

Tendon Repair ◽

Optimal Method ◽

Achilles Tendon Repair ◽

Procedure Cost ◽

Tendon Ruptures

Category: Hindfoot Introduction/Purpose: The optimal method of Achilles tendon repair remains undefined. Few previous studies have quantified the financial expenses of Achilles tendon repairs in relation to functional outcomes in order to assess the overall value of the accepted repair techniques. The purpose of this study is to demonstrate the value of supine positioning during open repair (OS) of acute Achilles tendon ruptures through the quantification of operative times, costs, and outcomes in comparison to the commonly performed percutaneous prone (PP) repair technique. Methods: A retrospective review was conducted on 67 patients undergoing OS and 67 patients undergoing PP primary Achilles tendon repair with two surgeons at four surgical locations. Total operating room usage times and operating times were collected from surgical site records. Total operating room times were used to estimate the costs of room usage and anesthesia, while costs of repair equipment were collected from the respective manufacturers. Patients undergoing OS repair completed the Foot and Ankle Ability Measure (FAAM) questionnaire, with activities of daily living (ADL) and sports subscales, Short Form-12 (SF-12), with mental (MCS) and physical (PCS) health subcategories, and the visual analog scale (VAS) for pain preoperatively and at final follow-up. Results: Even with a significantly longer mean surgical time (P=.035), OS repairs had a shorter duration of total operating room time when compared to that of PP repairs (58.4 versus 69.7 minutes, P<.001). Estimated time-dependent costs were lower in OS repairs ($739 versus $861 per procedure, P<.001), while the estimated average total per procedure cost was also lower for OS repairs ($801 versus $1,910 per procedure, P<.001). For patients undergoing OS repair, FAAM-ADL (P<.001), FAAM-Sports (P<.001), SF-12-PCS (P<.001) all increased and VAS grades (P<0.001) decreased from time of initial encounter to final follow-up and were comparable to reported outcomes in the current literature. The complication rate in OS repairs (6.0%) was lower than PP repairs (11.9%), with revisions only occurring in the latter technique. Conclusion: Performing open Achilles tendon repair in the supine position offers substantial value, or “health outcomes achieved per dollar spent”, to providers due to decreased total operating room times and costs with satisfactory functional outcomes.

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Clinical Outcomes of Acute Achilles Tendon Rupture Repair Utilizing Supine Positioning

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00364 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0036

Author(s):

Ryan Rogero ◽

David Beck ◽

Joseph Larwa ◽

Daniel Fuchs ◽

Steven M. Raikin

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Supine Position ◽

Functional Outcomes ◽

Open Repair ◽

Tendon Repair ◽

Complication Rates ◽

Achilles Tendon Repair ◽

Functional Scores ◽

Tendon Ruptures

Category: Sports, Trauma Introduction/Purpose: With no consensus regarding the optimal technique for repair of Achilles tendon ruptures, identifying techniques which minimize complications and maximize functional outcomes is essential. Previous studies on Achilles repair performed in the supine position have demonstrated low complication rates, avoidance of issues related to anesthesia set-up of prone positioning, and decreased operating room times, though these studies have included relatively low patient numbers and lacked functional outcomes. The purpose of this study is to evaluate the clinical outcomes of a large cohort of patients undergoing acute Achilles tendon repair in the supine position. Methods: We conducted a retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with supine positioning by one fellowship-trained foot & ankle surgeon at a single outpatient surgical location from 2010-2016. During each procedure, a longitudinal incision was made just medial to the tendon extending approximately 3.5 cm both proximally and distally from the level of the rupture. Exclusion criteria included age <18 years old, repair >21 days from date of injury, and undergoing any additional procedures other than concomitant tendon transfers. Postoperative chart notes were reviewed to identify any complications experienced by patients, and surgical site records were reviewed for tourniquet times. Patients were contacted and asked about their satisfaction with surgical outcome and to complete the Foot & Ankle Ability Measure (FAAM)- Activities of Daily Living (ADL) and –Sports subscales, as well as the Visual Analog Scale (VAS) for pain. Results: Two-hundred eleven patients, including 31 (14.7%) females, were included in the study, with a mean age of 40.9 years and mean BMI of 28.8 kg/m2. Patients had an average of duration from injury to surgery of 8.5 days (range, 1-21 days) and mean tourniquet time of 35.5 minutes (range, 16-77 minutes). Four patients (1.9%) experienced a postoperative complication, including 2 superficial wound infections and 2 deep vein thromboses. There were no sural nerve-related injuries or tendon re-ruptures. At an average of 56.8 months postoperatively (range 24-99 months), patients reported a mean VAS pain of 0.6 ± 1.3/10 and mean FAAM-ADL and FAAM-Sports scores of 93.9 ± 12.4/100 and 84.7 ± 19.6/100, respectively. Additionally, 91.4% reported being satisfied with the outcome of the surgery. Conclusion: With an extremely low complication rate, mid- to long-term functional scores comparable to other reported Achilles tendon repair techniques, and high rate of patient satisfaction, open repair of Achilles tendon ruptures performed in a supine position offers surgeons a safe and effective treatment method.

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Supine Surgical Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000345 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Katherine Sage ◽

Gregory Guyton

Keyword(s):

Achilles Tendon ◽

Supine Position ◽

Complication Rate ◽

Sural Nerve ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Wound Complications ◽

Achilles Tendon Repair

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Open Achilles tendon repair is typically performed in the prone position for easy visibility of the tendon, but serious complications may be associated with general anesthesia in this position. Open Achilles tendon repair with supine position has been described and potentially avoids these issues, but it is not known whether this position is safe. We reviewed the complication rate of supine open Achilles tendon repair in a retrospective series of patients, looking specifically at wound healing, infection, re-rupture, and sural nerve injury. Methods: CPT codes for Achilles tendon rupture were used to search the records of one surgeon for the years 2010-2014. The charts were then reviewed. Patients were included if they had an Achilles tendon rupture that was surgically treated with primary repair in the supine position within 15 days of injury. Patients were excluded if further reconstruction or tendon transfer was performed. A paramedian incision was utilized 1 cm medial to the Achilles sheath. Results: A total of 37 patients met the inclusion criteria. Of these 37 patients, 31 were men and 6 were women. The average age was 40.0 years (range, 20 to 66 years). Average length of follow-up was 159 days (range 25 to 1589 days). The average BMI was 28 (range 24-36). There were no major complications, including no infections or wound complications. No reruptures and no sural nerve injuries were observed. Conclusion: In 37 patients with early follow-up, supine open Achilles tendon repair had a complication rate equivalent to reported historical data for the prone procedure.

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A Method for Combined Percutaneous and Open Surgical Repair of Achilles Tendon Ruptures: A Report of Three Cases

Foot & Ankle International ◽

10.1177/107110079601700406 ◽

1996 ◽

Vol 17 (4) ◽

pp. 217-220 ◽

Cited By ~ 4

Author(s):

Behiç Tanil Esemenli ◽

Hakan Gündeş ◽

Mete Mecikoğlu

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Surgical Repair ◽

Functional Results ◽

Wound Complication ◽

Wound Complications ◽

Distal Stump ◽

Open Surgical Repair ◽

Tendon Ruptures

Surgical treatment of Achilles tendon ruptures provides excellent functional results in active individuals, although it carries an incidence of wound complications. After experiencing a 25% wound complication rate with the traditional techniques in Achilles tendon ruptures, we modified the Bosworth technique by passing the gastrocsoleus flap percutaneously through the distal stump. This modification eliminated one third of the distal incision, which appears to be the most vulnerable part. We performed the operation in three consecutive cases. At 2-year follow-up there were no wound complications and no reruptures.

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Adverse Events Following Minimally Invasive Achilles Tendon Repair

Foot & Ankle Specialist ◽

10.1177/1938640020950895 ◽

2020 ◽

pp. 193864002095089 ◽

Cited By ~ 1

Author(s):

Alexander J. Idarraga ◽

Daniel D. Bohl ◽

Eric Barnard ◽

Kamran Movassaghi ◽

Kamran S. Hamid ◽

...

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Tendon Repair ◽

Wound Complications ◽

Transverse Incision ◽

Longitudinal Incision ◽

Repair Technique ◽

Achilles Tendon Repair ◽

No Tourniquet

Background The rate of wound complications following traditional open Achilles tendon repair is reported at 7.6%. The purpose of this study is to characterize the rate of wound and other early complications following a specific minimally invasive Achilles tendon repair technique, and to identify any factors associated with increased risk. Methods The postoperative courses of 99 patients who underwent minimally invasive Achilles tendon repair by 2 surgeons at separate academic medical centers were retrospectively reviewed. Mean follow-up was 8.1 months (range 3.0-24.6 months). Repair technique was similar in all cases with the exception that 71 procedures used a longitudinal incision and a tourniquet, while 28 procedures used a transverse incision and no tourniquet (surgeon preference). The rates of complications were compared between patients with differing baseline and procedural characteristics. Results Of the 99 patients included in the study, 2 (2.0%) developed wound complications. There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (2.8% vs 0%; P = 1.000). Four patients (4.0%) developed sural neuropraxia. One patient developed deep venous thrombosis. There were no cases of rerupture. At final follow-up, all 99 patients had intact Thompson tests and well-healed wounds. Conclusions The rate of wound complications following minimally invasive Achilles tendon repair is low at 2.0%. Patients should be counseled that although risk for wound complications may be lower with this minimally invasive technique, there are risks for sural neuropraxia and deep suture reaction. Levels of Evidence: Level III, Retrospective study

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Outcomes of Plantaris Tendon Augmentation in Acute Achilles Tendon Rupture Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00409 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0040

Author(s):

Ryan G. Rogero ◽

Daniel Corr ◽

Andrew Fisher ◽

Joseph T. O’Neil ◽

Daniel J. Fuchs ◽

...

Keyword(s):

Achilles Tendon ◽

Functional Outcomes ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Complication Rates ◽

Plantaris Tendon ◽

Achilles Tendon Repair ◽

Patient Variables ◽

Tendon Ruptures

Category: Trauma; Ankle; Hindfoot; Sports Introduction/Purpose: Given the lack of consensus regarding the optimal surgical treatment for acute Achilles tendon ruptures, identifying techniques to maximize functional outcomes is crucial. Augmentation of Achilles tendon repair with the plantaris tendon is an established surgical technique that is thought to improve outcomes by reinforcing the repair site as well as decreasing soft tissue adhesions, though no studies have specifically looked at outcomes of its use. The purpose of this study is to compare the outcomes of acute Achilles tendon repairs managed with and without plantaris tendon augmentation. Methods: A retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with a single fellowship- trained foot & ankle surgeon from 2010-2016 was performed. Patients <18 years of age, those whose procedures were >21 days from the date of injury, or whose repair was augmented with a flexor hallucis longus (FHL) tendon transfer or V-Y advancement were excluded. Operative report review determined if repair included plantaris augmentation. Augmentation involved weaving the tendon through the Achilles above and below the rupture site creating a box type biologic augmentation. Patients were contacted at >=2 years postoperatively to complete the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales, visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the surgical outcome using a 5- point Likert scale. Mann-Whitney U, Chi-squared and Fisher’s exact tests were performed to compare patient variables and postoperative outcomes. Results: One hundred twenty-eight patients undergoing repair of an acute Achilles tendon rupture were included, including 59 (46.1%) with plantaris tendon augmentation and 69 (53.9%) without. The two patient cohorts did not differ in any preoperative patient variables (p>0.0892). Patients with and without plantaris augmentation did not experience any significant difference in the rate of postoperative complications (p=1.000), including a 0% re-rupture rate in each group. Additionally, at an average follow-up of 57.1 months, the groups did not differ in FAAM-ADL score (p=0.7116), FAAM-Sports score (p=0.4024), the Single Assessment Numeric Evaluation (SANE) as part of the FAAM-Sports subscale (p=0.2572), VAS pain (p=0.1885), or outcome satisfaction (p=0.7317). Conclusion: Our study demonstrates that plantaris tendon augmentation does not improve patient functional outcomes following acute Achilles tendon repair, but also is not associated with increased complication rates. Further studies, including either higher-level prospective, randomized clinical studies or biomechanical evaluation of the technique, are indicated to justify this adjunctive procedure. [Table: see text]

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Transverse versus longitudinal incision for minimally invasive Achilles tendon repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00161 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Daniel Bohl ◽

Eric Barnard ◽

Kamran Movassaghi ◽

Kamran Hamid ◽

Adam Schiff

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Suture Material ◽

Tendon Repair ◽

Wound Complications ◽

Transverse Incision ◽

Longitudinal Incision ◽

Achilles Tendon Repair ◽

Deep Suture ◽

No Tourniquet

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.

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The Effect of Obesity on Achilles Rupture Repair

Foot & Ankle Specialist ◽

10.1177/1938640018816376 ◽

2018 ◽

Vol 12 (6) ◽

pp. 503-512 ◽

Cited By ~ 1

Author(s):

Jeffery S. Hillam ◽

Neil Mohile ◽

Niall Smyth ◽

Jonathan Kaplan ◽

Amiethab Aiyer

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Wound Dehiscence ◽

Comorbid Conditions ◽

Improvement Program ◽

Acs Nsqip ◽

Achilles Tendon Repair ◽

Increased Risk ◽

American College Of Surgeons ◽

Tendon Ruptures

Introduction. Obesity is an increasingly common comorbidity that may negatively affect outcomes following orthopaedic surgery. It is valuable to determine whether obese patients are vulnerable for postoperative complications. The purpose of this study was to analyze data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to determine the effect of obesity on surgical treatment of Achilles tendon ruptures. Methods. Patients who underwent a surgical repair of the Achilles tendon were retrospectively identified through the ACS NSQIP. The patients were divided into 2 cohorts (obese and nonobese), then perioperative and postoperative factors were evaluated for association with obesity. Results. A total of 2128 patients were identified, of whom 887 (41.7%) were classified as obese. Obesity correlated with an increased operative time, 60.9 versus 56.1 minutes. The only postoperative complication associated with obesity was wound dehiscence. Logistic regression adjusted for comorbid conditions demonstrated that obesity was not associated with an increased risk of wound dehiscence. Conclusion. A large segment of the patient population undergoing Achilles tendon repair is obese. Obesity was found to have an increased association with wound dehiscence, likely related to comorbid conditions, following Achilles tendon repair. Obesity was not significantly associated with any other complication. Levels of Evidence: III, Retrospective Cohort Study

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The Clinical Outcomes After a Novel Mini-Open Achilles Tendon Repair

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00095 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0009

Author(s):

Craig C. Akoh ◽

Amanda N. Fletcher ◽

Selene G. Parekh ◽

Akhil Sharma

Keyword(s):

Achilles Tendon ◽

Clinical Outcomes ◽

Tendon Repair ◽

Postoperative Outcomes ◽

Categorical Variables ◽

Foot And Ankle ◽

Achilles Tendon Repair ◽

Tendon Ruptures ◽

The Mean ◽

Mini Open

Category: Sports; Other Introduction/Purpose: Achilles tendon ruptures are a common sporting injury, mostly occurring in men over the age of 40. Operative repair of Achilles tendon can lead to earlier return to activity and improved function in the active population. Mini-open repairs have recently been described for effective treatment of Achilles tendon ruptures. We aim to describe our unique mini- open Achilles tendon repair technique and to report our clinical outcomes. Methods: We retrospectively reviewed charts of patients from January 2010 and July 2019 who underwent a 3cm mini-open Achilles tendon repairs, without additional targeting devices, for closed acute Achilles tendon ruptures. Patients were followed up for a minimum of one year. We recorded pre- and postoperative Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS) scores. Subgroup analysis were performed for acute repairs (< 2 weeks) and subacute (2-6 weeks). Two-sided student’s t-test to compare preoperative and postoperative outcomes for continuous variables. Chi-square analyses were used to determine the strength of correlation between categorical variables. A p-value of < .05 was considered significant for all statistical analyses. Results: A total of 33 patients met the inclusion criteria and are included in this study. The mean age of our cohort was 43.8 years old (range 22-78) and 78.8% of patients were male. The mean length of follow-up was 4.4 years (range 1.0-9.8 years). The mean time from injury to surgery was 15.6 days (1-45 days). Patients reported a mean return to their previous level of activity at a mean of 5.6 months (range 1.7-22.1). The mean pre- and postoperative outcomes scores improved significantly for both the acute and subacute repair groups (p < 0.05). There were no significant differences for postoperative outcomes scores between the acute and subacute Achilles repair groups (p > 0.05). There were no reported complications in our patient cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There were no significant difference in outcomes for acute versus subacute repairs. Our mini-open Achilles tendon repair, which required no additional targeting instrumentation, has shown favorable mid-term results.

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There is a high return to sport rate but with reduced career lengths after Achilles tendon repair in Major League Soccer players

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000246 ◽

2019 ◽

Vol 4 (1) ◽

pp. 15-20 ◽

Cited By ~ 1

Author(s):

Kyle R Sochacki ◽

Robert A Jack II ◽

Takashi Hirase ◽

Patrick C McCulloch ◽

David M Lintner ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Return To Sport ◽

Level Of Evidence ◽

Postoperative Performance ◽

Achilles Tendon Repair ◽

Major League Soccer ◽

Major League ◽

And Performance

ObjectivesTo determine (1) return to sport (RTS) rate in Major League Soccer (MLS) players following Achilles tendon repair, (2) postoperative career length and games per season, (3) preoperative and postoperative performance, and (4) postoperative performance compared with control players matched by position, age, body mass index, sex, years of experience and performance.MethodsPublicly available records were used to identify MLS players who underwent Achilles tendon repair with a minimum of 1 year follow-up. Demographic and performance data were collected for each player. Matched controls were identified. RTS was defined as playing in one or more MLS games after surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired sample Student’s t-tests.ResultsTwenty-two players (mean age 28.4±4.0 years; mean 3.0±2.2 years follow-up) and 23 Achilles tendon repairs (one bilateral repair) were analysed. Seventeen players (18 Achilles tendon repairs; 77.3%) were able to RTS in the MLS at mean 306.6±199.2 days. Players who RTS after repair had shorter careers than matched controls (2.5±2.2 vs 4.5±3.0 seasons, respectively; p=0.021). Additionally, players who RTS after repair played in fewer games per season than matched controls (13.4±8.4 vs 23.2±6.5, respectively; p<0.001). There was no significant decrease in performance postsurgery compared with presurgery.ConclusionThere is a 77.3% RTS rate in the MLS following Achilles tendon repair. Following repair, players had shorter careers and played fewer games per season than matched controls. There was no significant decrease in performance postsurgery compared with presurgery nor in postsurgery compared with postindex. A significantly greater number of Achilles tendon tears occurred in the left versus the right lower extremity.Level of evidenceLevel III.

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