Prognostic model of clinical scores in evaluation of treatment outcome in patients with acute Achilles tendon rupture - surgery vs. immobilization

Introduction/Objective. When choosing the appropriate treatment for Achilles tendon rupture, there may be a dilemma when choosing the optimal treatment. The objective of this study was analyzing groups of patients with acute closed Achilles tendon injury, comparing early recovery and functional parameters in relation to treatment and first choice treatment suggestion. Methods. The prospective study included 80 patients with acute Achilles tendon rupture. The treatment was surgery or immobilization. Results. There is a difference in the mechanism of injury between surgically and non-surgically treated (p = 0.026). In total, 50 (62.5%) patients were operated and 30 (37.5%) patients were treated with circular plaster. The difference (p = 0.000) between the groups in the duration of treatment, The American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale of pain (VAS) was shown. Patients undergoing surgery in the first two days had better clinical results in terms of The Achilles tendon Total Rupture score (ATRS), AOFAS and VAS. Higher satisfaction was achieved in younger people (p = 0.036). Patients whose treatment lasted shorter were more satisfied with their status (p = 0.001). ATRS and AOFAS score are higher in patients who are more satisfied with their own status (ATRS p = 0.301; AOFAS score p = 0.001). Six months after the treatment, 78.75% (63/80) of patients were fully functional. Conclusion. The therapy of choice in the treatment of acute Achilles tendon rupture is surgical, as surgical treatment is shorter; rehabilitation is faster and shorter, and the total costs associated with treatment and absence from work are lower.

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Achilles tendon repair by a minimally invasive technique using Tenolig®

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1194 ◽

2020 ◽

Vol 14 (3) ◽

pp. 269-273

Author(s):

Vinicius Oliveira ◽

Sérgio Prata

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Postoperative Infection ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Case Series ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Aofas Score ◽

Functional Scores

Objective: To assess the degree of postoperative satisfaction of patients with acute Achilles tendon rupture who underwent surgical reconstruction by a minimally invasive technique using Tenolig®. Methods: A retrospective observational study was conducted with 18 patients with acute Achilles tendon rupture diagnosed by a positive Thompson test who underwent surgery. Outcomes were assessed using the American arthopaedic Foot and Ankle Society (AOFAS) score and the Foot Function Index (FFI). Furthermore, quantitative variables were descriptively treated, and patients’ age was correlated with FII and AOFAS score using Spearman’s correlation coefficient at a significance level of 5%. Results: Patients underwent surgery from one to six days after injury and were discharged one day later. Only one patient had a superficial postoperative infection. Patients’ AOFAS scores ranged from 75 to 100 points, and FFI ranged from 0 to 20%. The patient withsuperficial postoperative infection had an AOFAS score and a FFI of 75 points and 20%, respectively. Conclusion: Percutaneous repair of complete Achilles tendon rupture with Tenolig® resulted in high functional scores and a low rate of complications. Level of Evidence IV; Therapeutic Studies; Case Series.

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Seasonal Variation of Achilles Tendon Injury

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00179 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0017

Author(s):

Jon-Michael Caldwell ◽

Harry Lightsey ◽

Hasani Swindell ◽

Justin Greisberg ◽

J. Turner Vosseller

Keyword(s):

Seasonal Variation ◽

Achilles Tendon ◽

Tendon Rupture ◽

Seasonal Pattern ◽

Achilles Tendon Rupture ◽

Tendon Injury ◽

Categorical Variables ◽

Continuous Variables ◽

Significant Difference ◽

Tendon Ruptures

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.

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Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119887673 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711988767

Author(s):

Lu Bai ◽

Siyao Guan ◽

Tian You ◽

Wentao Zhang ◽

Peng Chen

Keyword(s):

Retrospective Study ◽

Achilles Tendon ◽

Clinical Outcomes ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Hamstring Graft ◽

Early Recovery ◽

Level Of Evidence ◽

Type 3

Background: Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon. Purpose: To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively. Results: The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group ( t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups. Conclusion: Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

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

Orthopedic Reviews ◽

10.4081/or.2010.e11 ◽

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.

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Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation

Foot & Ankle International ◽

10.1177/1071100716673589 ◽

2016 ◽

Vol 38 (2) ◽

pp. 167-173 ◽

Cited By ~ 3

Author(s):

Wataru Miyamoto ◽

Shinji Imade ◽

Ken Innami ◽

Hirotaka Kawano ◽

Masato Takao

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Plantar Flexion ◽

Weight Bearing ◽

Achilles Tendon Rupture ◽

Case Series ◽

Full Weight Bearing ◽

Aofas Score ◽

Accelerated Rehabilitation ◽

Athletic Activities

Background: Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. Methods: We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Results: Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. Conclusion: The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level of Evidence: Level IV, retrospective case series.

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Degenerative tendoachilles tear repaired and augumented by peroneous brevis tendon by dynamic loop technique one year follow up

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202686 ◽

2020 ◽

Vol 6 (4) ◽

pp. 788

Author(s):

K. Vijaya Bhaskar Reddy ◽

Narsimha Lavudi

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Age Groups ◽

Clinical Results ◽

Suture Technique ◽

Common Symptom ◽

Peroneus Brevis ◽

One Year

Background: Repair of degenerative rupture of tendoachilles is a challenge for orthopaedician. We used peroneus brevis tendon in our patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop.Methods: In our study, we evaluated 31 patients with Achilles tendon rupture treated by reconstruction using peroneus brevis tendon transfer by dynamic loop suture technique. The patients were from all age groups excluding those lesser than 35 years. The average follow-up being 6 months.Results: In total 31 patient’s majority of patients belong to 41-50 years (15 cases 48.4%). Male patients being 24 (77.4%) constituted the majority, right sided injury was noted in 23 (74.2%) of the patients. Most common symptom of Achilles tendon rupture is pain. The mechanism of injury in most of the patients by stumbling in the fields in 19 (61.3%). Results of testing the patient’s ability to heel raise for 60 seconds 20 patients were able to sustain, while 8 patients were able to stand on toe with heel raised but could not sustain it. 3 patients could not do raise the heel. 5 patients complained of sensory hypoesthesia at 12 months follow-up. By Rupp scoring, 77% patients had excellent or good results and 10% had fair or poor results.Conclusions: Results of reconstruction of Achilles tendon ruptures using peroneus brevis tendon show a strong and stable repair that allows early weightbearing ambulation with favourable clinical results in most patients.

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Minimally Invasive Knotless-Bridge Suture Technique for Acute Achilles Tendon Rupture

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00385 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Zhongmin Shi ◽

Xiaokang Wang

Keyword(s):

Minimally Invasive ◽

Return To Work ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Suture Technique ◽

Calf Circumference ◽

Aofas Score ◽

Superficial Infection

Category: Hindfoot Introduction/Purpose: To investigate the clinical effect of minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture. Methods: Totally 23 cases of acute achilles tendon rupture were treated from August 2016 to December 2016 including 21 cases of males and 2 cases of females with an average age of 42.1 years-old (from 29-51 years). Mini-invasive knotless-bridge suture technique was performed in all cases until the soft tissue condition improved. Ankle range of motion, calf circumference difference between two lower extrenities, number of repetions for single heel-rise in one minute, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Achilles Tendon Total Rupture Score(ATRS) and time to return to work were investigated at last follow-up, as well as complications during follow-up. Results: 23 cases were followed for an average of 28 months . At last follow-up, the average ankle ROM was 60.3±2.2°, calf circumference difference between two lower extrenities was 92.7±1.8%, number of repetions for single heel-rise in one minute was 25±2, AOFAS score was 91.5±2.2, ATRS score was 92.6±2.4, time to return to work ranged from 6 to 9 weeks, averaging 7 weeks.Wound was sutured in one stage and united in one stage.No skin necrosis, superficial infection, sural nerve injury occurred.No achilles tendon re-rupture was seen during follow-up. Conclusion: Minimally invasive knotless-bridge suture technique combined with PRP augamentation for acute achilles tendon rupture is operated easily and lesser-trama, enabling patients to return to work earlier and proved to be an effective treatment.

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Biomechanical Simulation of Achilles Tendon Strains during Hurdling

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.647.462 ◽

2013 ◽

Vol 647 ◽

pp. 462-465 ◽

Cited By ~ 1

Author(s):

Lin Jie Li ◽

Yan Xin Zhang

Keyword(s):

Achilles Tendon ◽

Motion Capture ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Muscle Length ◽

Tendon Injury ◽

Musculoskeletal Modeling ◽

Simulation Approach ◽

Biomechanical Simulation ◽

Capture Technique

Hurdling is one of the top athletic games with high injury risks, especially the Achilles tendon injury. The purpose of the study was to quantify the Achilles tendon strains using a biomechanical simulation approach, which incorporate motion capture technique and musculoskeletal modeling. The finding indicates that the main muscles of Achilles tendon, gastronomic and soleus, change greatly in muscle length during the hurdling takeoff. The peak angle of the knee and angle was observed at the end of foot touching phase. The results obtained in this study can serve as a basis for further research on Achilles tendon rupture.

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Clinical Results of Treatment for Achilles Tendon Rupture in Farmers.

JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE ◽

10.2185/jjrm.48.588 ◽

1999 ◽

Vol 48 (4) ◽

pp. 588-594

Author(s):

Shoji KUMAKI ◽

Hideki KURIBAYASHI ◽

Kouichiro YAMAMOTO ◽

Kazuhiko YUMOTO

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Clinical Results ◽

Results Of Treatment

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Modified gift box technique for acute compound posttraumatic Achilles tendon repair in young patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180684 ◽

2018 ◽

Vol 4 (2) ◽

pp. 302

Author(s):

Tushar Singhi ◽

Ashith Rao ◽

Abhay Agarwal ◽

Sunil Shetty ◽

Prakash Samant

Keyword(s):

Achilles Tendon ◽

Primary Repair ◽

Achilles Tendon Rupture ◽

Young Patients ◽

Clinical Results ◽

Tendon Injury ◽

Active Patients ◽

Toe Walking

Background: Treatment of Achilles tendon rupture in young active patient remains controversial. Open primary repair remains the mainstay of treatment with prolonged rehabilitation and high wound complication rate (20%). In compound injuries it becomes the default treatment. Newer techniques are being tried to decrease re-rupture rate, decrease local complications and facilitate early rehabilitation. Modified gift box technique of open repair, which has shown higher strength of repair in in-vitro studies and good clinical results in the hands of its inventor. The aim of our study was to evaluate the clinical results of this technique in young active patients with compound Achilles tendon injury.Methods: This is a retrospective study. The parameters recorded at follow up included general demography, ability to single toe raise (on neutral, incline, decline), toe walking for 40 feet, and pain on VAS scale. Achilles tendon total rupture score and modified Rupp score were administered.Results: Out of the 8 patients included in the study, 7 patients had unilateral tear and 1 patient had bilateral tear. The mean age was 27 yrs (20-35) and mean duration of follow up was 17.4 months (08-24 months). Single toe raise and toe walking for 40 ft. was possible in all patients. Two patients complained of grade 2 pain on VAS Scale. The ATRS score was 97.1 (94-99) and modified Rupp score was 28.3 (26-29). Conclusions: Modified gift box technique gives excellent results in young active patients with compound Achilles tendon injury with no re-rupture and return of pre-injury activity.

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