1
|
Park YH, Lee YB, Han SR, Kim HJ. Prognosis of Nonconcurrent Bilateral Achilles Tendon Rupture Is Worse Than Unilateral Achilles Tendon Rupture: Patient-Reported Outcomes at Minimum 2-Year Follow-up. Clin Orthop Surg 2024; 16:800-806. [PMID: 39364105 PMCID: PMC11444953 DOI: 10.4055/cios23126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 10/05/2024] Open
Abstract
Backgroud Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR. Methods We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers. Results The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively). Conclusions Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.
Collapse
Affiliation(s)
- Young Hwan Park
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Young Bin Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Sang Roc Han
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
2
|
Choi YH, Kwon TH, Choi JH, Han HS, Lee KM. Factors associated with Achilles tendon re-rupture following operative fixation. Bone Joint Res 2024; 13:315-320. [PMID: 38945531 PMCID: PMC11214864 DOI: 10.1302/2046-3758.137.bjr-2023-0258.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Aims Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation. Methods This retrospective cohort study analyzed a total of 43,287 patients from national health claims data spanning 2008 to 2018, focusing on patients who underwent surgical treatment for primary Achilles tendon rupture. Short-term ATRR was defined as cases that required revision surgery occurring between six weeks and one year after the initial surgical repair, while omitting cases with simultaneous infection or skin necrosis. Variables such as age, sex, the presence of Achilles tendinopathy, and comorbidities were systematically collected for the analysis. We employed multivariate stepwise logistic regression to identify potential risk factors associated with short-term ATRR. Results From 2009 to 2018, the short-term re-rupture rate for Achilles tendon surgeries was 2.14%. Risk factors included male sex, younger age, and the presence of Achilles tendinopathy. Conclusion This large-scale, big-data study reaffirmed known risk factors for short-term Achilles tendon re-rupture, specifically identifying male sex and younger age. Moreover, this study discovered that a prior history of Achilles tendinopathy emerges as an independent risk factor for re-rupture, even following initial operative fixation.
Collapse
Affiliation(s)
- Yoon H. Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Tae H. Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ji H. Choi
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Hee S. Han
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyoung M. Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| |
Collapse
|
3
|
Xergia SA, Tsarbou C, Liveris NI, Hadjithoma Μ, Tzanetakou IP. Risk factors for Achilles tendon rupture: an updated systematic review. PHYSICIAN SPORTSMED 2023; 51:506-516. [PMID: 35670156 DOI: 10.1080/00913847.2022.2085505] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Identifying risk factors for Achilles Tendon Rupture (ATR) is one of the first necessary steps for its prevention. This systematic review aimed to update the systematic review published in 2014 in ATR etiology. METHODOLOGY A systematic review was carried out using PubMed, EBSCO, and ScienceDirect databases. All types of research studies (Randomized Control Trials - RCTs, Cohort studies, Case-control studies and Cross-sectional studies) that considered ATR, were eligible. The inclusion criteria for eligibility of the studies were to be written in the English language, and to include populations of men and/or women, both athletes, and non-athletes, healthy individuals, and patients. Two independent reviewers used the assessment instrument Newcastle-Ottawa Scale independently, to evaluate the quality of each selected study. Further, two reviewers worked independently to extract the study characteristics, and the GRADE methodology was used to assess the level of certainty of each risk factor. RESULTS From 9526 studies initially identified, 19 studies were eligible for further analysis to identify risk factors for ATR. Seventeen studies were considered good quality, and two studies fair quality. Low to very low certainty of evidence was found for the following medications: steroids, quinolones, and oral bisphosphonate, as well as for other factors such as chronic tendon inflammation and Achilles' tendinopathy, spring season, diabetes, previous musculoskeletal injury, regular participation in athletic activity, hyperparathyroidism, renal failure, and genetic factors. CONCLUSIONS The risk factors found prove that ATR is a multifactorial injury. Appropriate methodologies and well-designed studies are needed to determine the factors and their significance in ATR risk. Finally, the role of biomechanical and psychological aspects in the ATR etiology may be of interest in future studies, as we could not extract relative data in our review.
Collapse
Affiliation(s)
- Sofia A Xergia
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Aigio, Greece
| | - Charis Tsarbou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Aigio, Greece
| | - Nikolaos I Liveris
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Aigio, Greece
| | - Μaria Hadjithoma
- Department of Health Science, European University of Cyprus, Nicosia, Cyprus
| | - Irene P Tzanetakou
- Department of Life Sciences, European University of Cyprus, Nicosia, Cyprus
| |
Collapse
|
4
|
Park YH, Kim W, Choi JW, Kim HJ. Ultrasonographic Finding of Contralateral Achilles Tendon in Patients With Acute Achilles Tendon Rupture: A Prospective Observational Study. Clin J Sport Med 2023; 33:598-602. [PMID: 37526501 DOI: 10.1097/jsm.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/03/2021] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Although the incidence of contralateral Achilles tendon in patients with Achilles tendon rupture is higher than in the general population, there are no studies evaluating the status of the contralateral Achilles tendon. The aim of this study was to investigate the status of the contralateral Achilles tendon in patients with acute Achilles tendon rupture. DESIGN Prospective observational cohort study. SETTING University hospital foot and ankle clinic. PARTICIPANTS Seventy-five patients with acute Achilles tendon rupture who met the inclusion criteria. INTERVENTION Ultrasonography performed by an orthopedic surgeon who had 8 years of experience in musculoskeletal ultrasonography. MAIN OUTCOME MEASURES Ultrasonographic abnormalities of the contralateral Achilles tendon at the time of diagnosis of acute Achilles tendon rupture. Abnormalities were categorized as intratendinous lesions, peritendinous lesions, changes in retrocalcaneal bursa, and Achilles tendon thickening. RESULTS The maximal Achilles tendon thickness had a mean of 4.8 ± 1.0 mm. Nine patients (12%) showed ultrasonographic abnormalities on the contralateral Achilles tendon, and the presence of exertional pain was the sole associating variable with ultrasonographic abnormalities. CONCLUSION The prevalence of ultrasonographic abnormalities in the contralateral Achilles tendon shown in this study was not higher than that reported in healthy or asymptomatic Achilles tendon. Therefore, routine evaluation of the contralateral Achilles tendon is unnecessary at the time of acute Achilles tendon rupture.
Collapse
Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | | | | | | |
Collapse
|
5
|
Chopra A, Parekh AS, Ramanathan D, Parekh SG. Bilateral Achilles Tendon Ruptures in the NFL. Foot Ankle Spec 2023; 16:397-401. [PMID: 35852395 DOI: 10.1177/19386400221108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Achilles tendon ruptures (ATR) can have devastating results for athletes in the National Football League (NFL). While many studies have examined the effects of an ipsilateral ATR, there are no reports on the impact of bilateral ATRs on NFL athlete performance. Methods: Publicly available online injury data for NFL athletes who sustained bilateral ATRs between the start of the 2007 season and the start of the 2021 season were queried using online news and sports analysis web sources. Results: After applying inclusion and exclusion criteria, 5 NFL athletes were identified. The findings demonstrated a significant difference in age at the time of each rupture (27.8 vs 30.4 years, P < .01) along with a decreasing trend in the number of Pro Bowl nominations following successive ATRs (P = .027). There were no differences reported for the duration and number of games missed during either rehabilitation period following an ATR. Upon analyzing defensive NFL athletes, forced fumbles was the only performance metric that significantly changed across successive ATRs. Conclusion: Overall, bilateral ATRs can adversely impact an NFL player's performance and further research should be performed to continue analyzing the effects of bilateral ATRs on these athletes.Level of Evidence: 4.
Collapse
Affiliation(s)
- Aman Chopra
- Georgetown University School of Medicine, Washington, District of Columbia (AC)
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (ASP, DR, SGP)
| | - Aarav S Parekh
- Georgetown University School of Medicine, Washington, District of Columbia (AC)
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (ASP, DR, SGP)
| | - Deepak Ramanathan
- Georgetown University School of Medicine, Washington, District of Columbia (AC)
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (ASP, DR, SGP)
| | - Selene G Parekh
- Georgetown University School of Medicine, Washington, District of Columbia (AC)
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (ASP, DR, SGP)
| |
Collapse
|
6
|
Waters TL, Ross BJ, Wilder JH, Cole MW, Collins LK, Sherman WF. Is Fluoroquinolone Exposure after Primary Tendon Repair Associated with Higher Rates of Reoperations? A Matched Cohort Study. Orthop Rev (Pavia) 2023; 15:67914. [PMID: 36843858 PMCID: PMC9946796 DOI: 10.52965/001c.67914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Background The association between tendon damage and fluoroquinolone (FQ) antibiotics has been well documented. However, there is limited data evaluating the impact of postoperative FQ use on outcomes of primary tendon repairs. The purpose of this study was to compare rates of reoperation for patients with FQ exposure after primary tendon repair versus controls. Methods A retrospective cohort study was conducted using the PearlDiver database. All patients who underwent primary repair of distal biceps ruptures, Achilles tendon ruptures, and rotator cuff tears were identified. For each tendon, patients who were prescribed FQs within 90 days postoperatively were propensity score matched at a 1:3 ratio with controls without postoperative FQ prescriptions across age, sex, and several comorbidities. Rates of reoperation were compared at two years postoperatively with multivariable logistic regression. Results A total of 124,322 patients who underwent primary tendon procedures were identified, including 3,982 (3.2%) patients with FQ prescriptions within 90 days postoperatively: 448 with distal biceps repair, 2,538 with rotator cuff repair, and 996 with Achilles tendon repair. These cohorts were matched with 1,344, 7,614, and 2,988 controls, respectively. Patients with postoperative FQ prescriptions exhibited significantly higher rates of revision surgery after primary repair of distal biceps ruptures (3.6% vs. 1.7%; OR 2.13; 95% CI, 1.09-4.04), rotator cuff tears (7.1% vs. 4.1%; OR 1.77; 95% CI, 1.48-2.15), and Achilles tendon ruptures (3.8% vs. 1.8%; OR 2.15; 95% CI, 1.40-3.27). Conclusion Patients with FQ prescriptions within 90 days after primary tendon repair demonstrated significantly higher rates of reoperations for distal biceps, rotator cuff, and Achilles tendon repair at two years postoperatively. To achieve optimal outcomes and avoid complications in patients following primary tendon repair procedures, physicians should consider prescribing alternative non-FQ antibiotics and counsel patients on the risk of reoperation associated with postoperative FQ use.
Collapse
Affiliation(s)
- Timothy L Waters
- Department of Orthopaedic Surgery Tulane University School of Medicine
| | - Bailey J Ross
- Department of Orthopaedic Surgery Emory University School of Medicine
| | - J Heath Wilder
- Department of Orthopaedic Surgery Tulane University School of Medicine
| | - Matthew W Cole
- Department of Orthopaedic Surgery Tulane University School of Medicine
| | - Lacee K Collins
- Department of Orthopaedic Surgery Tulane University School of Medicine
| | - William F Sherman
- Department of Orthopaedic Surgery Tulane University School of Medicine
| |
Collapse
|
7
|
Park YH, Kim W, Choi JW, Kim HJ. Absorbable versus nonabsorbable sutures for the Krackow suture repair of acute Achilles tendon rupture: a prospective randomized controlled trial. Bone Joint J 2022; 104-B:938-945. [PMID: 35909376 DOI: 10.1302/0301-620x.104b8.bjj-2021-1730.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR. METHODS A total of 40 patients were randomly assigned to either braided absorbable polyglactin suture or braided nonabsorbable polyethylene terephthalate suture groups. ATR was then repaired using the Krackow suture method. At three and six months after surgery, the isokinetic muscle strength of ankle plantar flexion was measured using a computer-based Cybex dynamometer. At six and 12 months after surgery, patient-reported outcomes were measured using the Achilles tendon Total Rupture Score (ATRS), visual analogue scale for pain (VAS pain), and EuroQoL five-dimension health questionnaire (EQ-5D). RESULTS Overall, 37 patients completed 12 months of follow-up. No difference was observed between the two groups in terms of isokinetic plantar flexion strength, ATRS, VAS pain, or EQ-5D. No re-rupture was observed in either group. CONCLUSION The use of absorbable sutures for the repair of acute ATR was not inferior to that of nonabsorbable sutures. This finding suggests that absorbable sutures can be considered for the repair of acute ATRs. Cite this article: Bone Joint J 2022;104-B(8):938-945.
Collapse
Affiliation(s)
- Young H Park
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Woon Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Jung W Choi
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Hak J Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| |
Collapse
|
8
|
Trivedi NN, Varshneya K, Calcei JB, Lin K, Sochaki KR, Voos JE, Safran MR, Calcei JG. Achilles Tendon Repairs: Identification of Risk Factors for and Economic Impact of Complications and Reoperation. Sports Health 2022; 15:124-130. [PMID: 35635017 PMCID: PMC9808838 DOI: 10.1177/19417381221087246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities. HYPOTHESIS Identify the independent risk factors for complications and reoperation after acute Achilles tendon repair and calculate the added cost of care associated with having each preoperative risk factor. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective review of a large commercial claims database was performed to identify patients who underwent primary operative management for Achilles tendon rupture between 2007 and 2016. The primary outcome measures of the study were risk factors for (1) postoperative complications, (2) revision surgery, and (3) increased healthcare resource utilization. RESULTS A total of 50,279 patients were included. The overall complication rate was 2.7%. The most common 30-day complication was venous thromboembolism (1.2%). The rate of revision surgery was 2.5% at 30 days and 4.3% at 2 years. Independent risk factors for 30-day complications in our cohort included increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Independent risk factors for revision surgery within 2 years included female sex, tobacco use, hypertension, obesity, and the presence of any postoperative complication. The average 5-year cost of operative intervention was $17,307. The need for revision surgery had the largest effect on 5-year overall cost, increasing it by $6776.40. This was followed by the presence of a postoperative complication ($3780), female sex ($3207.70), and diabetes ($3105). CONCLUSION Achilles tendon repair is a relatively low-risk operation. Factors associated with postoperative complications include increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Factors associated with the need for revision surgery include female sex, hypertension, obesity, and the presence of any postoperative complication. Female sex, diabetes, the presence of any complication, and the need for revision surgery had the largest added costs associated with them. CLINICAL RELEVANCE Surgeons can use this information for preoperative decision-making and during the informed consent process.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jacob G. Calcei
- Jacob G. Calcei, MD,
Assistant Professor, Department of Orthopaedic Surgery, University Hospitals,
Cleveland Medical Center, Case Western Reserve University School of Medicine,
Cleveland, OH 44106 ()
(Twitter: @drcalcei)
| |
Collapse
|