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Xue H, Xiao F, Li R, Wu G, Zhu Z, Zhang C, Li M. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation. Sci Rep 2024; 14:17815. [PMID: 39090165 PMCID: PMC11294335 DOI: 10.1038/s41598-024-68582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.
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Affiliation(s)
- Han Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Fengxu Xiao
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ruochen Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Guangwei Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Zheyue Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Chen Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Miao Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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Carmont MR, Gunnarsson B, Brorsson A, Nilsson-Helander K. Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: A retrospective cohort study. J ISAKOS 2024; 9:148-152. [PMID: 38154754 DOI: 10.1016/j.jisako.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Achilles tendon ruptures (ATRs) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. METHODS The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. RESULTS From February 2009 to August 2023, 556 patients presented with an ATR. Of these, 37 (6.7 %) patients were diagnosed with a MT tear. At final follow-up, at 12 months following injury, the MT group reported an Achilles tendon total rupture score (ATRS) of mean (standard deviation (SD)) of 83.6 (3.5) (95 % confidence interval (CI) 81.8, 85.4) and median (inter-quartile range (IQR)) ATRS of 86 points (78-95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59-95) (p = 0.673). Functional evaluation, however, revealed statistically significant differences in mean (SD) heel-rise height index MT group 79 % (25) (95%CI 65.9, 92.1) and MS group 59 % (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. CONCLUSIONS When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michael R Carmont
- Department of Trauma & Orthopaedic Surgery, Shrewsbury & Telford Hospital NHS Trust, Shropshire, TF1 6TF, United Kingdom; University of Keele, Staffordshire, ST5 5BG, United Kingdom; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 413 90, Sweden.
| | - Baldvin Gunnarsson
- Department of Orthopaedic Surgery, Mölndal Hospital, University of Gothenburg, 431 60, Sweden; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 413 90, Sweden
| | - Annelie Brorsson
- Department of Orthopaedic Surgery, Mölndal Hospital, University of Gothenburg, 431 60, Sweden; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 413 90, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedic Surgery, Mölndal Hospital, University of Gothenburg, 431 60, Sweden; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, 413 90, Sweden
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Suphinnapong P, Teeranon N, Teerakidpisan S, Tansuthunluck S, Apinun J. Validity and reliability of the Thai version of the Achilles tendon total rupture score. Knee Surg Sports Traumatol Arthrosc 2023; 31:2228-2235. [PMID: 36651942 DOI: 10.1007/s00167-023-07319-w] [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] [Received: 09/12/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to translate and cross-culturally adapt the Achilles Tendon Total Rupture Score (ATRS), a patient-reported outcome measurement (PROM) designed specifically to assess outcomes in patients with Achilles tendon rupture, into the Thai language and then determine its validity and reliability. METHODS The ATRS was translated into the Thai version (Thai-ATRS) according to internationally recognized guidelines. The study included 50 patients with Achilles tendon rupture from 2003 to 2017. The web-based online assessments were conducted two weeks apart. Construction validity was determined by assessing the correlation between the Thai-ATRS and the Thai version of the Foot and Ankle Outcome Score (Thai-FAOS). Reliability was determined with Cronbach's alpha and intraclass correlation coefficients (ICC). RESULTS The validity test displayed a strong correlation between the Thai-ATRS and the Thai-FAOS (r = 0.87). The reliability test showed good internal consistency with a Cronbach's alpha of 0.95 and excellent internal consistency with an ICC of 0.95, which represented excellent test-retest reliability. The MDC was 10.7 at the individual level and 1.5 at the group level. CONCLUSION The Thai-ATRS was demonstrated to be valid and reliable for assessing functional outcomes in Thai patients with Achilles tendon rupture. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Pawichaya Suphinnapong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Niphon Teeranon
- Rehabilitation Center, Siriraj-Piyamaharajkarun Hospital, Bangkok, Thailand
| | | | | | - Jirun Apinun
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Kim YD, Bardovskaya YI, Romanova SN, Pankratov AS, Shitikov DS. Novel classification of Achilles tendon ruptures. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the literature, the treatment of patients with Achilles tendon ruptures begins with diagnosis and diagnosis. Depending on the classification of Achilles tendon rupture, treatment tactics are determined. From our point of view, the existing classification of Achilles tendon ruptures does not sufficiently reflect and systematize the approach to surgical treatment, which served as a more detailed study and addition to the existing classification of Achilles tendon ruptures.
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Hoeffner R, Svensson RB, Bjerregaard N, Kjær M, Magnusson SP. Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:7445398. [PMID: 38655161 PMCID: PMC11022787 DOI: 10.1155/2022/7445398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 04/26/2024]
Abstract
Persistent muscle weakness, tendon elongation, and incomplete return to preinjury level are frequent sequelae after acute Achilles tendon rupture, and evidence-based knowledge of how to best rehabilitate the injury is largely absent in the literature. The objective of this review is to illuminate and discuss to what extent an Achilles tendon rupture affects muscle, tendon, and function when assessed with the Achilles tendon total rupture score (ATRS), muscle strength, muscle cross-sectional area, tendon length, and the heel-rise test. The patient-reported outcome measures (PROM) data in the literature suggest that the recovery takes longer than 6 months (ATRS, 70 out of 100), that one-year postinjury, the ATRS only reaches 82, and that this does not appear to noticeably improve thereafter. Loss of muscle mass, strength, and function can in some cases be permanent. Over the first 6 months postinjury, the tendon undergoes elongation, which appears to be negatively correlated to heel-rise function. More recently, there has been some interest in how muscle length and excursion is related to the reduced function. The available literature indicates that further research is highly warranted and that efforts to restore normal tendon length may improve the likelihood of returning to preinjury level after an Achilles tendon rupture.
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Affiliation(s)
- Rikke Hoeffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B. Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bjerregaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Myhrvold SB, Brouwer EF, Andresen TKM, Rydevik K, Amundsen M, Grün W, Butt F, Valberg M, Ulstein S, Hoelsbrekken SE. Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture. N Engl J Med 2022; 386:1409-1420. [PMID: 35417636 DOI: 10.1056/nejmoa2108447] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Whether surgical repair of an acute Achilles' tendon rupture by an open-repair or minimally invasive approach is associated with better outcomes than nonsurgical treatment is not clear. METHODS We performed a multicenter, randomized, controlled trial that compared nonoperative treatment, open repair, and minimally invasive surgery in adults with acute Achilles' tendon rupture who presented to four trial centers. The primary outcome was the change from baseline in the Achilles' tendon Total Rupture Score (scores range from 0 to 100, with higher scores indicating better health status) at 12 months. Secondary outcomes included the incidence of tendon rerupture. RESULTS A total of 554 patients underwent randomization, and 526 patients were included in the final analysis. The mean changes in the Achilles' tendon Total Rupture Score were -17.0 points in the nonoperative group, -16.0 points in the open-repair group, and -14.7 points in the minimally invasive surgery group (P = 0.57). Pairwise comparisons provided no evidence of differences between the groups. The changes from baseline in physical performance and patient-reported physical function were similar in the three groups. The number of tendon reruptures was higher in the nonoperative group (6.2%) than in the open-repair or minimally invasive surgery group (0.6% in each). There were 9 nerve injuries in the minimally invasive surgery group (in 5.2% of the patients) as compared with 5 in the open-repair group (in 2.8%) and 1 in the nonoperative group (in 0.6%). CONCLUSIONS In patients with Achilles' tendon rupture, surgery (open repair or minimally invasive surgery) was not associated with better outcomes than nonoperative treatment at 12 months. (Funded by the South-Eastern Norway Regional Health Authority and Akershus University Hospital; ClinicalTrials.gov number, NCT01785264.).
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Affiliation(s)
- Ståle B Myhrvold
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Espen F Brouwer
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Tor K M Andresen
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Karin Rydevik
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Madeleine Amundsen
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Wolfram Grün
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Faisal Butt
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Morten Valberg
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Svend Ulstein
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Sigurd E Hoelsbrekken
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
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De la Fuente C, Henriquez H, Carmont MR, Huincahue J, Paredes T, Tapia M, Araya JP, Díaz N, Carpes FP. Do the heel-rise test and isometric strength improve after Achilles tendon repair using Dresden technique? Foot Ankle Surg 2022; 28:37-43. [PMID: 33509663 DOI: 10.1016/j.fas.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achilles' tendon ruptures result in impaired plantar flexion strength and endurance. It is interesting to know the plantar flexion strength, the number of heel-rise repetitions, and the maximal calf circumference following Achilles' tendon ruptures repair. METHODS Both the injured and non-injured legs of thirty male patients with Achilles' tendon ruptures treated with the percutaneous Dresden technique were compared with the ankle function of 30 healthy participants. Rehabilitation involved partial weight-bearing for three weeks and then increased to full weight-bearing and ankle exercises. RESULTS The injured legs had weaker plantar flexion strength (1.64 ± 0.17 Nm/kg) compared with the non-injured legs (1.91 ± 0.24 Nm/kg; p = 0.002) and the healthy participants' legs (1.93 ± 0.32 Nm/kg; p < 0.001). The non-injured leg had greater ability in doing heel-rise repetitions (39.4 ± 6.1 rep.) compared with the injured legs (37.2 ± 5.7 rep.; p < 0.023) and the healthy participants' legs (31.0 ± 13.0 rep.; p < 0.001). CONCLUSIONS The injured leg had not recovered full isometric strength but had improved heel-rise repetition.
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Affiliation(s)
- Carlos De la Fuente
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil; Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile; Clinica MEDS, Santiago #7691236, Santiago, Chile; Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile
| | - Hugo Henriquez
- Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile; Traumatologia, Facultad de Medicina, Instituto Traumatológico-Universidad de Chile, Universidad de Chile, Santiago #8340220, Chile
| | - Michael R Carmont
- Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust #TF16TF, Shropshire, UK
| | - Javiera Huincahue
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Tamara Paredes
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - María Tapia
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Nicolás Díaz
- Interno de Medicina, Facultad de Medicina #8340220, Universidad de Chile, Santiago, Chile
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil.
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Cramer A, Jacobsen NC, Hansen MS, Sandholdt H, Hölmich P, Barfod KW. Diabetes and treatment with orally administrated corticosteroids negatively affect treatment outcome at follow-up after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2021; 29:1584-1592. [PMID: 33211215 DOI: 10.1007/s00167-020-06371-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Studies investigating the influence of comorbidities on patient-reported outcomes after acute Achilles tendon ruptures (ATR) are lacking. In this study, the aim was to investigate the effect of comorbidity and medical treatment on the patient-reported outcome measure Achilles tendon total rupture score (ATRS). METHODS The study was performed as a registry study from the Danish Achilles tendon Database (DADB). In the DADB, ATRS was registered at baseline (prior to rupture), at 3-6 month, 1-year and 2-year follow-ups. The outcomes were ATRS at follow-up and the change in ATRS from baseline to follow-up. Variables of interest were diabetes, hypertension, rheumatic disease and treatment with orally administrated corticosteroids. Linear mixed-effects models including all follow-up time points in the same model were used adjusting for sex, age group, treatment (operative or non-operative) and the investigated comorbidities. RESULTS Data were collected from 2012 to 2019. Two thousand and four patients with ATR were included. Patients with the investigated comorbidities and treatment with orally administrated corticosteroid scored 10.6-19.1 points lower in mean ATRS at baseline (prior to rupture) compared to patients without the respective disease or treatment. At follow-up, patients with diabetes (mean difference, [95% CI]) (- 6.2, [- 11.7; - 0.8]; P = 0.03) and patients in treatment with orally administrated corticosteroids (- 10.9, [- 16.2; - 5.7]; P < 0.01) had a statistically significantly worse ATRS than patients without the respective disease. However, change in ATRS from baseline to follow-up was not affected. Hypertension and rheumatic disease did not affect ATRS at follow-up but had a positive effect on change in ATRS (4.3, [0.5; 8.1]; P = 0.03) and (12.0, [5.0; 19.9]; P < 0.01), respectively. No other statistically significant differences were found. CONCLUSION This study showed that patients with diabetes, hypertension, rheumatic disease and patients in treatment with orally administrated corticosteroids had a lower ATRS at baseline (prior to the rupture) when compared to patients without the respective disease or treatment. Diabetes and treatment with orally administrated corticosteroids did negatively affect ATRS at follow-up, but none of the investigated comorbidities or treatment with orally administrated corticosteroids did negatively affect change in ATRS from baseline to follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Allan Cramer
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark.
| | - Nanna Cecilie Jacobsen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark
| | - Maria Swennergren Hansen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark.,Department of Physiotherapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark
| | - Håkon Sandholdt
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Kettegård Allé 30, Amager-Hvidovre, 2650, Hvidovre, Denmark
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Yassin M, Myatt R, Thomas W, Gupta V, Hoque T, Mahadevan D. Does size of tendon gap affect patient-reported outcome following Achilles tendon rupture treated with functional rehabilitation? Bone Joint J 2020; 102-B:1535-1541. [PMID: 33135439 DOI: 10.1302/0301-620x.102b11.bjj-2020-0908.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Functional rehabilitation has become an increasingly popular treatment for Achilles tendon rupture (ATR), providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications. Limited evidence exists on whether gap size should affect patient selection for this treatment option. The aim of this study was to assess if size of gap between ruptured tendon ends affects patient-reported outcome following ATR treated with functional rehabilitation. METHODS Analysis of prospectively collected data on all 131 patients diagnosed with ATR at Royal Berkshire Hospital, UK, from August 2016 to January 2019 and managed non-operatively was performed. Diagnosis was confirmed on all patients by dynamic ultrasound scanning and gap size measured with ankle in full plantarflexion. Functional rehabilitation using an established protocol was the preferred treatment. All non-operatively treated patients with completed Achilles Tendon Rupture Scores (ATRS) at a minimum of 12 months following injury were included. RESULTS In all, 82 patients with completed ATRS were included in the analysis. Their mean age was 51 years (standard deviation (SD) 14). The mean ATRS was 76 (SD 19) at a mean follow-up of 20 months (SD 11) following injury. Gap inversely affected ATRS with a Pearson's correlation of -0.30 (p = 0.008). Mean ATRS was lower with gaps > 5 mm compared with ≤ 5 mm (73 (SD 21) vs 82 (SD 16); p = 0.031). Mean ATRS was lowest (70 (SD 23)) with gaps > 10 mm, with significant differences in perceived strength and pain. The overall re-rupture rate was two out of 131 (1.5%). CONCLUSION Increasing gap size predicts lower patient-reported outcome, as measured by ATRS. Tendon gap > 5 mm may be a useful predictor in physically demanding individuals, and tendon gap > 10 mm for those with low physical demand. Further studies that control for gap size when comparing non-operative and operative treatment are required to assess if these patients may benefit from surgery, particularly when balanced against the surgical risks. Cite this article: Bone Joint J 2020;102-B(11):1535-1541.
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Affiliation(s)
- Mohamed Yassin
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Richard Myatt
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - William Thomas
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Vatsal Gupta
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Tagrit Hoque
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Devendra Mahadevan
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
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