SLR - November 2022 - Andrew Regal, DPM PGY-2
Title: Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic StudyReference: Oliva F, Marsilio E, Asparago G, Giai Via A, Biz C, Padulo J, Spoliti M, Foti C, Oliva G, Mannarini S, Rossi AA, Ruggieri P, Maffulli N. Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study. J Clin Med. 2022 Jun 27;11(13):3698. doi: 10.3390/jcm11133698. PMID: 35806982; PMCID: PMC9267833.
Level of Evidence: V
Reviewed by: Andrew Regal, DPM PGY-2
Residency Program: Ascension SE Wisconsin
Podiatric Relevance: Achilles Tendon Ruptures (ATR) are a condition frequently seen by podiatric surgeons, and are being diagnosed at a higher and higher rate. When considering this and the fact that metabolic pathologies can increase the likelihood of experiencing tendinous injury such as ATR, the podiatric physician should be familiar with changes in outcomes following these injuries and subsequent repair. This study helps to provide an outline of how metabolic pathologies and surgical technique utilized can influence post-operative results.
Methods: Records of all patients who received surgical intervention for acute Achilles Tendon Rupture (ATR) at one of 5 Italian Hospitals were reviewed. The patients were then contacted via telephone questionnaire that evaluated their past medical history, injury history, sport- and work-related activities, drug use, post-operative rehabilitation outcomes. A total of 340 patients were included in study. Metabolic pathologies specified include hypercholesterolemia, diabetes mellitus, hyperthyroidism, hypothyroidism, obesity.
Results: 28% of patients who had surgically repaired acute achilles tendon rupture had history of metabolic pathology. Of those patients, hypercholesterolemia was the most common (42%), followed by obesity (23%), thyroid disorders (18%), diabetes (17%). Multivariate analysis showed that dysmetabolic disease significantly predicted the risk of post-operative complications and a delayed return to sport and work activities, these are described as follows: slower return to sports/activities post-operatively seen in patients who have metabolic pathology, are older at time of repair and received repair using open surgical technique; medical complications seen intra- or post-operatively increased in patients who have metabolic pathology,decreased in those who received minimally invasive surgery (not percutaneous); immediate post operative weight bearing seen more frequently in those with history of competitive sport participation, more frequently in younger patients at time of surgery and less frequently in those who received repair using open surgical technique; immediate post operative weight bearing without assistance seen more frequently in those with history of competitive sport participation and less frequently in those who received repair using open surgical technique.
Conclusions: The authors conclude that metabolic conditions can strongly affect the post-operative outcomes of surgical reconstruction of the achilles tendon. This was shown by statistically significant results demonstrating slower recovery in metabolic pathology patients as described above. In addition, the results presented here suggest that minimally invasive surgery could lead to faster recovery. This study does have many limitations. It fails to consider any non-operative treatment, does not specify what is meant by open vs minimally invasive vs percutaneous surgeries, and includes many different rehabilitation protocols. More studies are necessary to include control groups and more clearly delineate surgical techniques and subsequent outcomes.