SLR - December 2011 - Nicholas R. Schmerbach(2)
Reference: Wallace, R. G., Heyes, G. J., & Michael, A. L. (2011). The non-operative functional management of patients with a rupture of the tendo Achilles leads to low rates of re-rupture. The Journal of Bone and Joint Surgery, 1362-1366.
Scientific Literature Review
Reviewed by: Nicholas R. Schmerbach, DPM
Residency Program: Columbia St. Mary’s Hospital, Milwaukee, WI
Podiatric Relevance:
There continues to be a great deal of debate associated with the treatment of tendo Achilles ruptures, specifically whether surgical or non-surgical treatment should be undertaken. This article looks at a non-surgical protocol and compares the results to previous published rates of re-rupture after surgical treatment was performed.
Methods:
The outcomes of 945 consecutive patients, which included 949 tendons diagnosed with a rupture of the tendo Achilles, managed between 1996 and 2008 were evaluated. The decision on non-operative treatment was based on whether the tendon ends were found to approximate well on palpation with the foot in plantar flexion. Of the 945 patients, there was a total of 690 men and 255 women with a mean age of 48.97 years with a range from 12-86, who were treated using the authors functional protocol. Data collected included a questionnaire that requested information on pre- and post-injury work, pre- and post-injury activity levels, time to return to work and other activities, medical history, drug history, history of tendo Achilles injury and treatment, complications, and details of physiotherapy.
Results:
Of the 949 tendons that were studied there was a total of 27 re-ruptures reported. All the re-ruptures occurred within three months of diagnosis. There was no significant difference in the rate of re-rupture between those with an acute and delayed presentation or according to gender. Good to excellent subjective assessment on discharge was noted in 939 patients (99.4%; 943 tendons). A total of six patients (0.6%; six tendons) had a poor score and subsequently underwent operative repair. All patients returned to work within three months of completing final functional protocol and all patients returned to pre-injury sporting levels.
Conclusions:
The results reported in this study demonstrate that with a non-operative approach there is a very low rate of complication. As a result the authors feel that this justifies non-operative functional treatment and feel that the healing of the tendon is as good as that achieved with surgical treatment. The author’s functional protocol can be applied to individuals who present at any time following rupture provided that the tendon ends approximate well on full plantar flexion as assessed by palpation.