SLR - December 2012 - Shabazz
Reference: Dan Bergkvist, Ingrid Åström, Per-Olof Josefsson, & Leif E. Dahlberg. Acute Achilles Tendon Rupture: A Questionnaire Of Follow-up Of 487 Patients, Journal of Bone and Joint Surgery. 2012 July 03;94(13):1229-1233.
Scientific Literature Review
Reviewed by: Karimah Shabazz, DPM
Residency Program: UH Richmond Heights Hospital/KSUCPM
Podiatric Relevance:
The optimum treatment of acute total Achilles tendon rupture remains controversial. In this study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex.
Methods:
The records of 487 consecutive patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas non-operative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and non-surgical treatment were compared on the basis of patient age and sex.
Results:
The mean age at the time of the injury was 45 years. In the surgical treatment group at Hospital 1, six (3 percent) of 201 patients had a re-rupture and three (1.5 percent) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6 percent (15 of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury.
Conclusions:
The relatively high Achilles Tendon Total Rupture Score in the non-surgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes this treatment a preferable option for most patients. However, the tendency for a lower re-rupture rate and better performance on the heel-raise test in surgically treated patients suggest surgery may be beneficial in selected patients.