Advanced

Acute Achilles Tendon Rupture: A Questionnaire Follow-up of 487 Patients.

Bergkvist, Dan; Åström, Ingrid; Josefsson, Per Olof LU and Dahlberg, Leif LU (2012) In Journal of Bone and Joint Surgery. American Volume 94(13). p.1229-1233
Abstract
BACKGROUND:

The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present 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 all 487 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 nonoperative 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... (More)
BACKGROUND:

The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present 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 all 487 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 nonoperative 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 nonsurgical treatment were compared on the basis of patient age and sex.



RESULTS:

The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen 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 good Achilles Tendon Total Rupture Score in the nonsurgically 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.



LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Bone and Joint Surgery. American Volume
volume
94
issue
13
pages
1229 - 1233
publisher
Journal Bone Joint Surgery Inc
external identifiers
  • wos:000306044200012
  • pmid:22760392
  • scopus:84863561858
ISSN
1535-1386
DOI
10.2106/JBJS.J.01601
language
English
LU publication?
yes
id
758fb4a6-0535-4588-a5ea-28d9f35c7038 (old id 2967510)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22760392?dopt=Abstract
date added to LUP
2012-08-09 15:48:48
date last changed
2017-08-20 03:17:30
@article{758fb4a6-0535-4588-a5ea-28d9f35c7038,
  abstract     = {BACKGROUND:<br/><br>
The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex.<br/><br>
<br/><br>
METHODS:<br/><br>
The records of all 487 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 nonoperative 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 nonsurgical treatment were compared on the basis of patient age and sex.<br/><br>
<br/><br>
RESULTS:<br/><br>
The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen 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.<br/><br>
<br/><br>
CONCLUSIONS:<br/><br>
The good Achilles Tendon Total Rupture Score in the nonsurgically 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.<br/><br>
<br/><br>
LEVEL OF EVIDENCE:<br/><br>
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.},
  author       = {Bergkvist, Dan and Åström, Ingrid and Josefsson, Per Olof and Dahlberg, Leif},
  issn         = {1535-1386},
  language     = {eng},
  number       = {13},
  pages        = {1229--1233},
  publisher    = {Journal Bone Joint Surgery Inc},
  series       = {Journal of Bone and Joint Surgery. American Volume},
  title        = {Acute Achilles Tendon Rupture: A Questionnaire Follow-up of 487 Patients.},
  url          = {http://dx.doi.org/10.2106/JBJS.J.01601},
  volume       = {94},
  year         = {2012},
}