Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice

Winson, Daniel M.G.; Macnair, R; Hutchinson, Anne-Marie; Owen, Nick; Evans, R. W.; Williams, Paul

doi:10.1016/j.foot.2020.101724

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…Patients with large tendon gaps are associated with poorer function and less favorable patient-reported outcomes if managed nonoperatively 11 . Recent randomized controlled trials and comparative prospective studies comparing nonoperative and operative management either excluded patients with delayed presentations 10 or had patients with a smaller tendon gap than the patient in our report 12 .…”

Section: Discussionmentioning

confidence: 96%

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft

Oudtshoorn

Maor

2023

JBJS Case Connector

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Case: A 15-year-old adolescent girl presented with a complete Achilles tendon rupture from playing netball, which was diagnosed 6 weeks later. Unfortunately, there was a significant deficit of 92 mm, and an allograft reconstruction was required to bridge the gap. Conclusion:Achilles tendon ruptures are rare in children and adolescents without a penetrating injury, but the diagnosis must not be missed. Achilles tendon ruptures should be considered in children with acute-onset ankle pain during running, jumping, or sudden dorsiflexion of the ankle. Tendon transfers and allograft may be required after rupture and retraction has occurred in subacute or chronic injuries.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B978).

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Section: Discussionmentioning

confidence: 96%

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft

Oudtshoorn

Maor

2023

JBJS Case Connector

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“…However, again, this seems to be derived from anectodical evidence rather than high-quality research. Only one included study investigates the role of conservative treatment and, to the best of our knowledge, the only article directly comparing operative versus conservative treatment in chronic ruptures is the 1953 study of Christensen [89,98]. This study does indeed suggest superiority of operative treatment; however, it is not possible to draw conclusions from a single small case series.…”

Section: Discussionmentioning

confidence: 99%

“…Other less commonly reported techniques include use of the Ligament Advanced Reinforcement System (LARS) graft (JK Orthomedic, Dollard-des-Ormeaux, Quebec, Canada), polyester tape, scar tissue interposition and Duthie's biological repair [10,43,45,91]. Only one study described nonoperative treatment, using an orthosis as part of the SMART protocol [89].…”

Section: Treatment Techniquesmentioning

confidence: 99%

Management of chronic Achilles ruptures: a scoping review

Arshad

Lau

Leow

et al. 2021

International Orthopaedics (SICOT)

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Purpose This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. Methods A scoping review was performed according to the frameworks of Arksey and O’Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. Results A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). Conclusion Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.

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“…This study was limited by a small number of patients, and 3 patients eventually required Flexor Hallucis Longus transfer after failing the SMART nonoperative protocol. 37…”

Section: Timing Of Treatmentmentioning

confidence: 99%

Nonoperative Management of Achilles Tendon Ruptures

King

Andrews

2023

Techniques in Foot &Amp; Ankle Surgery

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Acute Achilles tendon ruptures are an increasingly common injury. Although operative fixation continues to be dominant in the United States, a growing body of literature supports nonoperative management. Although the specifics of functional rehabilitation vary, many studies support this management approach. Continued controversies include the type of castor orthosis used, acceptable gap size, need for ultrasound evaluation, time to initiation of weight bearing, time to initiation of motion, duration of orthosis, length of treatment, and use of heel wedges in shoes once the orthosis is discontinued. Level of Evidence: Level I.

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Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice

Cited by 10 publications

References 22 publications

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft

A Missed Pediatric Achilles Tendon Rupture with a Large Gap Managed with Surgical Reconstruction with Allograft

Management of chronic Achilles ruptures: a scoping review

Nonoperative Management of Achilles Tendon Ruptures

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