Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture

Abstract

Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown. Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for analysis of adverse events. Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P = .028). In addition, the lateral difference (operated vs unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated on by resident surgeons ( P = .011 and 0.015, respectively). The number of adverse events did not differ significantly between the 2 groups. Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.

Early Predictors of Recovery From Nonoperatively Treated Achilles Tendon Rupture: 1 Year Follow‐Up Study

“…Participant height and body mass were measured, and BMI calculated. Previous follow‐up studies using similar methods have reported sample sizes of 22–86 individuals [4–6], and we aimed to include similar numbers.…”

“…Therefore, our aim was to assess whether early symmetry of AT and triceps surae muscle properties at 2 months after rupture were associated with side‐to‐side symmetry in isometric plantarflexor maximal voluntary contraction (MVC) and AT nonuniformity at 6 and 12 months. We examined whether participant age [3], sex [3], early symmetry of MG muscle and AT architecture [2, 4–7], ATRA [8, 15–17], or AT shear wave velocity (SWV, m × s −1 ) [7] measured at 2 months postinjury would serve as potential predictors of MVC and AT nonuniformity. We hypothesized that younger age and better structural and mechanical symmetry at 2 months would be related to better symmetry of MVC and AT nonuniformity at 6 and 12 months.…”

“…Regardless of the initial treatment strategy of operative or nonoperative care, some individuals regain more symmetrical side‐to‐side function, while others remain with pronounced deficits [1]. In addition to patient age [3], literature suggests that ultrasound imaging of the Achilles tendon (AT) and plantarflexor muscle structural characteristics may have a relevant role in predicting functional outcome [4–6]. For instance, early measurement of AT cross‐sectional area (CSA) [4–6] and ultrasound elastography‐based tendon stiffness may be associated with functional performance [4, 7].…”

“…In addition to patient age [3], literature suggests that ultrasound imaging of the Achilles tendon (AT) and plantarflexor muscle structural characteristics may have a relevant role in predicting functional outcome [4–6]. For instance, early measurement of AT cross‐sectional area (CSA) [4–6] and ultrasound elastography‐based tendon stiffness may be associated with functional performance [4, 7]. In addition to ultrasound imaging, a larger intraoperative Achilles tendon resting angle (ATRA) has been related with a more symmetrical heel‐rise performance in operatively treated patients [8].…”

Optimizing tendon repair and regeneration: how does the in vivo environment shape outcomes following rupture of a tendon such as the Achilles tendon?

“…The above discussion is relevant to tendon repair as after surgery, the affected limb is usually immobilized for various periods of time and thus, subjected to conditions that foster atrophy of muscle bone and the surgically repaired AT. This may also affect the vascular system as such patients may incur a deep vein thrombosis at a high rate [~50%; discussed in Saarensilta et al (2023b)]. However, this immobilization is occurring after surgery and based on the proteomic studies (Chen et al, 2022;Chen et al, 2023;Wu et al, 2023), biomarkers of good outcomes at 1-year were already evident prior to surgery.…”