No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

Abstract

Purpose This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex-and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients. Methods Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation. Results Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: − 6.9° (5.5), acute: − 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury. Conclusions Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair. Level of evidence III.

The Outcomes Between Acute and Delayed Repair After Achilles Tendon Rupture

“…This is related to the incision which is enough to expose the tendon and secure the suture. Our study has no rerupture after surgery, and we also achieved a clinical outcome which was similar to the previous study (15). Minimally incision may be lead to skin necrosis because of excessive retraction, and sural nerve injury.…”

“…There are only a few studies have been reported on the outcome of repair during the acute-on-chronic time period following delayed presentation (14,15).Anathatee using the Achillon system (Integra, Plainsboro, NJ, USA) to achieve proper approximation of the tendon ends, at 11-31 days following rupture (14).Michael performed end-to-end repair using minimally invasive repair (15).Both of the above two studies used minimally invasive techniques, but no literature has reported the outcomes and feasibility of open reconstruction combined with modi ed suture in the acute-on-chronic period.…”

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

“…In contrast to previous studies, we sought to investigate persons who experienced a functional deficit, and therefore, it is not surprising that the average ATRS score in the present study (52 points) was considerably lower than previous reports. 12,19,[55][56][57] On the other hand, these data highlight the fact that these persons have considerable structural changes in both muscle and tendon.…”

Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

“…There is no consensus for the optimal time for surgery, but in the majority of the studies operative treatment was initiated after a conservative approach. It is presumable that this might not affect patient outcomes, as seen in a recent study about a late minimally invasive Achilles tendon repair after 14 days [ 42 ]. Irrespective of the anatomic locations, there might be no relevant symptom improvement 3 months postoperatively, but there may be after 6–12 months with no deterioration after years [ 43 ].…”