Older Age Predicts Worse Function 1 Year After an Acute Achilles Tendon Rupture: A Prognostic Multicenter Study on 391 Patients

Abstract

Background:There is limited evidence regarding the patient-related factors that influence treatment outcomes after an acute Achilles tendon rupture.Purpose/Hypothesis:The purpose of this study was to determine the predictors of functional and patient-reported outcomes 1 year after an acute Achilles tendon rupture using a multicenter cohort and to determine patient characteristics for reporting within the top and bottom 10% of the Achilles tendon Total Rupture Score (ATRS) and heel-rise height outcomes. The hypothesis was that older age, greater body mass index (BMI), and female sex would lead to inferior outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:Patients were selected by combining 5 randomized controlled trials from 2 different centers in Sweden. Functional outcomes were assessed using validated heel-rise tests (height, number of repetitions, total work, and concentric power) for muscular endurance and strength, and the relationship between injured and uninjured legs was calculated as the limb symmetry index (LSI). Patient-reported outcomes were measured using the ATRS. All outcomes were collected at the 1-year follow-up. Independent predictors included were patient sex, smoking, BMI, age, and surgical versus nonsurgical treatment.Results:Of the 391 included patients, 307 (79%) were treated surgically. The LSI of heel-rise height at the 1-year follow-up decreased by approximately 4% for every 10-year increment in age (beta, –3.94 [95% CI, –6.19 to –1.69]; P = .0006). In addition, every 10-year increment in age resulted in a 1.79-fold increase in the odds of being in the lowest 10% of the LSI of heel-rise height. Moreover, a nonsignificant superior LSI of heel-rise height was found in patients treated surgically compared with nonsurgical treatment (beta, –4.49 [95% CI, –9.14 to 0.16]; P = .058). No significant predictor was related to the ATRS. Smoking, patient sex, and BMI did not significantly affect the 1-year results for the LSI of the heel-rise tests.Conclusion:Older age at the time of injury negatively affected heel-rise height 1 year after an Achilles tendon rupture. Irrespective of age, a nonsignificant relationship toward the superior recovery of heel-rise height was seen in patients treated surgically. None of the factors studied affected patient-reported outcomes.

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

“…39 Several patient characteristics may influence prognosis after Achilles tendon rupture. 10,14,39,53 Older age 10,39 and higher body mass index (BMI) 39 have been identified as predictors of inferior outcome. There is conflicting evidence for the effect of sex, with female patients reporting more symptoms and demonstrating more variable recovery of calf muscle endurance in 1 study 14 and better outcome in another.…”

Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series

“…The greatest patient-reported limitations were related to activities including running and jumping. Older age could be argued as a reason for lower scores in this patient group, however, patient age has previously been shown not to be a risk factor for inferior results in the ATRS after AATR, which indicates that the differences rather are associated with functional deficits and possibly also a negative experience of delayed treatment and, in some cases, misdiagnosis [ 43 ]. Patients with ATRR, who also have suffered a complication to the initial injury, have previously been reported to have poorer patient-reported outcomes than patients with an AATR, despite a similar recovery of muscle function [ 42 ].…”

“…Older age at the time of injury and greater intraoperative ATRA (i.e. tightness of repair) has previously been reported to predict inferior heel-rise height one year after AATR [ 6 , 31 , 43 ].…”

Deep venous thrombosis after Achilles tendon rupture is associated with poor patient-reported outcome

“…However, adjusting for confounding factors cannot be done for non-parametric variables. Patient age might therefore explain the observed difference in, e.g., concentric work better than the incidence of DVT, as patient age is a known factor to decrease the calf endurance of the patients [37].…”