Treatment of ruptured Achilles tendon: Operative or non-operative procedure?

Čukelj, Fabijan; Bandalović, Ante; Knežević, Josip; Pavić, Arsen; Pivalica, Božen; Bakota, Bore

doi:10.1016/j.injury.2015.10.070

Cited by 18 publications

(21 citation statements)

References 4 publications

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“…This is consistent with the epidemiology of ATRs documented in other literature [2,4,7]. The controversy regarding optimal management of ATR largely centers on weighing the risk of surgical complications against potentially longer recovery time and suboptimal functional results if patients are managed non operatively [14,15]. This study found a very low overall adverse event rate of 2% in the 30 day postoperative period for primary surgical ATR repair.…”

Section: Discussionsupporting

confidence: 87%

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Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

Pean

Christiano

Rubenstein

et al. 2017

Clin Res Foot Ankle

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Background: Operative treatment of Achilles tendon ruptures is associated with lower rates of rereupture compared to nonoperative treatment. However, concerns regarding adverse events (AE) in the postoperative period such as wound complications and surgical site infection (SSI) persist. The purpose of this study was to identify patient characteristics associated with the occurrence of adverse events in Achilles tendon rupture (ATR) surgical repair cases.

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Section: Discussionsupporting

confidence: 87%

“…A comparison of operative and conservative management by Cukelji et al found a lower rate of complications in patients undergoing percutaneous ATR repair and noted a lower operative time in these patients [14]. However, the sample size in their study was much smaller and specifically targeted athletes aged 25-40 years.…”

Section: Discussionmentioning

confidence: 93%

Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

Pean

Christiano

Rubenstein

et al. 2017

Clin Res Foot Ankle

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“…Operative treatment of Achilles tendon ruptures has been increasing in the United States . Surgical treatment has been thought to provide better outcomes compared to non‐operative treatment by achieving secure tendon end approximation and reduced rates of tendon re‐rupture . However, surgical repair is also associated with increased direct and indirect costs of care, and there are known risks of this surgical procedure, including deep infections, scarring, and sural nerve sensory disturbances .…”

mentioning

confidence: 99%

“…1 Surgical treatment has been thought to provide better outcomes compared to non-operative treatment by achieving secure tendon end approximation and reduced rates of tendon re-rupture. 2,3 However, surgical repair is also associated with increased direct and indirect costs of care, 4 and there are known risks of this surgical procedure, including deep infections, scarring, and sural nerve sensory disturbances. 5 Additionally, the affected patient population is increasing in average age and BMI, 6 potentially placing them at higher risk of these and other surgical complications.…”

mentioning

confidence: 99%

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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Conservative (non‐operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end‐to‐end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid‐point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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“…The major sign of a ruptured Achilles' tendon is the absence of plantar flexion of the foot. 2 After successful treatment, Achilles' tendon ruptures may reoccur, which could lead to soft tissue defects. 3 Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge.…”

Section: Introductionmentioning

confidence: 99%

Double-Layer Reconstruction of the Achilles’ Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata

et al. 2017

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Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles' tendons following tertiary repair.

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Treatment of ruptured Achilles tendon: Operative or non-operative procedure?

Cited by 18 publications

References 4 publications

Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Double-Layer Reconstruction of the Achilles’ Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata

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