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No clinically relevant difference between operative and non-operative treatment in tendon elongation measured with the Achilles tendon resting angle (ATRA) 1 year after acute Achilles tendon rupture

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Studies have shown that elongation of the injured Achilles tendon after acute Achilles tendon rupture (ATR) is negatively associated with clinical outcomes. The difference between operative and non-operative treatment on the length of the Achilles tendon is only sparsely investigated. The aim of the study was to investigate if the operative and non-operative treatment of ATR had different effects on tendon elongation.

Methods

The study was performed as a registry study in the Danish Achilles tendon database (DADB). The primary outcome of the study was an indirect measure of Achilles tendon length: the Achilles tendon resting angle (ATRA) at 1-year follow-up. The variable of interest was treatment (operative or non-operative).

Results

From August 2015 to January 2019, 438 patients (154 operatively treated and 284 non-operatively treated) were registered with full baseline data and had their ATRA correctly registered at 1-year follow-up in DADB. The analysis did not show a clinically relevant nor statistically significant difference in ATRA between operative and non-operatively treated patients at 1-year follow-up (mean difference − 1.2°; 95% CI − 2.5; 0.1; n.s) after adjustment for potential confounders.

Conclusion

There were neither clinically relevant nor statistically significant differences in terms of the ATRA at 1-year follow-up between the operative and non-operatively treated patients. This finding suggests that operative treatment does not lead to a clinically relevant reduction in tendon elongation compared to non-operative treatment and it should therefore not be used as an argument in the choice of treatment.

Level of evidence

Level III.

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Abbreviations

ATR:

Acute Achilles tendon rupture

DADB:

Danish Achilles tendon database

ATRA:

Achilles tendon resting angle

HRH:

Heel-rise height

LSI:

Limb symmetry index

ATRS:

Achilles tendon total rupture score

MRI:

Magnetic resonance imaging

RSA:

Stereo radiography

RCT:

Randomized clinical trial

ICC:

Intraclass correlation coefficient

SEM:

Standard error of measurement

CI:

Confidence interval

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Acknowledgements

We would like to thank the following hospitals in Denmark that have contributed data to the Danish Achilles tendon Database: Aalborg Hospital, Køge Hospital, Nykøbing Falster Hospital, Amager-Hvidovre Hospital, Kolding Hospital, Vendsyssel Hospital, Hjørring Hospital, Thy-Mors Hospital, Himmerland Farsø Hospital, Viborg Regional Hospital, Randers Regional Hospital and Slagelse Hospital.

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Authors and Affiliations

  1. Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Allan Cramer, Ebrahim Rahdi, Maria Swennergren Hansen, Per Hölmich & Kristoffer Weisskirchner Barfod

  2. Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark

    Maria Swennergren Hansen

  3. Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark

    Håkon Sandholdt

Authors
  1. Allan Cramer
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  2. Ebrahim Rahdi
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  3. Maria Swennergren Hansen
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  4. Håkon Sandholdt
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  5. Per Hölmich
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  6. Kristoffer Weisskirchner Barfod
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Contributions

The authors (AC, ER, MSH, HS, PH, KWB) designed the study and interpreted the data. AC, ER and HS made the statistical analysis. AC and KWB wrote the first version of the manuscript. All authors have critically revised the manuscript and have approved the final version.

Corresponding author

Correspondence to Allan Cramer.

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Conflict of interest

KWB is paid consultant for DJO Nordic. The rest of the authors declare that they have no competing interests.

Funding

No funds were received.

Ethical approval

Institutional review board (IRB) approval was given by the Ethical Review Board of the Capital Region of Denmark April 23 2020, registration no. H-20028220. Approval from the Danish Data Protection Agency of the Capital Region of Denmark was given March 11, 2020, registration no. P-2020-238.

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Informed consent was obtained from all study participants.

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Cramer, A., Rahdi, E., Hansen, M.S. et al. No clinically relevant difference between operative and non-operative treatment in tendon elongation measured with the Achilles tendon resting angle (ATRA) 1 year after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 29, 1617–1626 (2021). https://doi.org/10.1007/s00167-020-06391-w

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