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Conservative treatment outcome for Achilles tendon re-rupture occurring in the subacute phase after primary repair

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Until now, a treatment protocol for Achilles tendon re-rupture (ATRR) occurring in the postoperative period 5–12 weeks following primary Achilles tendon repair has not been established. We refer to this time frame as the subacute postoperative phase, and the objective of this study was to assess the efficacy of conservative treatment for subacute ATRR in this phase.

Materials and methods

We conducted a retrospective review of 390 cases (385 patients) who had undergone primary Achilles tendon repair using the 4-strand Krachow method between January 2010 and August 2021. All patients were subjected to more than 12 months of follow-up and were categorized into two groups based on the presence of subacute ATRR: Group 1 comprised 370 cases without ATRR, while Group 2 comprised 20 cases with ATRR. Following confirmation of ATRR, we immediately applied a below-knee cast in an ankle plantar flexed position (25°–30°), followed by bracing according to the same rehabilitation plan used for the primary repair. After administering conservative treatment to the patients with ATRR, we compared several outcome parameters between the two groups, including isokinetic plantar flexion power measured using a dynamometer, time required for a single heel raise (t-SHR), time needed for ten repetitive SHRs (t-SHR10), Achilles Tendon Total Rupture Score (ATRS), and Foot and Ankle Ability Measure (FAAM) scores. The baseline timepoints for Groups 1 and 2 were the dates of the primary repair and the re-injury event.

Results

After primary Achilles tendon repair, subacute ATRR occurred in 5.1% of patients. There were no significant differences between the groups in terms of t-SHR and t-SHR10 (P = 0.281, 0.486). Similarly, the isokinetic dynamometer measurements revealed no significant differences in peak torque for plantar flexion at angular velocities of 30°/s and 120°/s, both in absolute values and as a percentage of the contralateral side, between the groups (P > 0.05 for each). However, ATRSs were significantly lower in Group 2 compared to Group 1 before 6 months (P < 0.05), as were FAAM-Activities of Daily Living scores at 6 months (P < 0.05). After 12 months, there were no significant differences in these scores between the two groups (both P > 0.05).

Conclusion

Conservative treatment for subacute ATRR following primary Achilles tendon repair yields clinical outcomes comparable to those without ATRR. Therefore, we recommend that surgeons consider relying on the patient’s natural healing capabilities rather than opting for aggressive surgical interventions, as expediting such operations may be unnecessary for subacute injuries.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Ganestam A, Kallemose T, Troelsen A, Barfod KW (2015) Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 24:3730–3737

    Article  PubMed  Google Scholar 

  2. Ahn HS, Kim HJ, Kang TU, Kazmi SZ, Suh JS, Choi JY (2021) Dyslipidemia is associated with increased risk of Achilles tendon disorders in underweight individuals to a greater extent than obese individuals: a Nationwide, population-based, longitudinal cohort study. Orthop J Sports Med 9(10):23259671211042600. https://doi.org/10.1177/23259671211042599

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pajala A, Kangas J, Ohtonen P, Leppilahti J (2002) Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am 85(11):2016–2021

    Article  Google Scholar 

  4. Deng S, Sun Z, Zhang C, Chen G, Li J (2017) Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg 56(6):1236–1243

    Article  PubMed  Google Scholar 

  5. Ochen Y, Beks RB, van Heiji M, Hietbrink F, Leenen LPH, van der Velde D et al (2019) Operative treatment versus nonoperative treatment of Achilles tendon rupture: systematic review and meta-analysis. BMJ 364:k5120

    Article  PubMed  PubMed Central  Google Scholar 

  6. Reda Y, Farouk A, Abdelmonem I, El Shazly OA (2020) Surgical versus non-surgical treatment for acute Achilles’ tendon rupture. A systematic review of literature and meta-analysis. Foot Ankle Surg 26(3):280–288

    Article  PubMed  Google Scholar 

  7. Wilkins R, Bisson LJ (2012) Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med 40(9):2154–2160

    Article  PubMed  Google Scholar 

  8. Nilsson-Helander K, Swärd L, Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J (2008) A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 16(6):614–620

    Article  PubMed  Google Scholar 

  9. Rettig AC, Liotta FJ, Klootwyk TE, Porter DA, Mieling P (2005) Potential risk of rerupture in primary Achilles tendon repair in Athletes younger than 30 years of age. Am J Sports Med 33(1):119–123

    Article  PubMed  Google Scholar 

  10. Chestor R, Costa ML, Shepstone L, Donell ST (2003) Reliability of isokinetic dynamometry in assessing plantarflexion torque following Achilles tendon rupture. Foot Ankle Int 24(12):909–915

    Article  Google Scholar 

  11. Goren D, Ayalon M, Nyska M (2005) Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures. Foot Ankle Int 26(4):286–290

    Article  PubMed  Google Scholar 

  12. Park YH, Cho HW, Choi JW, Kim HJ (2021) Validation and cross-cultural adaptation of the Korean translation of the Achilles tendon Total Rupture Scoew. BMC Musculoskelet Disord 22:876

    Article  PubMed  PubMed Central  Google Scholar 

  13. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM (2005) Evidence of validity for the foot and ankle ability measure. Foot Ankle Int 26(11):968–983

    Article  PubMed  Google Scholar 

  14. Reb CW, Saini SS, Stenson JF, Albana AF, Pedowitz DI, Raikin SM et al (2018) Content relevance of the foot and ankle ability measure in patients with Achilles tendon disease. Foot Ankle Spec 11(3):217–222

    Article  PubMed  Google Scholar 

  15. Flint JH, Wade AM, Giuliani J, Rue JP (2014) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42(1):235–241

    Article  PubMed  Google Scholar 

  16. Hope M, Saxby TS (2007) Tendon healing. Foot Ankle Clin 12(4):553–567

    Article  PubMed  Google Scholar 

  17. Voleti PB, Buckley MR, Soslowsky LJ (2012) Tendon healing: repair and regeneration. Annu Rev Biomed Eng 14:47–71

    Article  PubMed  CAS  Google Scholar 

  18. Nagasawa K, Noguchi M, Ikoma K, Kubo T (2008) Static and dynamic biomechanical properties of the regenerating rabbit Achilles tendon. Clin Biomech 23(6):832–838

    Article  Google Scholar 

  19. Hiramatsu K, Tsujii A, Nakamura N, Mitsuoka T (2018) Ultrasonographic evaluation of the early healing process after Achilles tendon repair. Orthop J Sports Med 6(8):2325967118789883. https://doi.org/10.1177/2325967118789883

    Article  PubMed  PubMed Central  Google Scholar 

  20. Maempel JF, White TO, Mackenzie SP, McCann C, Clement ND (2022) The epidemiology of Achilles tendon re-rupture and associated risk factors: male gender, younger age and traditional immobilizing rehabilitation are risk factors. Knee Surg Sports Traumatol Arthrosc 30(7):2457–2469

    Article  PubMed  CAS  Google Scholar 

  21. Jildeh TR, Okoroha KR, Marshall NE, Abdul-Hak A, Zeni F, Moutzouros V (2018) Infection and rerupture after surgical repair of Achilles tendons. Orthop J Sports Med 6(5):2325967118774302. https://doi.org/10.1177/2325967118774302

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kennedy P, Saloky K, Yadavalli A, Barlow E, Aynardi M, Garner M et al (2019) Comparison of Achilles tendon healing after exposure to combusted tobacco, vaping, and control in a rat model. Orthop J Sports Med 7(7 suppl5):2325967119S00328

    PubMed Central  Google Scholar 

  23. Cheema AN, Newton JB, Boorman-Padgett JF, Weiss SN, Nuss CA, Gittings DJ et al (2019) Nicotine impairs intra-substance tendon healing after full thickness injury in a rat model. J Orthop Res 37(1):94–103

    Article  PubMed  CAS  Google Scholar 

  24. Metz R, van der Heijden GJ, Verleisdonk EJ, Andrlik M, van der Werken C (2011) Persistent disability despite sufficient calf muscle strength after rerupture of surgically treated acute Achilles tendon ruptures. Foot Ankle Spec 4(2):77–81

    Article  PubMed  Google Scholar 

  25. Pot JH, Frima H, Clevers GJ (2014) Clinical results of re-ruptures of the Achilles tendon. Foot Ankle Online J 7(3):5. https://doi.org/10.3827/faoj.2014.0703.0005

    Article  Google Scholar 

  26. Scott WN, Inglis AE, Sculco TP (1979) Surgical treatment of reruptures of the tendoachilles following nonsurgical treatment. Clin Orthop Relat Res 140:175–177

    Google Scholar 

  27. Westin O, Helander KN, Silbernagel KG, Samuelsson K, Brorsson A, Karlsson J (2018) Patients with an Achilles tendon re-rupture have long-term functional deficits in function and worse patient-reported outcome than primary ruptures. Knee Surg Sports Traumatol Arthrosc 26(10):3063–3072

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

Authors

Contributions

JY Choi wrote the article with organizing the data, participated in the design of the study, performed the statistical analysis and wrote the article. SK Choo involved in English editing. BH Kim sorted the involved patients with a review of medial record. JS Suh conceived of the study, and participated in its design and coordination and helped to draft the manuscript.

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Correspondence to Jin Soo Suh.

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Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study was approved by Inje University Ilsan Paik hospital institutional ethics review committee and performed according to the tenets of the Declaration of Helsinki (IRB number 2022-11-014-001).

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Written informed consent was obtained from all enrolled patients.

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Choi, J.Y., Choo, S.K., Kim, B.H. et al. Conservative treatment outcome for Achilles tendon re-rupture occurring in the subacute phase after primary repair. Arch Orthop Trauma Surg 144, 1055–1063 (2024). https://doi.org/10.1007/s00402-023-05161-w

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  • DOI: https://doi.org/10.1007/s00402-023-05161-w

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