Major functional deficits persist 2 years after acute Achilles tendon rupture
- 1.2k Downloads
The purpose of this prospective randomized controlled study was to evaluate the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically. The focus was to evaluate whether any improvements occurred between the one and 2-year evaluation.
Eighty-one patients (67 men, 14 women) with a mean (SD) age of 42 (9.1) were included in this study. Forty-two patients were treated surgically, and 39 treated non-surgically otherwise the treatment was identical for the two groups. All patients were evaluated using the Achilles tendon Total Rupture Score (ATRS), the Physical Activity Scale (PAS) and validated functional tests one and 2 years after injury.
There were significant functional deficits on the injured side compared with the contralateral side 2 years after Achilles tendon rupture, regardless of treatment. Only minor improvements, even though statistically significant, occurred between the 1- and 2-year evaluations. The physical activity level remained significantly reduced as compared with prior to injury, but the ATRS mean was relatively high in both groups (89 and 90).
This long-term follow-up indicates that the majority of patients with an Achilles tendon rupture have not fully recovered (in regards to symptoms, physical activity level and function) 2 years after injury regardless of surgical or non-surgical treatment. Furthermore, only minor improvements occur between the 1- and 2-year evaluations. This indicates that to enhance the final outcome the focus should be on improvements in treatment within the first year. The patients appear to have adjusted to their impairments since the patient-reported outcome is relatively high in spite of functional deficits and lower activity level compared with pre-injury.
Level of evidence
Prospective randomized study, Level I.
KeywordsAchilles tendon rupture Long-term results Functional tests Heel-rise work Patient-reported outcome ATRS
The authors thank Lotta Falkheden-Henning and Annelie Brorsson for their help treating and evaluating the patients. We would also thank Toran MacLeod for manuscript review. This study was supported by the Swedish National Centre for Research and Sports (CIF).
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Gustavsson A, Neeter C, Thomee P, Gravare Silbernagel K, Augustsson J, Thomee R, Karlsson J (2006) A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14(8):778–788PubMedCrossRefGoogle Scholar
- 10.Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87(10):2202–2210Google Scholar
- 13.Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, van der Werken C (2008) Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing–a randomized controlled trial. Am J Sports Med 36(9):1688–1694PubMedCrossRefGoogle Scholar
- 14.Mizner RL, Petterson SC, Clements KE, Zeni JA, Jr., Irrgang JJ, Snyder-Mackler L (2010) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments a longitudinal analysis of outcomes. J Arthroplasty, PMCID 3008304Google Scholar
- 15.Moller M, Lind K, Movin T, Karlsson J (2002) Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment. Scand J Med Sci Sports 12(1):9–16Google Scholar
- 16.Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–848Google Scholar
- 17.Mortensen HM, Skov O, Jensen PE (1999) Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg Am 81(7):983–990Google Scholar
- 19.Möller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–848Google Scholar
- 24.Nistor L (1981) Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg Am 63(3):394–399Google Scholar
- 27.Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 38(6):1104–1115Google Scholar
- 34.Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92(17):2767–2775PubMedCrossRefGoogle Scholar