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Achilles tendon Total Rupture Score at 3 months can predict patients’ ability to return to sport 1 year after injury

Knee Surgery, Sports Traumatology, Arthroscopy volume 24, pages 1365–1371 (2016)Cite this article

Abstract

Purpose

To investigate how the Achilles tendon Total Rupture Score (ATRS) at 3 months and 1 year after injury is associated with a patient’s ability to return to work and sports as well as to investigate whether sex and age influence ATRS after 3 months and 1 year.

Method

This is a retrospective study analysing the data from the Danish Achilles tendon Database. A total of 366 patients were included. Logistic regression was conducted to describe the effect of ATRS on return to work and sports. The effect of age and sex on ATRS was analysed by linear regression.

Results

Three months after injury patients had a significantly increased chance of return to sport after 1 year with an increased ATRS (OR 1.06, p = 0.001) but a non-significant effect on return to work. After 1 year, patients had a significantly increased probability of having returned to sport (OR 1.11, p < 0.001) and also having returned to work (OR 1.05, p = 0.007) with an increased ATRS. Men had an average 7 (p = 0.006) points higher ATRS at 3 months and an average 22 (p = 0.006) points higher at 1 year.

Conclusion

ATRS is associated with patients’ ability to return to sports and work. ATRS at 3 months can be used as a predictor of the patient’s ability to return to sports after 1 year. Hereby, ATRS might help to individualise rehabilitation by identifying patients who do not respond adequately to the chosen treatment.

Level of evidence

II.

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References

  1. Barfod KW, Bencke J, Lauridsen HB, Ban I, Ebskov L, Troelsen A (2014) Nonoperative dynamic treatment of acute Achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. J Bone Joint Surg Am 96:1497–1503

    Article  PubMed  Google Scholar 

  2. Bostick GP, Jomha NM, Suchak A, Beaupré L (2010) Factors associated with calf muscle endurance recovery 1 year after Achilles tendon rupture repair. J Orthop Sports Phys Ther 40:345–351

    Article  PubMed  Google Scholar 

  3. Carmont MR, Silbernagel KG, Mathy A, Mulji Y, Karlsson J, Maffulli N (2013) Reliability of Achilles tendon resting angle and calf circumference measurement techniques. Foot Ankle Surg 19:245–249

    CAS  Article  PubMed  Google Scholar 

  4. Ganestam A, Barfod K, Klit J, Troelsen A (2013) Validity and reliability of the Achilles tendon Total Rupture Score. J Foot Ankle Surg 52:736–739

    Article  PubMed  Google Scholar 

  5. 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. doi:10.1007/s00167-015-3544-5

    PubMed  Google Scholar 

  6. Gravare Silbernagel K, Brorsson A, Olsson N, Eriksson BI, Karlsson J, Nilsson-Helander K (2015) Sex differences in outcome after an acute Achilles tendon rupture. Orthop J Sports Med. doi:10.1177/2325967115586768

    PubMed Central  Google Scholar 

  7. Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York

    Book  Google Scholar 

  8. Houshian S, Tscherning T, Riegels-Nielsen P (1998) The epidemiology of Achilles tendon rupture in a Danish county. Injury 29:651–654

    CAS  Article  PubMed  Google Scholar 

  9. Hutchison M, Topliss C, Beard D, Evans RM, Williams P (2015) The treatment of a rupture of the Achilles tendon using a dedicated management programme. Bone Joint J 97:510–515

    Article  PubMed  Google Scholar 

  10. Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 36:765–773

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J (2014) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports 25:133–138

    Article  Google Scholar 

  12. Levi N (1997) The incidence Copenhagen of Achilles tendon rupture in Copenhagen. Injury 28:311–313

    CAS  Article  PubMed  Google Scholar 

  13. Magnusson SP, Hansen M, Langberg H, Miller B, Haraldsson B, Westh EK, Koskinen S, Aagaard P, Kjaer M (2007) The adaptability of tendon to loading differs in men and women. Int J Exp Pathol 88:237–240

    Article  PubMed  Google Scholar 

  14. Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW (2014) Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3180-5

    PubMed  Google Scholar 

  15. Metz R, Verleisdonk E-JMM, van der Heijden GJ-M-G, Clevers G-J, Hammacher ER, Verhofstad MHJ, 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 36:1688–1694

    Article  PubMed  Google Scholar 

  16. Miller BF, Hansen M, Olesen JL, Schwarz P, Babraj J, Smith K, Rennie MJ, Kjaer M (2007) Tendon collagen synthesis at rest and after exercise in women. J Appl Physiol 102:541–546

    CAS  Article  PubMed  Google Scholar 

  17. Ministry of Employment (2008) Analysis of sick-leave. http://bm.dk/~/media/BEM/Files/Dokumenter/Publikationer/2008/Sygefravaer.ashx

  18. Moller A, Astron M, Westlin N (1996) Increasing incidence of Achilles tendon rupture. Acta Orthop Scand 67:479–481

    CAS  Article  PubMed  Google Scholar 

  19. 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 81:983–990

    CAS  PubMed  Google Scholar 

  20. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J (2010) Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38:2186–2193

    Article  PubMed  Google Scholar 

  21. Nilsson-Helander K, Thomeé R, Silbernagel KG, Thomeé P, Faxén E, Eriksson BI, Karlsson J (2007) The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 35:421–426

    Article  PubMed  Google Scholar 

  22. Olsson N, Karlsson J, Eriksson BI, Brorsson A, Lundberg M, Silbernagel KG (2014) Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture. Scand J Med Sci Sports 24:152–158

    CAS  Article  PubMed  Google Scholar 

  23. Olsson N, Nilsson-Helander K, Karlsson J, Eriksson BI, Thomée R, Faxén E, Silbernagel KG (2011) Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19:1385–1393

    Article  PubMed  Google Scholar 

  24. Olsson N, Petzold M, Brorsson A, Karlsson J, Eriksson BI, Grävare Silbernagel K (2014) Predictors of clinical outcome after acute Achilles tendon ruptures. Am J Sports Med 42:1448–1455

    Article  PubMed  Google Scholar 

  25. Saxena A, Ewen B, Maffulli N (2011) Rehabilitation of the operated achilles tendon: parameters for predicting return to activity. J Foot Ankle Surg 50:37–40

    Article  PubMed  Google Scholar 

  26. Silbernagel KG, Steele R, Manal K (2012) Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. Am J Sports Med 40:1564–1571

    Article  PubMed  Google Scholar 

  27. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (2012) Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am 94:2136–2143

    Article  PubMed  PubMed Central  Google Scholar 

  28. Westh E, Kongsgaard M, Bojsen-Moller J, Aagaard P, Hansen M, Kjaer M, Magnusson SP (2008) Effect of habitual exercise on the structural and mechanical properties of human tendon, in vivo, in men and women. Scand J Med Sci Sports 18:23–30

    CAS  Article  PubMed  Google Scholar 

  29. 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 40:2154–2160

    Article  PubMed  Google Scholar 

  30. 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 92:2767–2775

    Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Physiotherapy and Occupational Therapy, Danish Achilles Tendon Database, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Maria Swennergren Hansen & Thomas Budolfsen

  2. Department of Physiotherapy and Occupational Therapy and Department of Orthopaedic Surgery, Danish Achilles Tendon Database, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Marianne Christensen

  3. Department of Orthopaedic Surgery, Danish Achilles Tendon Database, Lillebaelt Hospital, Skovvangen 2-8, 6000, Kolding, Denmark

    Thomas Friis Østergaard

  4. Department of Orthopaedics, Clinical Orthopaedic Research Hvidovre, Clinical Research Centre, Danish Achilles Tendon Database, Copenhagen University Hospital, Hvidovre, Denmark

    Thomas Kallemose

  5. Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Danish Achilles Tendon Database, Copenhagen University Hospital, Hvidovre, Denmark

    Anders Troelsen & Kristoffer Weisskirchner Barfod

Authors
  1. Maria Swennergren Hansen
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  2. Marianne Christensen
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  3. Thomas Budolfsen
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  4. Thomas Friis Østergaard
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  5. Thomas Kallemose
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  6. Anders Troelsen
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  7. Kristoffer Weisskirchner Barfod
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Correspondence to Maria Swennergren Hansen.

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Hansen, M.S., Christensen, M., Budolfsen, T. et al. Achilles tendon Total Rupture Score at 3 months can predict patients’ ability to return to sport 1 year after injury. Knee Surg Sports Traumatol Arthrosc 24, 1365–1371 (2016). https://doi.org/10.1007/s00167-015-3974-0

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Keywords

  • Achilles tendon rupture
  • Achilles tendon Total Rupture Score
  • Return to sport
  • Predictive value
  • Sex