Abstract
Introduction
A treatment protocol favouring non-operative treatment and based on early weight-bearing and early range-of-motion exercises was implemented in standard clinical care of a level I trauma clinic.
Materials and methods
All patients treated due to acute Achilles tendon rupture between 2008 and 2014 were included in the study (n = 411). The patient records were retrospectively evaluated.
Results
The mean age of patients was 47 (range 17–88) years. In total, 213 (52%) acute Achilles tendon ruptures were treated operatively and 198 (48%) non-operatively. The annual proportion of operatively treated patients declined from 70 to 21% during the study period. The traumatic re-rupture rate was similar between the operative (4%) and the non-operative (6%) treatment groups (p = 0.385), even though the patients in the non-operative group were significantly older and had more co-morbidities than the operatively treated patients. Of the operatively treated patients, 10% (n = 21) had wound healing problems. In 6/198 patients, the non-operative treatment had to be converted to surgical treatment in the early phase. Unsatisfactory functional outcome after the treatment was reported in 7/213 patients in the operative and 10/198 in the non-operative group (p = 0.234).
Conclusions
Our study showed that it is possible to implement a standardised treatment protocol to guide the decision-making and treatment and of an acute Achilles tendon rupture as a part of the daily care in a large standard trauma hospital. The clinical outcome and the rate of complications were fully comparable to the good clinical results achieved in RCT-study settings despite the heterogeneity of the treated patients and non-specialisation of the medical staff, showing that the protocol could find the most reasonable treatment for each patient and reduced dramatically the rate of operative treatment.
Level of evidence
Level III, comparative series.
Similar content being viewed by others
References
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
Holm C, Kjaer M, Eliasson P (2015) Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports 25(1):e1-10
Hutchison AM, 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-B(4):510–515
Huttunen TT, Kannus P, Rolf C, Fellander-Tsai L, Mattila VM (2014) Acute achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med 42(10):2419–2423
Kangas J, Pajala A, Ohtonen P, Leppilahti J (2007) Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med 35(1):59–64
Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev(9):CD003674
Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ (2004) Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev(3):CD003674
Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Leppilahti J (2015) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports 25(1):e133-138
Lantto I, Heikkinen J, Flinkkila T et al (2016) A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. Am J Sports Med 44(9):2406–2414
Mattila VM, Huttunen TT, Haapasalo H, Sillanpaa P, Malmivaara A, Pihlajamaki H (2015) Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study. Br J Sports Med 49(16):1084–1086
Metz R, Verleisdonk EJ, van der Heijden GJ et al (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):1688–1694
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):9–16
Nilsson-Helander K, Silbernagel KG, Thomee R et al (2010) Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38(11):2186–2193
Olsson N, Nilsson-Helander K, Karlsson J et al (2011) Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19(8):1385–1393
Olsson N, Petzold M, Brorsson A, Karlsson J, Eriksson BI, Silbernagel KG (2014) Predictors of clinical outcome after acute Achilles tendon ruptures. Am J Sports Med 42(6):1448–1455
Schepull T, Kvist J, Aspenberg P (2012) Early E-modulus of healing Achilles tendons correlates with late function: similar results with or without surgery. Scand J Med Sci Sports 22(1):18–23
Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal SB (2017) The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J, 99(B(1)):78–86
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(23):2136–2143
van der Eng DM, Schepers T, Goslings JC, Schep NW (2013) Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg 52(5):622–628
Wang D, Sandlin MI, Cohen JR, Lord EL, Petrigliano FA, SooHoo NF (2015) Operative versus nonoperative treatment of acute Achilles tendon rupture: an analysis of 12,570 patients in a large healthcare database. Foot Ankle Surg 21(4):250–253
Willits K, Amendola A, Bryant D et al (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):2767–2775
Wu Y, Lin L, Li H et al (2016) Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses. Int J Surg 36(Pt A):305–311
Acknowledgements
The study was financially supported by the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, grant numbers 9R006 and 9R031.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
The study protocol has been approved by the Ethics Committee of Pirkanmaa District Hospital (approval number R11005).
Informed consent
The study data were collected retrospectively from the medical records of the patients who were treated according the hospital treatment protocol, so informed consent was not needed.
Rights and permissions
About this article
Cite this article
Haapasalo, H., Peltoniemi, U., Laine, HJ. et al. Treatment of acute Achilles tendon rupture with a standardised protocol. Arch Orthop Trauma Surg 138, 1089–1096 (2018). https://doi.org/10.1007/s00402-018-2940-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-018-2940-y