Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 8, pp 1089–1096 | Cite as

Treatment of acute Achilles tendon rupture with a standardised protocol

  • Heidi HaapasaloEmail author
  • Ulla Peltoniemi
  • Heikki-Jussi Laine
  • Pekka Kannus
  • Ville M. Mattila
Trauma Surgery

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.

Keywords

Achilles tendon Acute Achilles tendon rupture Treatment protocol Complications 

Notes

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.

Compliance with ethical standards

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.

References

  1. 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 ArthroscGoogle Scholar
  2. 2.
    Holm C, Kjaer M, Eliasson P (2015) Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports 25(1):e1-10CrossRefPubMedGoogle Scholar
  3. 3.
    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):510–515Google Scholar
  4. 4.
    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):2419–2423CrossRefPubMedGoogle Scholar
  5. 5.
    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):59–64CrossRefPubMedGoogle Scholar
  6. 6.
    Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev(9):CD003674Google Scholar
  7. 7.
    Khan RJ, Fick D, Brammar TJ, Crawford J, Parker MJ (2004) Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev(3):CD003674Google Scholar
  8. 8.
    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):e133-138CrossRefGoogle Scholar
  9. 9.
    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):2406–2414CrossRefPubMedGoogle Scholar
  10. 10.
    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):1084–1086CrossRefPubMedGoogle Scholar
  11. 11.
    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):1688–1694CrossRefPubMedGoogle Scholar
  12. 12.
    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):9–16CrossRefPubMedGoogle Scholar
  13. 13.
    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):2186–2193CrossRefPubMedGoogle Scholar
  14. 14.
    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):1385–1393CrossRefPubMedGoogle Scholar
  15. 15.
    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):1448–1455CrossRefPubMedGoogle Scholar
  16. 16.
    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):18–23CrossRefPubMedGoogle Scholar
  17. 17.
    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)):78–86Google Scholar
  18. 18.
    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):2136–2143CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    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):622–628CrossRefPubMedGoogle Scholar
  20. 20.
    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):250–253CrossRefPubMedGoogle Scholar
  21. 21.
    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):2767–2775CrossRefPubMedGoogle Scholar
  22. 22.
    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):305–311CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyTampere University HospitalTampereFinland
  2. 2.Satakunta District HospitalPoriFinland
  3. 3.Injury and Osteoporosis Research CenterUKK InstituteTampereFinland
  4. 4.The School of MedicineUniversity of TampereTampereFinland
  5. 5.COXA Hospital for Joint ReplacementTampereFinland

Personalised recommendations