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Favorable Outcome of Percutaneous Repair of Achilles Tendon Ruptures in the Elderly

  • Symposium: Recent Advances in Foot and Ankle Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Percutaneous repair of Achilles tendon (AT) ruptures reportedly reduces the risk of rerupture compared to nonoperative treatment and reduces the risk of wound infection compared to open surgery. We retrospectively reviewed the postoperative Achilles tendon total rupture score (ATRS), and the maximum calf circumference in 35 patients over 65 years of age who sustained an acute tear of the AT and underwent percutaneous repair of the AT. There were 26 men and nine women with a mean age at operation of 73.4 ± 8.7 years (range, 65–86 years). Of the 35 recruited patients, we report on 27 patients for whom we have a full data set. The minimum followup was 49 months (mean, 88 months; range, 49–110 months). The ATRS had a postoperative average rating of 69.4 ± 14 (range, 56–93). All patients were able to bear weight fully on the affected limb by the eighth postoperative week. The data suggest that percutaneous repair of the AT is a suitable option for patients older than 65, producing similar outcomes when compared to percutaneous repair in younger patients of previous reports.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Ames PR, Longo UG, Denaro V, Maffulli N. Achilles tendon problems: Not just an orthopaedic issue. Disabil Rehabil. 2008;30:1646–1650.

    Article  PubMed  Google Scholar 

  2. Backmand H, Kaprio J, Kujala UM, Sarna S, Fogelholm M. Physical and psychological functioning of daily living in relation to physical activity. A longitudinal study among former elite male athletes and controls. Aging Clin Exp Res. 2006;18:40–49.

    PubMed  Google Scholar 

  3. Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N. Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med. 2002;12:273–278.

    Article  PubMed  Google Scholar 

  4. Carmont MR, Maffulli N. Less invasive Achilles tendon reconstruction. BMC Musculoskelet Disord. 2007;8:100.

    Article  PubMed  Google Scholar 

  5. Carmont MR, Maffulli N. Modified percutaneous repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:199–203.

    Article  PubMed  Google Scholar 

  6. Cetta G, Tenni R, Zanaboni G, De Luca G, Ippolito E, De Martino C, Castellani AA. Biochemical and morphological modifications in rabbit Achilles tendon during maturation and ageing. Biochem J. 1982;204:61–67.

    CAS  PubMed  Google Scholar 

  7. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;21:791–799.

    Article  CAS  PubMed  Google Scholar 

  8. Coutts A, MacGregor A, Gibson J, Maffulli N. Clinical and functional results of open operative repair for Achilles tendon rupture in a non-specialist surgical unit. J R Coll Surg Edinb. 2002;47:753–762.

    CAS  PubMed  Google Scholar 

  9. Cretnik A, Kosanovic M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg. 2004;43:72–81.

    Article  PubMed  Google Scholar 

  10. Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med. 2005;33:1369–1379.

    Article  PubMed  Google Scholar 

  11. Cretnik A, Zlajpah L, Smrkolj V, Kosanovic M. The strength of percutaneous methods of repair of the Achilles tendon: a biomechanical study. Med Sci Sports Exerc. 2000;32:16–20.

    Article  CAS  PubMed  Google Scholar 

  12. Ebinesan AD, Sarai BS, Walley GD, Maffulli N. Conservative, open or percutaneous repair for acute rupture of the Achilles tendon. Disabil Rehabil. 2008;30:1721–1725.

    Article  PubMed  Google Scholar 

  13. Floridi A, Ippolito E, Postacchini F. Age-related changes in the metabolism of tendon cells. Connect Tissue Res. 1981;9:95–97.

    Article  CAS  PubMed  Google Scholar 

  14. Gillies H, Chalmers J. The management of fresh ruptures of the tendo achillis. J Bone Joint Surg Am. 1970;52:337–343.

    CAS  PubMed  Google Scholar 

  15. Haggmark T, Liedberg H, Eriksson E, Wredmark T. Calf muscle atrophy and muscle function after non-operative vs operative treatment of achilles tendon ruptures. Orthopedics. 1986;9:160–164.

    CAS  PubMed  Google Scholar 

  16. Hubbard RP, Soutas-Little RW. Mechanical properties of human tendon and their age dependence. J Biomech Eng. 1984;106:144–150.

    Article  CAS  PubMed  Google Scholar 

  17. Inglis AE, Scott WN, Sculco TP, Patterson AH. Ruptures of the tendo achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg Am. 1976;58:990–993.

    CAS  PubMed  Google Scholar 

  18. Jacobs D, Martens M, Van Audekercke R, Mulier JC, Mulier F. Comparison of conservative and operative treatment of Achilles tendon rupture. Am J Sports Med. 1978;6:107–111.

    Article  CAS  PubMed  Google Scholar 

  19. Jones PR, Pearson J. Anthropometric determination of leg fat and muscle plus bone volumes in young male and female adults. J Physiol. 1969;204:63–66.

    Google Scholar 

  20. Kader D, Deehan DJ, Maffulli N. What is the best treatment of subcutaneous rupture of the Achilles tendon? In: MacAuley D, Best TM, eds. Evidence-based Sports Medicine. 2nd ed. Malden, MA: Blackwell Publishing; 2007:562–585.

  21. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005;87:2202–2210.

    Article  PubMed  Google Scholar 

  22. Leppilahti J, Forsman K, Puranen J, Orava S. Outcome and prognostic factors of achilles rupture repair using a new scoring method. Clin Orthop Relat Res. 1998;346:152–161.

    Article  PubMed  Google Scholar 

  23. Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon–a prospective randomized controlled study. Foot Ankle Int. 2001;22:559–568.

    CAS  PubMed  Google Scholar 

  24. Longo UG, Ramamurthy C, Denaro V, Maffulli N. Minimally invasive stripping for chronic Achilles tendinopathy. Disabil Rehabil. 2008; 30:1709–1713.

    Article  PubMed  Google Scholar 

  25. Maffulli N. Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia. Int Orthop. 2005;29:134.

    Article  PubMed  Google Scholar 

  26. Maffulli N. Immediate weight-bearing is not detrimental to operatively or conservatively managed rupture of the Achilles tendon. Aust J Physiother. 2006;52:225.

    PubMed  Google Scholar 

  27. Maffulli N, Ajis A, Longo UG, Denaro V. Chronic rupture of tendo Achillis. Foot Ankle Clin. 2007;12:583–596, vi.

    Article  PubMed  Google Scholar 

  28. Maffulli N, Barrass V, Ewen SW. Light microscopic histology of achilles tendon ruptures. A comparison with unruptured tendons. Am J Sports Med. 2000;28:857–863.

    CAS  PubMed  Google Scholar 

  29. Maffulli N, Dymond NP, Regine R. Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med. 1990;11:78–84.

    Article  CAS  PubMed  Google Scholar 

  30. Maffulli N, Kenward MG, Irwin AS, Porter RW. Assessment of late results of surgery in talipes equino-varus: a reliability study. Eur J Pediatr. 1997;156:317–319.

    Article  CAS  PubMed  Google Scholar 

  31. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14:840–843.

    CAS  PubMed  Google Scholar 

  32. Maffulli N, Longo UG. Conservative management for tendinopathy: is there enough scientific evidence? Rheumatology (Oxford). 2008;47:390–391.

    Article  CAS  Google Scholar 

  33. Maffulli N, Longo UG, Gougoulias N, Denaro V. Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon. BMC Musculoskelet Disord. 2008;9:100.

    Article  PubMed  Google Scholar 

  34. Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med. 2003;31:692–700.

    PubMed  Google Scholar 

  35. Maffulli N, Tallon C, Wong J, Peng Lim K, Bleakney R. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness. 2003;43:367–379.

    CAS  PubMed  Google Scholar 

  36. Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9:157–160.

    CAS  PubMed  Google Scholar 

  37. McClelland D, Maffulli N. Percutaneous repair of ruptured Achilles tendon. J R Coll Surg Edinb. 2002;47:613–618.

    CAS  PubMed  Google Scholar 

  38. McClelland D, Maffulli N. Neglected rupture of the Achilles tendon: reconstruction with peroneus brevis tendon transfer. Surgeon. 2004;2:209–213.

    Article  CAS  PubMed  Google Scholar 

  39. Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, van der Werken C. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing–a randomized controlled trial. Am J Sports Med. 2008;36:1688–1694.

    Article  PubMed  Google Scholar 

  40. Miller D, Waterston S, Reaper J, Barrass V, Maffulli N. Conservative management, percutaneous or open repair of acute Achilles tendon rupture: a retrospective study. Scott Med J. 2005;50:160–165.

    CAS  PubMed  Google Scholar 

  41. Moller M, Lind K, Movin T, Karlsson J. Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment. Scand J Med Sci Sports. 2002;12:9–16.

    Article  CAS  PubMed  Google Scholar 

  42. Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br. 2001;83:843–848.

    Article  CAS  PubMed  Google Scholar 

  43. Mortensen HM, Skov O, Jensen PE. 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. 1999;81:983–990.

    CAS  PubMed  Google Scholar 

  44. Nakagawa Y, Hayashi K, Yamamoto N, Nagashima K. Age-related changes in biomechanical properties of the Achilles tendon in rabbits. Eur J Appl Physiol Occup Physiol. 1996;73:7–10.

    Article  CAS  PubMed  Google Scholar 

  45. Narici MV, Maffulli N, Maganaris CN. Ageing of human muscles and tendons. Disabil Rehabil. 2008;30:1548–1554.

    Article  PubMed  Google Scholar 

  46. Nestorson J, Movin T, Moller M, Karlsson J. Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years. Acta Orthop Scand. 2000;71:64–68.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  48. Nilsson-Helander K, Thomee R, Gravare-Silbernagel K, Thomee P, Faxen E, Eriksson BI, Karlsson J. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007;35:421–426.

    Article  PubMed  Google Scholar 

  49. Saxena A, Maffulli N, Nguyen A, Li A. Wound complications from surgeries pertaining to the Achilles tendon: an analysis of 219 surgeries. J Am Podiatr Med Assoc. 2008;98:95–101.

    PubMed  Google Scholar 

  50. Shadwick RE. Elastic energy storage in tendons: mechanical differences related to function and age. J Appl Physiol. 1990;68:1033–1040.

    Article  CAS  PubMed  Google Scholar 

  51. Shields CL Jr, Kerlan RK, Jobe FW, Carter VS, Lombardo SJ. The Cybex II evaluation of surgically repaired Achilles tendon ruptures. Am J Sports Med. 1978;6:369–372.

    Article  PubMed  Google Scholar 

  52. Strocchi R, De Pasquale V, Guizzardi S, Govoni P, Facchini A, Raspanti M, Girolami M, Giannini S. Human Achilles tendon: morphological and morphometric variations as a function of age. Foot Ankle. 1991;12:100–104.

    CAS  PubMed  Google Scholar 

  53. Sutherland A, Maffulli N. A modified technique of percutaneous repair of ruptured Achilles tendon. Oper Orthop Traumatol. 1998;10:50–58.

    Article  CAS  PubMed  Google Scholar 

  54. Vogel HG. Influence of maturation and aging on mechanical and biochemical properties of connective tissue in rats. Mech Ageing Dev. 1980;14:283–292.

    Article  CAS  PubMed  Google Scholar 

  55. Washburn SD, Caiozzo VJ, Wills CA, Hunt BJ, Prietto CA. Alterations in the in vivo torque-velocity relationship after Achilles tendon rupture. Further evidence of speed-specific impairment. Clin Orthop Relat Res. 1992;279:237–245.

    PubMed  Google Scholar 

  56. Waterston SW, Maffulli N, Ewen SW. Subcutaneous rupture of the Achilles tendon: basic science and some aspects of clinical practice. Br J Sports Med. 1997;31:285–298.

    Article  CAS  PubMed  Google Scholar 

  57. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of achilles tendon ruptures. Am J Sports Med. 2002;30:565–575.

    PubMed  Google Scholar 

  58. Worth N, Ghosh S, Maffulli N. Management of acute Achilles tendon ruptures in the United Kingdom. J Orthop Surg (Hong Kong). 2007;15:311–314.

    CAS  Google Scholar 

  59. Wredmark T, Carlstedt CA. Tendon elongation and muscle function after repair of Achilles tendon rupture. Scand J Med Sci Sports. 1992;2:139–142.

    Google Scholar 

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Acknowledgments

We thank Mrs. Gayle D. Walley for her help in performing the present study. We acknowledge the help of the British Orthopaedic Foot and Ankle Society in carrying out this work.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Keele University School of Medicine, Stoke on Trent, UK

    Nicola Maffulli MD, MS, PhD, FRCS(Orth) & Anil Khanna MRCS, MS(Orth)

  2. Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy

    Umile Giuseppe Longo MD & Vincenzo Denaro MD

  3. Department of Orthopaedics and Traumatology, University of Insubria Ospedale di Circolo, Varese, Italy

    Mario Ronga MD

  4. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England

    Nicola Maffulli MD, MS, PhD, FRCS(Orth)

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  1. Nicola Maffulli MD, MS, PhD, FRCS(Orth)
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  2. Umile Giuseppe Longo MD
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  3. Mario Ronga MD
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  4. Anil Khanna MRCS, MS(Orth)
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  5. Vincenzo Denaro MD
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Correspondence to Nicola Maffulli MD, MS, PhD, FRCS(Orth).

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

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Keele University School of Medicine, Staffs., England.

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Maffulli, N., Longo, U.G., Ronga, M. et al. Favorable Outcome of Percutaneous Repair of Achilles Tendon Ruptures in the Elderly. Clin Orthop Relat Res 468, 1039–1046 (2010). https://doi.org/10.1007/s11999-009-0944-1

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