Chronic Achilles tendon rupture - surgical reconstruction and post-operative outcomes

Link directly to the doctoral thesis GUPEA

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Surgical reconstruction and post-operative outcomes
Achilles tendon ruptures are common, and the incidence is increasing. Despite that medical history and clinical examinations are considered to be sufficient in establishing the diagnosis, several Achilles tendon ruptures are being missed with a potentially delayed treatment. The combination of a delayed treatment by more than 4 weeks, and symptoms like long-term pain and an affected gait-pattern, classifies the Achilles tendon rupture as chronic. The purpose of this thesis was to examine the outcome of chronic Achilles tendon ruptures in terms of long-term functional outcomes, patient-reported outcomes, biomolecular changes, and the economic healthcare costs.

Chronic Achilles tendon ruptures were found to have generally good functional and patient-reported outcomes to a reasonable cost. An endoscopically-assisted reconstruction with a semitendinosus graft produced satisfactory results when compared to previous techniques. There is still a lack of knowledge on how patients are affected by chronic Achilles tendon ruptures and how to optimize the treatment in the future. Larger cohorts with matched controls are needed to fully understand these ruptures and the impairments they imply.

- It is important that all patients who seek care with symptoms from the ankle and lower leg undergo a proper clinical examination of their Achilles tendon. In some studies, it has been seen that as many as 15-20 percent of all tendon ruptures are missed and initially mistreated. One such examination is Thompson's test where the examiner squeezes the patient's calf to see if the Achilles tendon is severed or possibly extended (Figure 1 below), Niklas Nilsson says.

Figure 1: The calf squeeze test (Thompson’s test) is performed with the patient lying in a prone position on the examination couch. If a calf squeeze induces plantar flexion of the foot, as seen in the picture, the test is considered negative with a likely continuous tendon. From figure 6 page 34 in thesis.