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No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture.

Journal article
Authors Michael R Carmont
Jennifer A Zellers
Annelie Brorsson
Karin Grävare Silbernagel
Jon Karlsson
Katarina Nilsson-Helander
Published in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN 1433-7347
Publication year 2018
Published at Institute of Clinical Sciences, Department of Orthopaedics
Language en
Links dx.doi.org/10.1007/s00167-018-5340-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Orthopedics

Abstract

This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients.Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation.Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: - 6.9° (5.5), acute: - 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury.Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair.III.

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