Abstract
PurposeThis 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.MethodsRepair 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.ResultsNine 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.ConclusionsPatients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair.Level of evidenceIII.
Highlights
Late presentation and diagnosis of Achilles tendon ruptures occurs in as many as 1 in 5 patients, with symptomatic patients reporting an abnormal gait with an inability to push off and persistent weakness [17, 21]
This study aimed to evaluate the recovery of symptoms/ disability and functional outcome of patients after Achilles tendon repair, with minimally invasive surgery including peripheral circumferential running suture, in patients with delayed presentation compared with patients treated acutely post rupture
Patients were included in the delayed presentation group if they presented after 14 days following injury and had received no treatment during this time period
Summary
Late presentation and diagnosis of Achilles tendon ruptures occurs in as many as 1 in 5 patients, with symptomatic patients reporting an abnormal gait with an inability to push off and persistent weakness [17, 21]. This may be due to a lack of appreciation of the injury or an inaccurate history resulting in delayed diagnosis. Once the diagnosis of Achilles tendon rupture is made, the aim of initial treatment is to appose tendon ends. In the context of delayed treatment, there is concern for poor long-term prognosis if apposition of the ruptured tendon ends has not been achieved
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