Abstract
PurposeEvaluate the one-year postoperative outcomes in patients with Chronic Achilles tendon rupture.MethodsPatients surgically treated for Chronic Achilles tendon rupture (n = 22, 14 males and 8 females, mean age 61 ± 15) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf muscle endurance test, counter movement jump, Hopping, ultrasound measurement of tendon length, Achilles Tendon Resting Angle, dorsi flexion range of motion and calf muscle circumference. Muscle function and tendon length outcomes on the injured side were compared with the healthy side.ResultsThe patients scored a mean of 62 ± 26 on the Achilles tendon Total Rupture Score. Median scores on the injured compared with the healthy side were lower in heel-rise repetitions (20 vs 24 cm, p = 0.004), hel-rise height (8 vs 10 cm, p < 0.001), heel-rise total work (872 vs 1590 joule, p < 0.001) and hopping ratio (0.37 vs 0.48, p = 0.005). Median calf circumference was smaller (37 vs 38 cm, p = 0.001) and the mean tendon elongation greater on the injured side; Achilles tendon resting angle (55 vs 50°, p < 0.001) and ultrasound (22.4 vs 20.5 cm, p = 0.006).ConclusionsAt one year postoperatively, patients with chronic Achilles tendon rupture reported persistent limitations in subjective foot and ankle function. Heel-rise height and total work as well as hopping ratio were not recovered, and there was an elongation of the injured Achilles tendon compared with the healthy tendon.Level of evidence IV
Highlights
The majority of Achilles tendon ruptures (ATR) occur during intense sporting activities and are most common in middle-aged men [8, 10, 14]
ATR has become more common in individuals over 60 years of age, in whom the injury mechanism is usually associated with less force and previous Achilles tendinopathy [8,9,10, 17, 18]
The patients performed less well in the heel-rise test on the injured side compared with the healthy side (Table 3), with a median (IQR) of 20 (10) vs 24 (12) in heel-rise repetitions (p = 0.004), 8 (7) vs 10 (8) cm in heel-rise height (p < 0.001), 872 (1740) vs 1590 (2145) joule in total heelrise work (p = 0.001) and 0.37 vs 0.48 in hopping ratio (p = 0.005)
Summary
The majority of Achilles tendon ruptures (ATR) occur during intense sporting activities and are most common in middle-aged men [8, 10, 14]. ATR has become more common in individuals over 60 years of age, in whom the injury mechanism is usually associated with less force and previous Achilles tendinopathy [8,9,10, 17, 18]. An atypical patient history and clinical presentation makes the assessment more difficult and may result in the ATR being mistaken for another diagnosis, typically a tendinopathy, ankle sprain or calf muscle tear [2, 9]. If the rupture occurs spontaneously during daily activities or in conjunction with minor trauma, the patient may not understand the extent of the injury and may wait to seek treatment as swelling and probably pain decrease [21]
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