Time to Surgery is an Important Factor for Acute Achilles Tendon Repair

Abstract

Category: Ankle; Trauma Introduction/Purpose: Achilles tendon ruptures are a common ankle injury, predominantly affecting young, active, and athletic populations. Surgical repair is often favored in healthy and active individuals due to decreased re-rupture rates. Both open and minimally invasive percutaneous techniques have been described with excellent outcomes and reduced rates of re-rupture compared to non-surgical treatment. However, little research has focused on the impact of time-to-surgery on complications, re- rupture rates, and patient reported outcomes (PROs). The purpose of this study was to investigate outcomes following Achilles repair with respect to time-to-surgery and surgical technique. Outcomes were established both clinically and functionally, as indicated by complication rates and patient-reported outcomes, respectively. Methods: Patient records from a single institution were retrospectively reviewed from October 2016 to March 2022. Patients with an acute Achilles tendon rupture surgically treated within 6 weeks from injury and a minimum follow up of 3 months ± 14 days were eligible for inclusion. Injury and surgical variables included mechanism of injury, rupture grade and location, time-to- surgery, surgical technique, and operative time. Postoperative complications included deep vein thrombosis (DVT), major and minor wound complication, re-rupture, sural nerve injury, and postoperative neuropathic pain. PROs included PROMIS Physical Function CAT (PF), Pain Interference CAT, and Foot and Ankle SANE. Patients were stratified based both by operative technique and time-to-surgery (0-6 days, 7-13 days, and 14-42 days). Categorical variables were compared using Fischer exact tests, while numerical variables were evaluated using an unpaired t-test and ANOVA, depending on the number of groups compared. Results: 327 patients (79% male, mean age 40.4) were included. PRO data was available for 154 (47%). Average clinical and PRO follow-up was 155 days and 575 days, respectively. 149 were treated open, while 178 were percutaneously repaired. No significant differences were observed in complications between treatment groups; however, percutaneous repairs recorded shorter operative times (55.3 vs 65.8 minutes, p< 0.001). Stratifying by timepoints, follow-up physical function scores were significantly higher in patients repaired within 0-6 days (p < 0.05, Figure). There were 11 re-ruptures (3.3%), with 10/11 occurring within 3 months of surgery. Most re-ruptures were attributed to falls (4) and non-compliance (3), while 4 occurred following prescribed protocols. When stratified by time-to-surgery, the fewest re-ruptures (0) were observed for repairs performed 7-13 days following rupture. Conclusion: While no significant differences were observed in PROs or complications rates between open and percutaneous groups, our data suggests that time-to-surgery may play an important role in long-term patient reported physical function. Stratified by surgical timing, we also found significantly lower rates of re-rupture when surgical intervention occurred 7-13 days following injury. However, nearly all re-ruptures occurred within 3-months, with most occurring following postoperative falls or documented patient non-compliance with immobilization or protected weight-bearing instructions. The significance of surgical timing and re-rupture rates therefore requires additional investigation given the low failure rates and mechanisms of re-rupture.