Repair Of Achilles Tendon Rupture Research Articles

Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study.

In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level III, retrospective cohort study.

Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials.

Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture. Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85, Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87. A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26-4.17; I2=44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76-7.27; I2=51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91-9.99; I2=0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96-5.43; I2=20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00-7.73; I2= 64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11-3.59; I2=21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12-3.90; I2=0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76-6.89; I2=33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25-4.03; I2=22.09%). This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.

Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair.

The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. Level Ⅲ.

The Influence of Patient Characteristics and Social Determinants of Health on Postoperative Complications Following Achilles Tendon Rupture.

The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair. A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables (P < .05) were included in a multivariate regression. Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P = .03) and VTE (OR = 0.32, P = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P < .01) and shorter TTS with reruptures (OR = 0.02, P = .02). Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications. Level IV, case series.

Fabrication of atelocollagen-coated bioabsorbable suture and the evaluation of its regenerative efficacy in Achilles tendon healing using a rat experimental model

Recently, the incidence of Achilles tendon ruptures (ATRs) has become more common, and repair surgery using a bioabsorbable suture is generally preferred, particularly in the case of healthy patients. Sutures composed of poly(lactic-co-glycolic acid) (PLGA) are commonly used in ATR surgeries. Nevertheless, owing to the inherent limitations of PLGA, novel bioabsorbable sutures that can accelerate Achilles tendon healing are sought. Recently, several studies have demonstrated the beneficial effects of atelocollagen on tendon healing. In this study, poly(3,4-dihydroxy-L-phenylalanine) (pDOPA), a hydrophilic biomimetic material, was used to modify the hydrophobic surface of a PLGA suture (Vicryl, VC) for the stable coating of atelocollagen on its surface. The main objective was to fabricate an atelocollagen-coated VC suture and evaluate its performance in the healing of Achilles tendon using a rat model of open repair for ATR. Structural analyses of the surface-modified suture indicated that the collagen was successfully coated on the VC/pDOPA suture. Postoperative in vivo biomechanical analysis, histological evaluation, ultrastructural/morphological analyses, and western blotting confirmed that the tendons in the VC/pDOPA/Col group exhibit superior healing than those in the VC and VC/pDOPA groups after 1 and 6 weeks following the surgery. The this study suggests that atelocollagen-coated PLGA/pDOPA sutures are preferable for future medical applications, especially in the repair of ATR.

Commentary on: Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials.

Commentary on: Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials.

All-inside endoscopic semiautomatic running locked stitch technique shows favourable outcomes for acute Achilles tendon ruptures.

The safety and reliability of endoscopic Achilles tendon rupture repair are still concerning aspects. This study's aim is to evaluate an all-inside endoscopic semiautomatic running locked stitch (Endo-SARLS) technique. Forty cases with acute Achilles tendon rupture were treated with the all-inside Endo-SARLS technique between 2020 and 2021. Under endoscopic control, the proximal tendon stumps were stitched with the running locked method using a semiautomatic flexible suture passer. The threads of the high-strength suture were grasped through the paratenon subspace and then fixed into calcaneal insertion with a knotless anchor. Magnetic resonance imaging (MRI), surgical timeand complications were assessed. Achilles Tendon Total Rupture Score (ATRS), Achilles Tendon Resting Angle (ATRA)and Heel Rise Height Scale (HRHS) were utilised to evaluate final outcomes. The average follow-up time was 25.4 ± 0.4 (range: 24-32) months. Appropriate tendon regeneration was observed on MRI after 12 months. At the final follow-up, the median value of ATRS score was 95 (interquartile range: 94, 98). Furthermore, there is no significant difference between the injured and contralateral side in the average ATRA (18.2 ± 1.8 vs. 18.3 ± 1.9°, ns) and median value of HRHS [14.5 (13.3, 15.5) vs. 14.8 (13.5, 15.6) cm, ns]. No infection and nerve injuries were encountered. Thirty-ninepatients reported that they resumed casual sports activity after 6 months. One patient had a slight anchor cut-out, due to an addition injury, which was removed after 5 months. An all-inside Endo-SARLS technique showed promising clinical results for acute Achilles tendon ruptures. This procedure reduces the risk of sural nerve injuries while establishing a reliable connection between the tendon stumps. Level IV.

No difference in operative time, outcomes, cosmesis, or return to activity and/or sport after minimally invasive versus open repair of primary Achilles ruptures: a retrospective review.

To compare clinical outcomes and the rate of return to sport among patients that have undergone minimally invasive repair versus open approach of an acute Achilles tendon rupture. Patients who underwent surgical repair of acute Achilles tendon rupture at a single urban academic institution from 2017 to 2020 with minimum 2-year follow-up were reviewed retrospectively. Preinjury sport participation and preinjury work activity information, the Achilles tendon Total Rupture Score (ATRS), the Tegner Activity Scale, Patient-Reported Outcomes Measurement Information System for mobility and pain interference were collected. In total, 144 patients were initially included in the study. Of these, 63 patients were followed with a mean follow-up of 45.3 ± 29.2months. The mean operative time did not significantly differ between groups (p = 0.938). Patients who underwent minimally invasive repair returned to sport at a rate of 88.9% at a mean of 10.6 ± 5.8months, compared to return rate of open procedures of 83.7% at 9.5 ± 5.5months. There were no significant differences in ATRS (p = 0.246), Tegner (p = 0.137) or VAS pain (p = 0.317) scores between groups. There was no difference in cosmetic satisfaction between PARS and open repair groups (88.4 vs. 76.0; p = 0.244). Patients who underwent minimally invasive repair of acute Achilles tendon ruptures demonstrate no significant differences with respect to cosmesis, operative time, patient-reported outcomes and the rate and level of return to activities when compared to an open approach. III.

Primary Repair of Achilles Tendon Rupture Using a Mini-incision: A Novel Technique

The use of minimally invasive techniques in the treatment of primary Achilles rupture has become more popular in the past few decades as they have been associated with a lower wound complication rate. Most of the techniques demand the use of procedure-specific instruments and are designed mainly for midsubstance lesions. This article aims to present a novel technique for Achilles tendon repair that can be used for both insertional and midsubstance ruptures, using a mini-incision and with no special instruments required. Level of Evidence: Diagnostic Level V.

Long-term results and complication following Achilles tendon rupture repair

Introduction Currently,there is no consensus regarding optimal treatment options of Achilles tendon rupture. The purpose of this study was to evaluate long term results of Achilles tendon repair using different surgical techniques, assess complication rate and subjective satisfactionMethods The study included patients treated for Achilles tendon rupture using minimally invasive and open surgical repair. Complications including re-rupture, infection, deep vein thrombosis and neuropraxia were identified. In order to evaluate the factors influencing the risk of postoperative complications, logistic regression analysis was performed. The Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Score (AOFAS) evaluated subjective outcomes.Results 130 patients with Achilles tendon tear were enrolled (123 primary and 7 revision cases). In primary repairs percutaneous technique was used in 60 % of cases (74/123), mini open technique – in 16 % (19/123), and open technique – in 24 % (30/123). Re-rupture occurred in 2.4 % of patients treated with minimally invasive techniques. There were no repeated ruptures following open repairs. Predominant number of infections was registered after open repairs and made 10 %, while minimally invasive techniques had 3.2 % of infections. Logistic regression analyses showed that steroid injection, open repair, application of tapes and autografts increased the risk of infectious complications. There were no significant differences in ATRS and AOFAS scores between different primary Achilles tendon repair techniques (p &gt; 0.05).Discussion Results, obtained in the current study, are consistent with previously published data.Conclusions Open Achilles tendon repair showed a higher rate of infections, and lower rate of re-ruptures. The anamnesis of steroid injection, open repair, application of tapes and autografts increases the risk of infectious complications.

Comparison of percutaneous and open repair of Achilles tendon rupture: results and complications from a single institution

BackgroundThe Achilles tendon is the strongest tendon in the human body, but it is prone to injury, especially in modern times when recreational sports are growing in popularity. As a result, Achilles tendon rupture is becoming an increasingly common medical problem in modern society. The main objective of this study was to compare the outcomes of percutaneous repair and open repair for the treatment of Achilles tendon rupture.MethodsA retrospective study was conducted involving a total of 316 patients who had undergone surgical treatment for Achilles tendon rupture between 2013 and 2021. The data collected from the medical history of these patients included the type of surgical procedure, the mechanism of injury, the age and sex of the patients, the time spent in the hospital, and any possible complications of the surgical treatment (such as infections, reruptures, or sural nerve injuries).ResultsThe study revealed that there was no significant difference between percutaneous and open surgical approaches in terms of sural nerve injury. However, there was a statistically significant advantage of the percutaneous method in terms of the number of infections, which was significantly lower than that of the open method. Additionally, the median length of hospital stay was found to be four days longer with the open approach. However, the study noted that a statistically significant advantage of the percutaneous method for rerupture could not be established due to the small number of patients with rerupture and the insufficient ratio of patients with rerupture in relation to the size of the observed population.ConclusionsPercutaneous repair is an effective treatment option for Achilles tendon rupture and has outcomes equal to or better than those of open repair. Therefore, this approach is recommended as the preferred method of treatment due to the presence of fewer complications, provided that the indications for this technique are appropriate.

Traditional Open Repair and Reconstruction of Achilles Tendon Rupture

Despite the development of minimally invasive techniques and more effective nonoperative functional rehabilitation protocols, traditional open approaches remain viable options for both acute and chronic Achilles tendon rupture repair and reconstruction. Here, techniques for open Achilles tendon repair and reconstruction are discussed, along with outcomes, possible complications, and brief comparisons to other management options.Level of Evidence:Level V.

Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study

Background: A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery. Purpose: To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time. Results: Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001). Conclusion: Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.

Early Tendon Morphology as a Biomarker of Long-term Patient Outcomes After Surgical Repair of Achilles Tendon Rupture: A Prospective Cohort Study

Background: Patient outcome after acute Achilles tendon rupture (ATR) varies and is difficult to predict. Whether early variations in healing, visualized with ultrasonography, can predict long-term patient outcome is unclear. Purpose: To (1) examine the associations of Achilles tendon cross-sectional area (CSA) and elongation (TE) during healing of ATR repair with patient outcomes at 12 months postoperatively and (2) investigate the predictive or diagnostic capacity of the morphological biomarkers. Study Design: Cohort study; Level of evidence, 2. Methods: This study was based on previously collected data from 86 patients who underwent acute standardized ATR repair between 2013 and 2018 and who were included in a prior randomized trial investigating early functional mobilization (EFM). In the EFM group, loading was allowed immediately after surgery, while in the comparison group, loading was allowed first at 2 weeks postoperatively. Achilles tendon CSA and length were measured with ultrasound at 6 weeks, 6 months, and 12 months postoperatively. CSA ratio and absolute difference in the length of the healthy and injured tendons were calculated. Patient-reported outcome was registered with the validated Achilles tendon Total Rupture Score and functional outcome with the heel-rise endurance test at 12 months postoperatively. The limb symmetry index (LSI) was calculated for maximum heel-rise height (HRHmax) and total concentric work. Multiple linear regression adjusted for age was used, and the area under the receiver operating characteristic curve (AUC) was calculated to evaluate predictive capacity. Results: A larger CSA ratio at 6 weeks was associated with higher LSI HRHmax at 12 months ( R2, 0.35; P &lt; .001) and exhibited good predictive capacity (AUC, 0.82). More TE at 12 months was associated with lower LSI total concentric work at 12 months ( R2, 0.21; P = .001) and exhibited acceptable predictive capacity (AUC, 0.71). Conclusion: Greater Achilles tendon CSA seen on ultrasound 6 weeks after surgical repair had good clinical prediction for long-term functional outcome. TE at 12 months was predictive of inferior functional outcome. Registration: NCT02318472 (ClinicalTrials.gov identifier).

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study

PurposePrevious studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function. MethodsIn this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference. ResultsAOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = −17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = −8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period. ConclusionAchilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.

The Association Between Distressed Community Index and Clinical Outcomes Following Surgical Repair of Acute Achilles Tendon Rupture

Category: Ankle; Other Introduction/Purpose: Operative management of acute Achilles tendon ruptures can be associated with a myriad of complications1,2. Demographics and comorbidities have been previously explored in relation to outcomes after operative management of Achilles tendon ruptures3,4. However, the relationship between socioeconomic factors and postoperative outcomes in these patients has not been explored. Distressed community index (DCI) is a score that represents a community’s level of well-being across the United States, with higher scores representing greater distress experienced in the community. Independent socioeconomic deprivation factors have been shown to be associated with suboptimal postoperative outcomes for patients undergoing certain orthopedic surgeries6–9. The purpose of this study is to determine if there is any association between DCI scores and short-term complication rates and functional outcomes following ruptured Achilles tendon repair. Methods: Patients who underwent surgical repair of ruptured Achilles tendon between 2015 and 2019 were identified. Patients’ residence zip codes were obtained and matched to corresponding DCI scores (0-100) based on data provided by the Economic Innovation Group for the same time period (2015-2019). Scores were divided into quintiles. Patient age, race, ethnicity, alcohol and smoking history, need for assistance with activities of daily living, ambulation status unrelated to injury, and access to transportation were also noted. Complications such as re-rupture, superficial or deep infection, wound complications, and deep vein thrombosis within 1-year since date of surgery were noted. Preoperative Foot and Ankle Ability Measure and Visual Analogy Pain scales were compared to postoperative scores at 6 months, 1 year, and 2 years. Analysis of variance (ANOVA) was used to determine the statistical significance of differences in the rate of complications and FAAM-VAS scores between quintiles. Results: Patients in the 2nd DCI quintile experienced the highest rate (9.25%) of total complications while patients in the 5th quintile experienced the lowest rate (3.33%). Difference in complication rates across DCI quintiles was not statistically significant (p=0.925). Out of the 17 patients who experienced complications, 12 (70.6%) patients belonged to the 1st and 2nd quintile while 2 patients (11.7%) belonged to the 4th and 5th quintiles. The differences in FAAM and VAS pain scores were not significantly different at preoperative and at 1-year and 2-year postoperative time points across quintiles. However, patients in the 5th and 4th quintiles experienced the greatest improvement in FAAM Overall scores at 1-year and 2-year postoperative time points, respectively. Conclusion: Patients living in more distressed communities did not experience greater postoperative complication rates or report lower patient-reported outcomes up to 2 years following operative repair of Achilles tendon rupture.

Postoperative Rehabilitation Protocols May Affect Rates of Achilles Tendon Re-Rupture after Acute Surgical Repair: A Systematic Review

Category: Ankle; Hindfoot Introduction/Purpose: Acute achilles tendon ruptures (AATR) are the most common tendon rupture in the lower limb with an incidence of up to 37 patients per 100,000 patient population annually. Several different guidelines exist on time to full weight bearing after AATR repair. Advantages of surgical management of AATR repairs are to maximize function of the tendon and reduce post-operative complications such as re-ruptures. A systematic review of the literature was performed which evaluated post-operative rehabilitation protocols, their complications and if an optimal post-operative treatment algorithm can be determined. Methods: In October 2022, MEDLINE, EMBASE and Cochrane Library databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence (LOE) and quality of evidence (QOE) were evaluated, and statistics on clinical outcomes, post-operative management and complications were calculated. Results: Eleven studies with 437 patients were included. Two studies were LOE I, three were LOE II, three were LOE III and three studies were LOE IV. Mean post-operative follow-up was 33.4 ± 31.2 months. Weighted mean post-operative return to full-weight bearing (FWB) was 4.8 ± 6.4 weeks. Post-operative return to neutral ankle position was achieved at an average of 4.6 ± 3.9 weeks. The overall complication rate was 3.0% (16 of 420 patients) with surgical wound infection (1.9%) and re-rupture (1.2%) the most common. Seven studies described an early rehabilitation protocol that commenced within 4 weeks from surgery. Subgroup analysis showed that early full weight-bearing (≤4 weeks) was associated with a higher re-rupture rate: 1.5% versus 0.7%. Conclusion: This systematic review demonstrated marked heterogenicity in reported rehabilitation protocols after AATR repair. While the risk of re-ruptures after surgical repair are low, we found that rehabilitation protocols that incorporate early weight- bearing within 4 weeks have a markedly increased risk of re-rupture. While there is increasing use of early rehabilitation after surgical repair of achilles tendon ruptures, further study is required to determine the optimal protocol to optimise outcome while decreasing the risk of failure.

Biomechanical Comparison of Open vs Percutaneous Techniques for Primary Mid-Substance Achilles Tendon Repair: A Systematic Review and Meta-Analysis

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

Absorbable vs Nonabsorbable Sutures for Achilles Tendon Repair: A Systematic Review and Meta-analysis.

Nonabsorbable sutures are still the main choice for acute Achilles tendon rupture (AATR) repair due to strength provided. However, the rerupture rates, infection risks, foreign body reaction, and postsurgical recovery differences between absorbable and nonabsorbable suture materials in AATR repair have not been carefully reviewed. A systematic review was done on PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Embase to find research studies in relation to complications associated with AATR repair using the PRISMA guidelines. The risk of bias from each study included will be assessed using the Cochrane Risk of Bias Tool for randomized study (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) for nonrandomized study. Five studies with a total of 255 patients, 105 in the absorbable suture group and 150 in the nonabsorbable suture group, were included for analysis. Risk of rerupture, infection, and foreign body reaction shown no significant difference between groups, and the mean difference of recovery scores were similar. Existing literature shows that absorbable sutures appear to be associated with similar outcomes to nonabsorbable sutures regarding rates of rerupture, infection, foreign body reaction, and outcomes grading following surgical repair of acute Achilles tendon repair.

The Influence of Patient Characteristics and Social Determinants of Health on Post-Operative Complications Following Achilles Tendon Ruptures

Category: Sports; Hindfoot Introduction/Purpose: While patient comorbidities are known to affect surgical complication rates after Achilles tendon rupture (ATR) repair, the correlation between social determinants of health (SDH) and postoperative complication rates is poorly understood. Two validated indices representative of SDH include the Area Deprivation Index (ADI), which ranks neighborhoods by social disadvantage, and the Social Vulnerability Index (SVI), which uses 16 US census variables to identify communities at risk before or after natural disasters. In this study, we aim to determine whether there is any correlation between patient demographics, SDH, and postoperative complication rates following surgical treatment of ATR. Methods: A retrospective chart review identified 521 patients who underwent surgical repair of an acute ATR between 2015 and 2021. Inclusion criteria included age ≥ 18 years, a minimum 30 day follow up, and patients who underwent acute repair within 28 days of ATR. Collected variables included patient demographics, time to surgery (TTS), injury characteristics, and postoperative complications sub-categorized into venous thromboembolism (VTE), re-rupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included age, race, smoking status, insurance status, level of education, and employment status. The ADI and SVI measurements of patient deprivation or vulnerability were also extracted from the data. A univariate regression test was performed to determine the correlation between each complication and each SDH indicator. Variables that showed significance (p &lt; 0.05) were then included in a multivariate regression to determine the correlation coefficients and significance. Results: Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed higher ADI was associated with VTE occurrence (OR = 0.39, 95% CI: 0.16 –0.91, p = 0.03). Female patients and open surgical approach correlated with decreased VTE occurrence (OR = 0.24, 95% CI: 0.09 – 0.66, p&lt; 0.01), (OR = 0.15, 95% CI: 0.04 – 0.55, p&lt; 0.01), respectively. Higher BMI was associated with VTE (OR = 1.62, 95% CI: 1.05 – 2.51, p=0.03) and re-rupture (OR = 3.86, 95% CI: 1.51 – 9.08, p&lt; 0.01). Women experienced decreased wound dehiscence rates (OR = 0.25, 95% CI: 0.09 – 0.69, p&lt; 0.01) and SSI (OR = 0.31, 95% CI: 0.11 – 0.93, p=0.04) compared to men. TTS correlated with sural nerve injuries (OR=2.09, 95% CI: 1.32 – 3.31, p&lt; 0.01). Conclusion: This study found that SDH, such as ADI, impacts complication rates after ATR repair, though the nature of this relationship remains unclear. Patient demographic and anthropometric factors such as gender and BMI also have an impact. Future studies should include a larger, more diverse sample population to better understand the impact of these factors on surgical outcomes.