Abstract
Purpose
The purpose of this prospective randomized controlled study was to evaluate the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically. The focus was to evaluate whether any improvements occurred between the one and 2-year evaluation.
Method
Eighty-one patients (67 men, 14 women) with a mean (SD) age of 42 (9.1) were included in this study. Forty-two patients were treated surgically, and 39 treated non-surgically otherwise the treatment was identical for the two groups. All patients were evaluated using the Achilles tendon Total Rupture Score (ATRS), the Physical Activity Scale (PAS) and validated functional tests one and 2 years after injury.
Results
There were significant functional deficits on the injured side compared with the contralateral side 2 years after Achilles tendon rupture, regardless of treatment. Only minor improvements, even though statistically significant, occurred between the 1- and 2-year evaluations. The physical activity level remained significantly reduced as compared with prior to injury, but the ATRS mean was relatively high in both groups (89 and 90).
Conclusion
This long-term follow-up indicates that the majority of patients with an Achilles tendon rupture have not fully recovered (in regards to symptoms, physical activity level and function) 2 years after injury regardless of surgical or non-surgical treatment. Furthermore, only minor improvements occur between the 1- and 2-year evaluations. This indicates that to enhance the final outcome the focus should be on improvements in treatment within the first year. The patients appear to have adjusted to their impairments since the patient-reported outcome is relatively high in spite of functional deficits and lower activity level compared with pre-injury.
Level of evidence
Prospective randomized study, Level I.
Similar content being viewed by others
References
Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W (1990) Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res 255:204–214
Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, Sprague S, Schemitsch EH (2002) Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res 400:190–200
Bostick GP, Jomha NM, Suchak AA, Beaupre LA (2010) Factors associated with calf muscle endurance recovery 1 year after achilles tendon rupture repair. J Orthop Sports Phys Ther 40(6):345–351
Fitzgerald GK, Axe MJ, Snyder-Mackler L (2000) A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 8(2):76–82
Grimby G (1986) Physical activity and muscle training in the elderly. Acta Med Scand Suppl 711:233–237
Gustavsson A, Neeter C, Thomee P, Gravare Silbernagel K, Augustsson J, Thomee R, Karlsson J (2006) A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14(8):778–788
Kangas J, Pajala A, Ohtonen P, Leppilahti J (2007) Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med 35(1):59–64
Kangas J, Pajala A, Siira P, Hamalainen M, Leppilahti J (2003) Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 54(6):1171–1180
Kerkhoffs GM, Struijs PA, Raaymakers EL, Marti RK (2002) Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 122(2):102–105
Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87(10):2202–2210
Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ (2002) Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med 30(6):783–790
Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R (2003) Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med 31(5):692–700
Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, van der Werken C (2008) Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing–a randomized controlled trial. Am J Sports Med 36(9):1688–1694
Mizner RL, Petterson SC, Clements KE, Zeni JA, Jr., Irrgang JJ, Snyder-Mackler L (2010) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments a longitudinal analysis of outcomes. J Arthroplasty, PMCID 3008304
Moller M, Lind K, Movin T, Karlsson J (2002) Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment. Scand J Med Sci Sports 12(1):9–16
Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–848
Mortensen HM, Skov O, Jensen PE (1999) Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg Am 81(7):983–990
Mortensen NH, Saether J, Steinke MS, Staehr H, Mikkelsen SS (1992) Separation of tendon ends after Achilles tendon repair: a prospective, randomized, multicenter study. Orthopedics 15(8):899–903
Möller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J (2001) Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–848
Neumayer F, Mouhsine E, Arlettaz Y, Gremion G, Wettstein M, Crevoisier X (2009) A new conservative-dynamic treatment for the acute ruptured Achilles tendon. Arch Orthop Trauma Surg 130(3):363–368
Nilsson-Helander K (2008) A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 16(6):614–620
Nilsson-Helander K, Silbernagel KG, Thomee R, Faxen E, Olsson N, Eriksson BI, Karlsson J (2010) Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38(11):2186–2193
Nilsson-Helander K, Thomee R, Gravare-Silbernagel K, Thomee P, Faxen E, Eriksson BI, Karlsson J (2007) The Achilles tendon total rupture score (ATRS): development and validation. Am J Sports Med 35(3):421–426
Nistor L (1981) Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg Am 63(3):394–399
Nystrom B, Holmlund D (1983) Separation of tendon ends after suture of achilles tendon. Acta Orthop Scand 54(4):620–621
Parent E, Moffet H (2002) Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil 83(1):70–80
Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 38(6):1104–1115
Schepull T, Kvist J, Andersson C, Aspenberg P (2007) Mechanical properties during healing of Achilles tendon ruptures to predict final outcome: a pilot Roentgen stereophotogrammetric analysis in 10 patients. BMC Musculoskelet Disord 8:116
Silbernagel KG, Gustavsson A, Thomee R, Karlsson J (2006) Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 14(11):1207–1217
Silbernagel KG, Nilsson-Helander K, Thomee R, Eriksson BI, Karlsson J (2010) A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 18(2):258–264
Suchak AA, Bostick GP, Beaupre LA, Durand DC, Jomha NM (2008) The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am 90(9):1876–1883
Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med 35(12):2033–2038
Weber M, Niemann M, Lanz R, Muller T (2003) Nonoperative treatment of acute rupture of the achilles tendon: results of a new protocol and comparison with operative treatment. Am J Sports Med 31(5):685–691
Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92(17):2767–2775
Wong J, Barrass V, Maffulli N (2002) Quantitative review of operative and nonoperative management of achilles tendon ruptures. Am J Sports Med 30(4):565–575
Acknowledgments
The authors thank Lotta Falkheden-Henning and Annelie Brorsson for their help treating and evaluating the patients. We would also thank Toran MacLeod for manuscript review. This study was supported by the Swedish National Centre for Research and Sports (CIF).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Olsson, N., Nilsson-Helander, K., Karlsson, J. et al. Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19, 1385–1393 (2011). https://doi.org/10.1007/s00167-011-1511-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-011-1511-3