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Scientific Articles   |    
Acute Achilles Tendon RuptureA Questionnaire Follow-up of 487 Patients
Dan Bergkvist, MD1; Ingrid Åström, PT, MSc2; Per-Olof Josefsson, MD, PhD1; Leif E. Dahlberg, MD, PhD1
1 Department of Orthopaedics, Malmö University Hospital, Lund University, Södra Förstadsgatan 101, 20502 Malmö, Sweden. Email address for D. Bergkvist: dan.bergkvist@glocalnet.net. E-mail address for P. Josefsson: perolof.josefsson@skane.se. E-mail address for L.E. Dahlberg: leif.dahlberg@med.lu.se
2 Department of Orthopaedics, Lund University Hospital, Getingevägen 4, 221 85 Lund, Sweden. E-mail address: ingrid.astrom@me.com
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Department of Orthopaedics, Malmö University Hospital, Lund University, Södra Förstadsgatan 101, 20502 Malmö, Sweden. Email address for D. Bergkvist: dan.bergkvist@glocalnet.net. E-mail address for P. Josefsson: perolof.josefsson@skane.se. E-mail address for L.E. Dahlberg: leif.dahlberg@med.lu.se
Department of Orthopaedics, Lund University Hospital, Getingevägen 4, 221 85 Lund, Sweden. E-mail address: ingrid.astrom@me.com
Investigation performed at the Department of Orthopaedics, Malmö University Hospital, Lund University, Malmö, Sweden, and the Department of Orthopaedics, Lund University Hospital, Lund, Sweden

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 03;94(13):1229-1233. doi: 10.2106/JBJS.J.01601
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Abstract

Background: 

The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex.

Methods: 

The records of all 487 patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas nonoperative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and nonsurgical treatment were compared on the basis of patient age and sex.

Results: 

The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury.

Conclusions: 

The good Achilles Tendon Total Rupture Score in the nonsurgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes this treatment a preferable option for most patients. However, the tendency for a lower re-rupture rate and better performance on the heel-raise test in surgically treated patients suggest surgery may be beneficial in selected patients.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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