Achilles Tendon Rupture Kristoff Reid MD Assistant Professor

Achilles Tendon Rupture Kristoff Reid, MD Assistant Professor, MUSC

Introduction and Disclaimer CPG published 2009 Latest comprehensive review – JAAOS 2017, Kadakia Et al. › Generally similar conclusions. › Updates highlighted

Clinical Examination 1/4 – Consensus • Physical exam should be performed • 2 or more of: › Thompson test (Simmonds squeeze) › Decreased plantarflexion strength › Presence of palpable gap › Increased dorsiflexion with gentle manipulation

Imaging 0/4 – Inconclusive • No studies of MRI or Radiographs • Two level V studies for ultrasound (unreliable data)

Nonoperative management 2/4 – Limited evidence (in comparison trials) • • Functional outcomes positive in 1/2 Improved return to activity/sport in 1/3 1/4 showed improvement in rerupture rate Higher complication rates in operative group

Functional bracing Inconclusive Two studies. Only outcome analyzable was rerupture rate – inconclusive Update: Multiple functional bracing studies. Benefits to rerupture rates vs immobilization Overall similar outcomes to surgery with lower complications Possible diminished plantarflexion and time to activity

Operative Treatment 2/4 – Limited evidence (not comparison studies) • • 8 studies for open 6 studies for MIS 73 -100% return to activity at 6 months 92% pain free at 12 months

Risk factors for surgery 1/4 Consensus • No studies addressing comorbidities for repair • Consider nonoperative treatment for patients with conditions that inhibit wound healing

Preoperative care Inconclusive • Unable to recommend for or against preop immobilization or restricted weight bearing

MIS 2/4 Limited Evidence • • • 6 comparative trials demonstrated no difference in rerupture 2 studies showed no faster recovery for percutaneous 2 studies showed improved return to activity for limited open No statistical difference in satisfaction One percutaneous study in favor of improved wound healing

Biological adjuncts Inconclusive • No studies for allograft, xenograft, or biologic adjuvants • 3 studies showed no benefit to autograft • 1 study showed no benefit to synthetic tissue Update: Multiple studies on biologic adjuvants, no clinical benefit demonstrated

DVT Prophylaxis Inconclusive • No studies

Postoperative weight bearing 3/4 Moderate Evidence • Suggest early (2 weeks) protected weight bearing for operatively treated achilles tendon rupture • 4 level II studies • 3 studies showed improved return to activity

Postoperative mobilization 3/4 Moderate evidence • Suggest use of a device that allows mobilization 2 -4 weeks postop • 5 studies using a device that limited dorsiflexion

Physical Therapy Inconclusive

Return to daily activity Inconclusive

(Operative) Return to sports 2/4 Limited Evidence • It’s an option to return to sports 3 -6 months postop

Nonop return to activity Inconclusive • Unable to recommend a specific timeline to return to activity.

Questions