Functional outcomes of conservatively managed acute tendo Achilles ruptures

J.E. Lawrence, P. Nasr, D. Fountain, L. Berman, A. Robinson

Aims: This prospective cohort study aimed to determine if the size of the tendon gap following acute tendo Achillis rupture influences the functional outcome following non-operative treatment.

Patients and methods: All patients presenting with acute unilateral tendo Achillis rupture were considered for the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon rupture score (ATRS) six months after the completion of a rehabilitation programme.

Results: 38 patients (mean age 52 years, range 29-78 years) completed the study. Patients with a gap ≥10mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10mm (mean 23.3% vs 14.3%, P=0.023). However, there was no overall correlation between gap size and torque deficit (τ=0.103), suggesting a non-linear relationship. There was also weak correlation between ATRS and peak torque deficit (τ=-0.305), with no difference in ATRS between the two groups (mean score 87.2 vs 87.4, P=0.467).

Conclusion: This is the first study to identify tendon gap size as a predictor of functional outcome in acute tendo Achillis rupture, although the precise relationship between gap size and plantarflexion strength remains unclear. Large, multi-centre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures.