Conservatively managed Achilles Tendon Rupture Healing – A case cohort analysis

Résumé fourni par la source

Objectives: The objective of this study was to describe the morphological changes on ultrasound scan of healing Achilles tendons that have sustained a full thickness rupture. Design: This is a case cohort study of patients referred for the conservative management of Achilles tendon ruptures. Methods: This is an observational study of 100 patients presenting with Achilles tendon ruptures who attended a consultant podiatry clinic. All patients diagnosed with an Achilles tendon rupture were conservatively managed and placed in an air shell walker boot with the patient fully weightbearing with wedges in-situ to maintain the foot in an equinus position in order to reduce the ruptured tendon gap. The wedges were removed incrementally from week 6, and the boot removed at week 10. At the initial appointment and each follow up a series of ultrasound measures were captured at the musculotendinous junction of the soleus (MTJ), gap (rupture) location (GL), corresponding gap location (CGL) of contralateral tendon and the osseo-tendinous junction at the calcaneus (OTJ). A patient reported outcome measure (ATRS) was also collected at each contact. Results: All ruptured Achilles tendons became fully united. ANOVA results of the ruptured Achilles tendon data conclude that there were statistically significant (p <0.05) differences among the means of the three anatomical locations (MTJ, GL, OTJ) for the three time points (weeks 6, 10, and 20). This suggests that the AP measure changes significantly over time across the three time points. There was no statistically significant (p <0.05) difference between measurements for each asymptomatic anatomical location over the same time period. The ruptured location of the Achilles tendon had a mean of 58.6 mm with a minimum of 14.1 mm and a maximum of 73.3 mm from the osseo-tendinous junction. 85 /100 patients ruptured between 30 mm and 60 mm proximally to the osseo-tendinous junction. The ruptured tendon gap reduced with the foot placed in 10 degrees of plantarflexed position during ultrasound. For 80 patients the gap was between 0 and 1.6 mm. Two patients presented with a gap between 8 and 9.6 mm with the foot plantarflexed. From baseline (0 weeks) to 20 weeks these data suggest a significant improvement in the ATRS scores from an average score of 3.25 at 0/52 weeks to 83.25 at 20 weeks. A Pearson’s correlation coefficient of final 20 week ATRS score suggested that age does not appear to be correlated with outcomes for ATRS (p <0.05). Conclusions: All ruptured Achilles tendons became fully united and significantly thickened by the six week time point on the pathway. By the end of the pathway significant AP thickness was observed in most cases, with significant improvements in ATRS scores. AP measure thickness at each time point was a determinant of higher ATRS scores. No significant differences in AP thicknesses were observed in the OTJ and MTJ measures of the symptomatic or tendons.

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