Disability From Complications of Surgery for Achilles Tendon Rupture
The diagnosis: acute Achilles tendon rupture. The treatment: minimally invasive surgery (MIS). The result: complications! The final outcome: that's what this report is all about. Surgeons in The Netherlands followed 211 patients who had surgery to repair a ruptured Achilles tendon. The particular interest was in final outcomes for patients who developed complications following the procedure.
What type of complications are we talking about here? Nerve injury was the most common complication affecting about 20 per cent of the patients. Rerupture and other problems such as a skin infection, pain at the suture site, scar adhesion, and pneumonia made up the list of complications reported by the rest of the group. Only one of the 211 patients had a serious wound infection.
To assess the affect of these complications on the long-term results, the authors used a test called The Achilles Tendon Total Rupture Score (ATRS). The ATRS is based on points given for 10 items.
The items were self-reported by answering questions about calf muscle strength, ability to run and jump or participate in sports and recreation, and performance of daily activities. Each item on the ATRS is worth 10 points. With 10 items, there is a maximum number of 100 points possible. The closer the patient was to scoring 100, the better the results. Lower scores were an indication of disability.
To back track just a bit, you should know that there were a total of 340 patients who had this surgery for an acute Achilles tendon rupture. Not all of those individuals wanted to participate in the study. But from looking at the medical records, the authors could tell that there was a total of 16.5 per cent of patients who had complications from the minimally invasive procedure.
Of the 211 patients in the study, 135 people had no complications. Seventy-six (76) of the 211 did have complications. That's more than one third of the group (about 36 per cent actually).
But the goal of the study wasn't to see how many patients developed problems or complications. The goal was to see how the complications affected their overall function and assess their level of disability. And as it turns out, the long-term results were quite excellent.
Most of the complications were temporary. Once the patients recovered from their early post-operative problems, their healing and recovery was uneventful. Rerupture was really the most difficult complication. It required another surgery and a delay in completing rehab.
The authors conclude that preventing rerupture is the single most important way to avoid delays in recovery from surgery following an acute Achilles tendon rupture. Even the temporary nerve damage was minor compared to a second tendon tear.
Reruptures increased the chances of preventing sports athletes from returning to play two-fold (i.e., doubled the risk). Some players changed the sport they were involved in, a decision that could be potentially very disappointing for some. Others bide their time and are able to return to full participation in the sport of their choice at their preinjury level.
Roderick Metz, MD, PhD., et al. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures. Report on 211 Cases. In The American Journal of Sports Medicine. April 2011. Vol. 39. No. 4. Pp. 820-824.