Midterm Outcomes of Operatively and Nonoperatively Managed Achilles Tendon Ruptures in Young Adults

Laurence Ge; Noah Saunders; Dakota Betts; James R Holmes; David M Walton; Paul G Talusan

doi:10.1177/24730114231198849

Midterm Outcomes of Operatively and Nonoperatively Managed Achilles Tendon Ruptures in Young Adults

Foot Ankle Orthop. 2023 Sep 26;8(3):24730114231198849. doi: 10.1177/24730114231198849. eCollection 2023 Jul.

Authors

Laurence Ge¹, Noah Saunders², Dakota Betts¹, James R Holmes¹, David M Walton¹, Paul G Talusan¹

Affiliations

¹ Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA.
² The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.

Abstract

Background: There continues to be controversy regarding treatment options for Achilles tendon ruptures (ATR). The aim of our study is to compare outcomes between operatively and nonoperatively managed Achilles ruptures in young adults (age 18-30 years), which has not been previously evaluated.

Methods: At a single institution, all patients aged 18-30 years at time of injury who underwent treatment for an acute ATR from 2014 to 2021 were evaluated. Medical records were reviewed to collect demographics, dates of injury and treatment, smoking status, body mass index (BMI), Charlson Comorbidity Index (CCI), rate of deep venous thrombosis (DVT) after treatment, and rate of rerupture. Patients then completed Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) questionnaires. Mann-Whitney nonparametric testing was used to evaluate for any statistical differences in PROMIS scores.

Results: Sixty-six operative patients qualified and 28 (42%) participated. Thirty-seven nonoperative patients qualified and 14 (38%) participated. All patients had a CCI of 0. One patient in the operative cohort and 2 in the nonoperative reported active smoking. In the operative and nonoperative cohorts, respectively, the average age was 24.4 and 27.8 years; average BMI 26.5 (SD = 4.8) and 27.3 (SD = 4.3, P = .52); DVT rates 4 (6.1%) and 2 (5.4%); and rerupture rates 2 (3.0%) and 1 (2.7%), respectively. PROMIS scores did not differ in the operative and nonoperative groups: PROMIS PF mean of 60.4 (SD = 9.8) and 62.9 (SD = 9.1), respectively (P = .33); as well as PROMIS PI mean of 44.6 (SD = 5.9) and 43.9 (SD = 6.5), respectively (P = .59).

Conclusion: This study should be interpreted with the understanding that we had a considerable loss to follow-up rate. In the study cohort, we found that young adults with ATR may be considered for either operative or nonoperative management. Rates of DVT, rates of rerupture, and PROMIS scores were not dissimilar between the 2 cohorts.

Level of evidence: Level III, retrospective cohort study.

Keywords: ATRS; Achilles tendon rupture; DVT; PROMIS; accelerated functional rehabilitation; rerupture.