A literature review has found successful outcomes for an Achilles tendon rupture with either minimally invasive surgery or non-surgical bracing with a removable boot, especially in recreational athletes. The use of platelet rich plasma (PRP), the injection of plasma-enriched platelets at the injury site, was not deemed an effective treatment.
A tear (rupture) of the Achilles tendon – the largest tendon in the body that connects the calf muscles to the heel bone – is among the most common injuries, affecting approximately 30,000 Americans each year, primarily recreational athletes age 30 to 49.
Earlier studies found a higher rate of re-injury, as well as a greater risk for related wounds and infection, with non-surgical casting following an Achilles tear. Today, non-surgical treatment options include functional rehabilitation – the use of an adjustable, removable boot that allows for movement and exercise – providing a lower risk for infection and re-rupture than immobilisation with a hard cast. Surgical repair of an Achilles tendon tear, which also has evolved to minimise the risk of complication and infection, may still be optimal for high-performance athletes, or patients in physically-demanding professions.
Re-injury rates with functional rehabilitation were lower than previously reported; recent research found no difference in re-rupture rates between functional rehabilitation and minimally invasive surgical repair (a small incision with minimal disruption of the surrounding soft tissue).
There were no significant long-term differences in ankle range of motion, strength, calf circumference, or functional outcome scores between patients undergoing functional rehabilitation and those with surgical treatment.
Functional rehabilitation resulted in faster return to mobility and work compared with casting for eight weeks. Surgical treatment (full, open or minimally invasive) was associated with return to work up to 19 days earlier than nonsurgical treatment; however, specific criteria for returning to work were not defined in the research parameters and likely varied among the studies.
Patients undergoing surgery had a small, yet statistically significant increase in plantar flexion (flexing of the ankle when pointing the foot and toes) strength at one and two years after surgical repair, which may be advantageous for high-performance athletes.
"The treatment of acute Achilles tendon ruptures has evolved over the last decade demonstrating improved outcomes with functional rehabilitation compared to prolonged cast immobilization," said Dr Anish Kadakia, associate professor of orthopaedic surgery at Northwestern University-Feinberg School of Medicine, and lead author of the article. "Given the high demands of the athlete, minimally invasive surgical treatment should be considered over non-operative management as it minimises the soft tissue complications while maximising the power and strength of the patient."
Finally, there is no existing research to support the use of platelet-rich plasma injections for Achilles tendon tears, as studies, to date, found no improvement in functional outcomes with use. However, the use of bone marrow-derived stem cells has shown promising results in animal studies.
Abstract
Acute rupture of the Achilles tendon is common and seen most frequently in people who participate in recreational athletics into their thirties and forties. Although goals of treatment have not changed in the past 15 years, recent studies of nonsurgical management, specifically functional bracing with early range of motion, demonstrate rerupture rates similar to those of tendon repair and result in fewer wound and soft-tissue complications. Satisfactory outcomes may be obtained with nonsurgical or surgical treatment. Newer surgical techniques, including limited open and percutaneous repair, show rerupture rates similar to those of open repair but lower overall complication rates. Early research demonstrates no improvement in functional outcomes or tendon properties with the use of platelet-rich plasma, but promising results with the use of bone marrow–derived stem cells have been seen in animal models. Further investigation is necessary to warrant routine use of biologic adjuncts in the management of acute Achilles tendon ruptures.
Authors
Anish R Kadakia, Robert G Dekker, Bryant S Ho
[link url="https://www.sciencedaily.com/releases/2017/01/170109113759.htm"]American Academy of Orthopaedic Surgeons material[/link]
[link url="http://journals.lww.com/jaaos/Abstract/2017/01000/Acute_Achilles_Tendon_Ruptures___An_Update_on.4.aspx"]Journal of the American Academy of Orthopaedic Surgeons abstract[/link]