Return to sport after surgical repair of the Achilles tendon

Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair

BACKGROUND

The Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.

PURPOSE/HYPOTHESIS

The main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.

RESULTS

A total of 50 patients (24 women and 26 men), with a mean age of 38.3 ± 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 ± 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.

CONCLUSION

The Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient's psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.

The Correlation of Dynamic Magnetic Resonance Imaging Evaluation With Histological, Biochemical, and Biomechanical Properties in Healing Progress After Achilles Tendon Injury: A Review

Achilles tendon injury is a common sports injury, and an in-depth understanding of its healing process is essential for improving rehabilitation strategies. As a non-invasive imaging technology with excellent anatomical and functional information extraction abilities, magnetic resonance imaging (MRI) has been widely used in the evaluation and monitoring of Achilles tendon injury. MRI scans at different stages of Achilles tendon healing can provide information about the structure of the Achilles tendon tissue, blood supply, composition, and metabolism. The change pattern on dynamic MRI evaluation is closely related to the specific stage of Achilles tendon healing and tissue characteristics. For example, the signal strength of dynamic enhanced MRI sequences can reflect blood supply to the Achilles tendon, whereas some quantitative MRI techniques can provide information on the recovery of water and collagen contents in the Achilles tendon. This article discusses the pathophysiological changes after Achilles tendon injury and summarizes the clinical and research status of the MRI techniques used for monitoring Achilles tendon healing. The feasibility of various MRI techniques for monitoring Achilles tendon healing and their correlation with histology, biochemistry, and biomechanics are reviewed, along with the challenges, limitations, and potential opportunities for their application. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

BACKGROUND

Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

METHODS

A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

RESULTS

Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

CONCLUSION

Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.