A Literature Review Exploring Time to Re-Rupture after Functional Rehabilitation Treatment of Achilles Tendon Rupture

Abstract

Category:

Ankle; Trauma

Introduction/Purpose:

Achilles tendon rupture is a common ankle injury. Patients who suffer a rupture may be treated operatively or nonoperatively. Nonoperative treatment with functional rehabilitation has grown in popularity over the last decade. However, re-rupture remains a known complication with this treatment.

The current literature review explored time to re-rupture (TTR) in patients treated with functional rehabilitation for an Achilles tendon rupture. So that orthopaedists can optimally counsel patients with regard to return to activity, our primary goal was to investigate the time from initial injury to re-rupture. Secondary endpoints included the mechanism of re-rupture as well as the age, athletic status, and sex of patients who re-ruptured.

Methods:

A literature search was performed using PubMed. Articles examining functional rehabilitation published in English after 2010 with data on TTR were included. Mechanism of re-rupture, athletic status, and treatment method were collected. Studies where patients were immobilized for longer than four weeks were excluded. When TTR was reported as a range, authors were contacted, and data were used only if specific TTR was available.

Results:

Eleven articles were included. Of the 1,653 patients, 78 sustained a re-rupture (4.7%). The average TTR was 9 weeks (range, 2 to 28 weeks). Seventy-seven of the patients (98.7%) re-ruptured at or prior to 20 weeks (4.6 months), with a single re-rupture at 28 weeks. Most patients were male (77.5%). There was no significant difference in TTR by re-rupture mechanism (high energy vs low energy, p=0.09), age (≥40 vs < 40, p=0.35), sex (male vs female, p=0.53), and athlete status (non-athlete/unknown vs athlete, p=0.42). Re-rupture was more often treated operatively than nonoperatively (72.5% vs 27.5%).

Conclusion:

This data adds to our understanding of re-rupture following functional rehabilitation for Achilles tendon rupture. Orthopaedists can counsel patients that the vast majority of re-ruptures occur within 20 weeks of injury and are rarely seen after 6 months.

Summary of Included Patients Experiencing Re-Rupture After Functional Rehabilitation