Percutaneous Repair versus Non-Operative Management of Acute Achilles Tendon Rupture

Salman Sadiq, Natalie Grocott, Matthew Philpott, Ali Ashique

Introduction: The aim of this study was to assess any difference in patient reported outcomes between patients managed operatively with percutaneous repair versus non-operatively following an acute Achilles tendon rupture.

Method: This was a single-centre prospective cohort study over a 10-year period performed at University Hospital North Midlands. Patients were asked to fill an Achilles tendon Total Rupture Score (ATRS) at 3-month, 6-month and 12-month intervals post injury. Patients were followed up for up to 12 months. Statistical significance was deemed if p<0.05.

Results: 181 patients were included who underwent percutaneous repair with an average age of 46.2 years (SD 12.8). In the non-operative group, 193 patients were included with an average age of 52.8 years (SD 14.3). At 12 months, 98 patients from the operative group (54%) and 103 patients from the non-operative group (53%) filled the ATRS questionnaire. At 3-month and 6-month intervals, there was no statistically significant difference in ATRS scores (p= 0.17 and p=0.70 respectively). At 12 months, there was a statistically significant difference in ATRS scores (p<0.001) in favour of the operative group. When individual ATRS questions were analysed at 12 months, there was a statistically significant difference in favour of the operative group (p<0.002), especially in relation to intense physical activity. The improvement was seen in all age groups. Four patients in the non-operative group sustained a DVT or PE and five patients had a re-rupture. In the operative group, one patient sustained a DVT, one patient was found to have a surgical site infection, and three patients had a re-rupture.

Conclusion: Patients undergoing percutaneous repair have improved ATRS scores at 12 months. Percutaneous repair is therefore a safe and valid management option, especially for highly active patients or heavy labourers. Those patients who do not require these attributes may benefit from non-operative intervention.