Functional evaluation of professional athletes treated with a mini-open technique for achilles tendon rupture

Vadalà, Antonio; Lanzetti, Riccardo Maria; Ciompi, A.; Rossi, Cristian; Lupariello, Domenico; Ferretti, A.

doi:10.32098/mltj.02.2014.16

Cited by 21 publications

(26 citation statements)

References 24 publications

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“…This result is similar to that reported in the study on UEFA players10, where no sporting retirements were reported in the nine cases of ATR included. Also, a return to the pre-injury sport level of 91% was reported in a series of 36 professional athletes, 25 of whom were football players 9. A systematic review of 108 studies and 6506 patients reported a rate of return to play of 80%,8 lower than that found in the present study.…”

Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

“…There are very limited data with which to advise professional football (soccer) players 9–11. One study of surgical treatment in 36 athletes (25 football players) reported that 91% resumed their preoperative sport activity level,9 but the results for the football cohort were not reported separately. Gajhede-Knudse et al 10 reported a mean lay-off time of 161±65 days after Achilles tendon injuries in nine professional UEFA football (soccer) players, and Franchini et al 11 described return to sport after surgical treatment of ATR in a single case report of a Serie A Elite football (soccer) player.…”

Section: Introductionmentioning

confidence: 99%

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Eighty-two per cent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair

Grassi¹,

Rossi

D’Hooghe

et al. 2019

Br J Sports Med

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ObjectiveTo evaluate the time to return to playing following acute Achilles tendon rupture (ATR) and surgical repair in professional male football (soccer) players.MethodsProfessional male football (soccer) players who sustained an ATR and underwent surgical repair were identified through internet-based injury reports from January 2008 to August 2018. Only League 1 and 2 players with injuries who had at least 1 year of follow-up from the search date were included. Injury history and time to return to play were retrieved from the public platform transfermarkt.com. For athletes who competed for at least two seasons after returning to play, re-ruptures and number of matches played were reported.Results118 athletes (mean age 27.2±7.2 years) were included. 113 (96%) returned to unrestricted practice after a mean of 199±53 days, with faster recovery in players involved in national teams. Return to competition was after a mean of 274±114 days. In the 76 athletes with at least two seasons of follow-up, 14 (18%) did not compete at the pre-injury level during the two seasons following the index injury. Six players (8%) sustained a re-rupture within the first two seasons after return to play; four re-ruptures were in footballers who returned to play <180 days after injury. Age >30 years and re-ruptures had higher odds ratios of not returning to the same level of play.Conclusions96% of professional male football players who underwent surgery to repair an ATR returned to unrestricted practice and then competition after an average time of 7 and 9 months, respectively. However, 18% did not return to the same level of play within the two seasons following their return, with a higher risk in those experiencing a re-rupture.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Eighty-two per cent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair

Grassi¹,

Rossi

D’Hooghe

et al. 2019

Br J Sports Med

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“… 26 Investigations using a variety of other percutaneous or limited open techniques have also generally reported positive outcomes, with AOFAS scores ranging from 93.3 to 97.7, 2 , 24 , 47 12-Item Short Form Health Survey (SF-12) scores of 104.8, 16 and an average VISA-A score of 93.1 in a cohort of professional athletes. 48 Although widely utilized, the AOFAS score remains an unvalidated outcome measure 8 and has been shown to overemphasize pain and underemphasize functional outcomes such as strength and stiffness in acute percutaneous Achilles tendon repairs. 10 As such, we elected to use the FAAM, which has been shown to be a better indicator of physical function than the AOFAS score.…”

Section: Discussionmentioning

confidence: 99%

“…Originally validated for Achilles tendinopathy, 44 it has been used to report outcomes after Achilles tendon rupture repair. 48 Higher levels of function are represented by higher scores, with a maximum achievable score of 100; healthy patients typically have scores of 96 to 100. The minimal clinically important difference has been reported to be 6.5 points.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Limited Open Achilles Repair Using Modified Ring Forceps

Telleria

Smith

Ready

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The optimal treatment of acute Achilles tendon ruptures remains controversial. When surgical repair is undertaken, the reported rate of infections and wound-healing complications ranges from 2% to 5%. Meta-analyses have demonstrated that minimally invasive approaches have equivalent rerupture rates, a significantly lower risk of superficial infections, and higher patient satisfaction rates compared with traditional open Achilles repair techniques.Purpose:To review the clinical outcomes of acute, limited open Achilles tendon repair using modified ring forceps and to analyze functional results using foot and ankle–specific outcome measures.Study Design:Case series; Level of evidence, 4.Methods:The clinical records of 32 consecutive patients (mean age, 44 years) with 33 acute Achilles tendon ruptures were retrospectively reviewed. All patients underwent limited open repair with modified ring forceps through a 2- to 3-cm midline incision. Suture placement into the tendon stumps was guided using a pair of ring forceps bent 30°. Three No. 2 nonabsorbable sutures were placed in the proximal and distal segments, the tendon ends were reapproximated, and the sutures were tied to secure the tendon. Outcomes from a 10-cm visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sport Assessment–Achilles (VISA-A) were assessed.Results:At final follow-up (mean, 42.1 months [range, 6-90 months]), 31 of 32 patients (33 Achilles tendons) reported no pain in their Achilles, with a mean Achilles VAS score of 0.7 ± 4.2 of 100. The mean postoperative VISA-A score was 82.3 ± 19.5 of 100. The mean FAAM activities of daily living and sports subscores were 96.5% ± 5.2% and 85.1% ± 21.2%, respectively. Regarding current functional level, 19 of 33 tendons (57.6%) were rated as “normal,” 10 (30.3%) as “nearly normal,” and 4 (12.1%) as “abnormal”; none were rated as “severely abnormal.” There was 1 case (3.0%) of a superficial infection; there were no cases of deep infections, sural neuritis, or reruptures. The cost of the modified ring forceps technique is 5.3 to 12.1 times less than commercially available devices.Conclusion:Limited open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief, favorable functional outcomes, and a very low complication rate at midterm follow-up.

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Comparative analysis of Achilles tendon healing outcomes after open tenotomy versus percutaneous tenotomy: An experimental study in rats

Song

Kang

Han

et al. 2021

Journal Orthopaedic Research

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There is growing interest in conservative treatment of Achilles tendon rupture. However, the majority of experimental studies of Achilles tendon have been performed by open tenotomy. More appropriate model of conservative treatment of Achilles tendon rupture is required. We performed an experimental study to evaluate whether outcomes differ between open tenotomy and percutaneous tenotomy of the Achilles tendon in rats. The Achilles tendons of 48 rats were transected. The animals were divided into two groups according to surgical technique: open tenotomy or microscopy‐assisted percutaneous tenotomy. After 1, 2, and 4 weeks, functional, biomechanical, and histological analyses were performed. Western blot was performed for quantitative molecular analysis at 1 week. The Achilles functional index was superior in the percutaneous tenotomy group, compared with the open tenotomy group, at 1 week. The cross‐sectional area was significantly larger in the percutaneous tenotomy group than in the open tenotomy group at 4 weeks. Relative to the native tendons, load to failure and stiffness yielded comparable results at 2 weeks in the percutaneous tenotomy group and at 4 weeks in the open tenotomy group. The histological score was significantly better in the percutaneous tenotomy group than in the open tenotomy group at 1 week. At 1 week, interleukin‐1β expression in the open tenotomy group was higher than in the percutaneous tenotomy group. In summary, Achilles tendon healing was substantially affected by the tenotomy method. We presume that our percutaneous tenotomy method might constitute a useful experimental animal model for conservative treatment of Achilles tendon rupture.

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Functional evaluation of professional athletes treated with a mini-open technique for achilles tendon rupture

Cited by 21 publications

References 24 publications

Eighty-two per cent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair

Eighty-two per cent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair

Outcomes of Limited Open Achilles Repair Using Modified Ring Forceps

Comparative analysis of Achilles tendon healing outcomes after open tenotomy versus percutaneous tenotomy: An experimental study in rats

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