Infection and Rerupture After Surgical Repair of Achilles Tendons

Abstract

Background:Surgical repair of an Achilles tendon rupture has been shown to decrease rerupture rates. However, surgery also increases the risk of complications, including infection.Purpose:To determine the risk factors for infection and rerupture after primary repair of Achilles tendon ruptures.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was performed on 423 patients who underwent operative treatment of Achilles tendon ruptures between the years 2008 and 2014. The primary outcome of interest was the total rate of infection, and the secondary outcome of interest was the incidence of rerupture within 2 years of operation.Results:A total of 423 patients were analyzed, with a mean age of 46 years (range, 16-83 years) and a mean body mass index of 31.4 kg/m2 (range, 17-55 kg/m2). The overall infection rate was 2.8%, and the rerupture rate was 1%. The median time between surgery and superficial surgical site infection was 30 days, and the median time between surgery and rerupture was 38 days. Longer tourniquet times (100.3 ± 34.7 minutes vs 69.9 ± 21.4 minutes; P = .04) and greater estimated blood loss (15.0 ± 9.1 mL vs 5.1 ± 12.0 mL; P = .01) were associated with an increased rate of deep surgical site infections. Patients who had longer operation and tourniquet times trended toward higher rerupture rates (P = .06 and .08, respectively). When compared with nonsmokers, current and previous smokers had an increased incidence of superficial or deep surgical site infections (6.25% vs 1.42%; P = .02). Age, sex, race, body mass index, alcohol use, diabetes, past steroid injections, and mechanism of injury did not contribute to complication rates.Conclusion:Achilles tendon repairs were associated with a low risk of infection and rerupture. Patients with longer tourniquet times, higher estimated blood loss, and a history of smoking were at increased risk for surgical site infections. Patients with longer operative times had increased rates of rerupture.

Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial

“…However, somewhat paradoxically, only patients in the late weightbearing and mobilization cohort were found to have reruptures. 1,7,14 In our study, no patient in either the early weightbearing or the traditional cohort had a rerupture. Furthermore, all patients expressed satisfaction with their range of motion and function.…”

“…Additionally, no differences in rerupture rates were demonstrated in this study as well as more current research demonstrating that accelerated weightbearing protocols are safe after Achilles tendon repair and do not lead to an increased rate of reruptures. 4,7…”

“…Additionally, no differences in rerupture rates were demonstrated in this study as well as more current research demonstrating that accelerated weightbearing protocols are safe after Achilles tendon repair and do not lead to an increased rate of reruptures. 4,7 Historically, surgeons implemented long immobilization periods after Achilles tendon repair due to concern for reruptures. 14 In their study of early versus late weightbearing, Eliasson et al 4 found a 2.7% rerupture rate, which is consistent with published rates.…”

Endoscopic Surgery for Delayed Wound Healing After Achilles Tendon Suture Repair: A Report of Three Cases

“…In addition, due to the lack of sebaceous glands on the soles and the presence of abundant sweat glands, the foot, especially when wearing airtight shoes, provides a unique environment for the growth of many bacteria, resulting in bacterial breeding 14,15 . Patient factors that affect the occurrence of postoperative complications include age, obesity 16,17 , and frequent tobacco use 18 . Older patients may, therefore, benefit from the use of absorbable sutures during surgery and postoperative antibiotics for a few days after surgery.…”

Open Achilles Tendon Rerupture: A Case Report and Review of the Literature

“…Rerupture of a surgically repaired Achilles tendon is uncommon, and there has been little written in regards to its management other than to describe inferior outcomes after rerupture [ 12 – 14 ]. In this report ,we describe an interesting case of an open rerupture after primary Achilles repair and review the few cases in the literature regarding open Achilles tendon reruptures.…”