The treatment of a rupture of the Achilles tendon using a dedicated management programme

Abstract

The Swansea Morriston Achilles Rupture Treatment (SMART) programme was introduced in 2008. This paper summarises the outcome of this programme. Patients with a rupture of the Achilles tendon treated in our unit follow a comprehensive management protocol that includes a dedicated Achilles clinic, ultrasound examination, the use of functional orthoses, early weight-bearing, an accelerated exercise regime and guidelines for return to work and sport. The choice of conservative or surgical treatment was based on ultrasound findings. The rate of re-rupture, the outcome using the Achilles Tendon Total Rupture Score (ATRS) and the Achilles Tendon Repair Score, (AS), and the complications were recorded. An elementary cost analysis was also performed. Between 2008 and 2014 a total of 273 patients presented with an acute rupture 211 of whom were managed conservatively and 62 had surgical repair. There were three re-ruptures (1.1%). There were 215 men and 58 women with a mean age of 46.5 years (20 to 86). Functional outcome was satisfactory. Mean ATRS and AS at four months was 53.0 (sd 14), 64.9 (sd 15) (n = 135), six months 67.8 (sd 16), 73.8 (sd 15) (n = 103) and nine months (72.4; sd 14) 72.3 (sd 13) (n = 43). The programme realised estimated cost savings exceeding £91,000 per annum. The SMART programme resulted in a low rate of re-rupture, a satisfactory outcome, a reduced rate of surgical intervention and a reduction in healthcare costs.

Functional dynamic bracing and functional rehabilitation for Achilles tendon ruptures: A case series

“…The zero re-rupture rate in those who complied with the programme and completed the study (0/21) is similar to the results from Hutchison et al [8], who reported 1.1% (3/273). Our rate is lower than other studies such as Neumayer et al [7] who reported 9%, with 5 full re-ruptures and 2 partial ones, in 57 patients, and Weber et al [15] who reported a re-rupture rate of 17% (4/23).…”

“…Our rate is lower than other studies such as Neumayer et al [7] who reported 9%, with 5 full re-ruptures and 2 partial ones, in 57 patients, and Weber et al [15] who reported a re-rupture rate of 17% (4/23). It is notable that the current study reports a similar re-rupture rate to Hutchison et al [8] who attributed their low rate to various factors including a detailed ultrasonographic examination, a dedicated physiotherapist led Achilles tendon rupture clinic and use of a physiotherapy protocol. The current study was also based on a dedicated physiotherapist led Achilles tendon rupture clinic, however it differs from the Hutchison regimen as it did not use ultrasound scan for assessment on all patients.…”

“…Of interest, the current study found the mean ATRS score to be 76.9 at 6 months in comparison to the value of 67.8 reported in the study by Hutchison et al [8]. The physiotherapy protocol also differed between the current study and that of Hutchison et al [8], with the current study advocating introduction of jogging from 4 months post rupture rather than 5 months as described by Hutchison.…”

“…Of interest, the current study found the mean ATRS score to be 76.9 at 6 months in comparison to the value of 67.8 reported in the study by Hutchison et al [8]. The physiotherapy protocol also differed between the current study and that of Hutchison et al [8], with the current study advocating introduction of jogging from 4 months post rupture rather than 5 months as described by Hutchison. As previous research [13] has estimated a 10 point difference in ATRS scores to be clinically significant, the difference between the outcome scores of the two studies could perhaps be attributed to the difference in rehabilitation protocols with the earlier introduction of jogging in the current study.…”

“…Neumayer et al [7] reported low rates of re-rupture (9%) using this intervention, but did not collect any validated patient 5 reported outcome measures. Hutchison et al [8] reported a re-rupture rate of 1% in a descriptive case series study of a dedicated conservative management programme incorporating functional dynamic bracing.…”