ACHILLES TENDON TEARS AND THE QUICKEST...
Transcript of ACHILLES TENDON TEARS AND THE QUICKEST...
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ACHILLES TENDON TEARS AND THE QUICKEST RETURN
TO SPORTS
Fernando A. Peña, MDAssistant Professor
Dept. of Orthopaedic SurgeryUniversity of Minnesota
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ACHILLES TENDON TEARS
• No conflict of interest
• No disclosures to reveal
• No mention of off-label use of devices
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ACHILLES TENDON TEARS
Treatment options:
• Surgical repair: open, percutaneous, minimally invasive.
• Conservative treatment
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ACHILLES TENDON TEARS
What is the goal?
• Return to sports as quickly as possible
• AND… with as few complications as possible
- Re-ruptures
- Residual pain
- Weakness
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ACHILLES TENDON TEARS
Two main variables are:
• Type of treatment: Surgical vs. non-surgical
• Type of rehabilitation after either treatment
– Immobilization vs. functional rehabilitation
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ACHILLES TENDON TEARS
Main functional goal: Achilles final length
8 Achilles tendon ruptures 10 controls
Achilles tendon length measured by US
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ACHILLES TENDON TEARS
Main functional goal: Achilles final length
- How much extra length is well tolerated?
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ACHILLES TENDON TEARS
Predictive factors:
N=93 Mean age= 39.7yo BMI=26
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ACHILLES TENDON TEARS
Age= Decreased functional results
BMI= Greater degree of symptoms
Increased level of activ.= More symptoms at 12m
Pain= No correlation with function
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ACHILLES TENDON TEARS
When will I return to sports, doc?
• More than one million hours of exposure
• 8029 injuries. 2.5% were Achilles related
- 4% were ruptures (8 out of 203)
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ACHILLES TENDON TEARS
Return to play= 169 days
Rugby= 185 Turkish football league= 180
Symptoms prior to rupture= None
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ACHILLES TENDON TEARS
When will I return to sports, doc?
N=9 7 back to NFL Average= 273 days
One athlete back at 166 days
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ACHILLES TENDON TEARS
Surgical vs. Non-surgical
N= 816 Mean age: 39.8 years
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ACHILLES TENDON TEARS
• Same calf girth, ROM, strength, and functional outcomes.
• Risk difference for re-rupture: 5.5
– Drops to 1.7 if functional rehabilitation
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ACHILLES TENDON TEARS
Surgical vs. Non-surgical
N=576 No mention of demographics
No difference on strength between groups
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ACHILLES TENDON TEARS
Re-rupture rate: 5% vs. 11%
Complications: Minor 11% vs. 5%
Major 17% vs. 8%
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ACHILLES TENDON TEARS
Immobilization vs. functional rehabilitation
• Meta-analysis of 12 studies
• Look at WB vs. NWB
• Look at immobilization vs. early ROM
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ACHILLES TENDON TEARS
Immobilization vs. functional rehabilitation
![Page 20: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/20.jpg)
ACHILLES TENDON TEARS
Immobilization vs. functional rehabilitation
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ACHILLES TENDON TEARS
Immobilization vs. functional rehabilitation
![Page 22: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/22.jpg)
ACHILLES TENDON TEARS
Immobilization vs. functional rehabilitation
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ACHILLES TENDON TEARS
• Presenter’s method:
– Present both options to the patient
• Important to remember that both options have the same length of recovery
– Who chooses surgical?
• Young, athletic, weekend warriors
– Non-surgical option provides good results if expectations are adjusted.
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ACHILLES TENDON TEARS
• Conservative treatment option.
– Placed in a short leg cast in plantarflexion
– Advance the dorsiflexion every 2 weeks with the goal of reaching neutral by the 6 week appointment
– 6-12 weeks: PT to match dorsiflexion of the opposite side and isometric strengthening
– After 12 weeks: no restrictions
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ACHILLES TENDON TEARS
• Surgical treatment option.
– Placed in a short leg cast in plantarflexion
– Advance the dorsiflexion every 2 weeks with the goal of reaching neutral by the 6 week appointment
– 6-12 weeks: PT to match dorsiflexion of the opposite side and isometric strengthening
– After 12 weeks: no restrictions
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ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
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ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 28: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/28.jpg)
ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 29: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/29.jpg)
ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 30: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/30.jpg)
ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 31: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/31.jpg)
ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 32: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/32.jpg)
ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
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ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
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ACHILLES TENDON TEARS
• Surgical treatment option.
Lower leg
Foot
![Page 35: ACHILLES TENDON TEARS AND THE QUICKEST …tria.com/wp-content/uploads/2014/07/Achilles-Tears-and...ACHILLES TENDON TEARS •Conservative treatment option. –Placed in a short leg](https://reader033.fdocuments.in/reader033/viewer/2022041806/5e545ca164ad6e6be53232e4/html5/thumbnails/35.jpg)
ACHILLES TENDON TEARS• Surgical treatment option.
Lower leg
Foot
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ACHILLES TENDON TEARS
Advantages of the surgical treatment:
• Full re-approximation of the tendon
• Decrease the chances for excessive elongation
• Decrease the amount of interposed scar tissue
• SHORTER healed Achilles tendon