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First published on June 26, 2006, doi:10.1177/0363546506288678
This version was published on September 1, 2006
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Right arrow Achilles tendon
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The American Journal of Sports Medicine 34:1395-1400 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Dynamic Ultrasound as a Selection Tool for Reducing Achilles Tendon Reruptures

Rohit Kotnis, MBChB, BSc, MRCS*,{dagger}, Saronjini David, MBChB, MRCS{ddagger}, Robert Handley, MBChB, FRCS{dagger}, Keith Willett, MBChB, FRCS{dagger} and Simon Ostlere, MBChB, FRCR{dagger}

From {dagger} John Radcliffe Hospital, Oxford, United Kingdom, and {ddagger} Cardiff University Hospital, Cardiff, United Kingdom

* Address correspondence to Rohit Kotnis, MBChB, Bsc, MRCS, Kadoorie Centre for Critical Care and Research, Level 3, John Radcliffe Hospital, Headington, Oxford, OX3 7LD UK (e-mail: rkotnis{at}hotmail.com).

Background: The optimal method of treatment for acute tendo-Achilles ruptures continues to be debated.

Hypothesis: The reported lower rerupture rate for operatively treated patients is an effect of tendon end apposition during the healing process, and patients in whom apposition can be demonstrated using ultrasound will have a similar rate of rerupture if treated nonoperatively.

Study Design: Cohort study; Level of evidence, 2.

Method: The authors reviewed all patients with an Achilles tendon rupture who were treated to a standard protocol during a 5-year period (2000–2005). Patients with a gap of 5 mm or more in equinus on ultrasound underwent surgery; those with a gap of less than 5 mm received nonoperative treatment. All patients were followed up to a minimum of 12 months.

Results: After exclusions, 125 patients were included: 67 treated operatively and 58 nonoperatively. There were 2 reruptures in the nonoperative group and 1 with surgery. There was no significant difference between the groups for any complication.

Conclusion: Reduction of rerupture and surgery risks may be possible using dynamic ultrasound case selection. Further studies are needed to show whether functional results are the same with surgical and nonsurgical treatment when dynamic ultrasound criteria are used for case selection.

Key Words: Achilles tendon • ultrasound • preselection tool • rerupture




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[Abstract] [Full Text] [PDF]


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