Percutaneous Repair in Patients Aged 50 Years and Older Is Associated With Good Outcomes in Acute Achilles Tendon Rupture.

BACKGROUND

The incidence of Achilles tendon ruptures in patients aged ≥50 years is increasing worldwide with an aging population that is increasingly physically active and taking up recreational activities, such as pickleball and paddleball. The aim of this study was to assess patient-reported outcomes in patients aged ≥50 years with a complete Achilles tendon rupture comparing percutaneous repair to non-operative management over 12 months.

METHODS

This is a single-centre prospective cohort study with patients recruited over a 10-year period. Patients filled an Achilles tendon Total Rupture Score (ATRS) at 3-month, 6-month and 12-month intervals.

RESULTS

173 patients were included; 70 patients were managed operatively and 103 patients were managed non-operatively. At 12 months, 50 patients (71.4%) in the operative group and 57 patients (55.3%) in the non-operative group completed the ATRS score. At 3-month and 6-month intervals, there was no statistically significant difference in average ATRS scores (P = .23 and P = .32, respectively). At 12 months, the average ATRS score in the operative group was 89.9 (SD 11.1 and 95% CI 86.7-93.1), with 74.3 (SD 19.5 and 95% CI 69.1-79.5) in the non-operative group; this was statistically significant (P = .001). The biggest improvement in the operative group was seen in questions related to running, jumping and hard physical labour.In the operative group, 1 patient sustained a re-rupture (1.4%), with 1 patient sustaining a pulmonary embolism (1.4%). In the non-operative group, 3 patients sustained re-ruptures (2.9%) and 2 patients (1.9%) sustained a pulmonary embolism.

CONCLUSION

Patients aged ≥50 years who undergo percutaneous repair had higher ATRS scores at 12 months compared with non-operative care. Percutaneous repair appears to be a valid option for management of these injuries in an increasingly active population aged ≥50 years.

LEVEL OF EVIDENCE: Level II, prospective cohort study.