Dynamic ultrasound as a selection tool for reducing achilles tendon reruptures.
BACKGROUND
The optimal method of treatment for acute tendo-Achilles ruptures continues to be debated.


OBJECTIVE
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.


METHODS
Cohort study; Level of evidence, 2.


METHODS
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.


CONCLUSIONS
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.
Kotnis
Rohit
R
MBChB, Bsc, MRCS, Kadoorie Centre for Critical Care and Research, Level 3, John Radcliffe Hospital, Headington, Oxford, OX3 7LD UK. rkotnis@hotmail.com
David
Saronjini
S
Handley
Robert
R
Willett
Keith
K
Ostlere
Simon
S
D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002370:Casts, Surgical; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012421:Rupture / Q000517:prevention & control / Q000534:rehabilitation / Q000601:surgery; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography