title: Effect of complications after minimally invasive surgical repair of acute achilles tendon ruptures: report on 211 cases.
abstract: BACKGROUND
  Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown.
  
  
  OBJECTIVE
  The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally invasive surgical Achilles tendon rupture repair with a complicated postoperative course.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The charts of 340 consecutive patients treated for an acute Achilles tendon rupture by minimally invasive surgical repair were reviewed. Complications were categorized as rerupture, severe wound infection, sural nerve injury, and other. Level of disability was evaluated by the 10-item ATRS with a sum score of minimum 0 to maximum 100 points.
  
  
  RESULTS
  A total of 211 patients returned a completed questionnaire: mean follow-up was 6.2 years (range, 3-10 years). Mean ATRS for all 211 patients was 84 (95% confidence interval: 82, 87). The mean ATRS for the 135 (64%) uncomplicated cases was 89 of 100 points, 71 points for the 17 (8%) patients with a rerupture (95% confidence interval: 63, 79; P < .0001), 79 points for the 41 patients (19%) with a sural nerve injury (95% confidence interval: 74, 85; P = .0008), and 75 points for the 17 patients (8%) with another complication (95% confidence interval: 67, 83; P = .001). Of these other complications, 13 patients (6%) suffered a wound-healing complication considered minor. Their average ATRS score was 80 points (95% confidence interval: 71, 88.7; P = .0445). One patient suffered a severe wound infection as well, scoring 28 of 100 points. Rerupture significantly increased the risk of quitting or changing sport participation on the long term.
  
  
  CONCLUSIONS
  Long-term outcome after minimally invasive Achilles tendon rupture repair is excellent. Rerupture and severe wound infection are the most important complications with lasting negative effect on outcome. It justifies the use of rerupture as a relevant outcome measure in treatment evaluation.
authors.affiliation: Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands. metz_r@hotmail.com
authors.forename: Roderik
authors.initials: R
authors.lastname: Metz
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Egbert-Jan M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.forename: Nicky
authors.initials: N
authors.lastname: Kolfschoten
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Verhofstad
authors.forename: Christiaan
authors.initials: C
authors.lastname: van der Werken
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects; D012008:Recurrence; D012421:Rupture / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D016896:Treatment Outcome