title: Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients.
abstract: BACKGROUND
  The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex.
  
  
  METHODS
  The records of all 487 patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas nonoperative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and nonsurgical treatment were compared on the basis of patient age and sex.
  
  
  RESULTS
  The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury.
  
  
  CONCLUSIONS
  The good Achilles Tendon Total Rupture Score in the nonsurgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes this treatment a preferable option for most patients. However, the tendency for a lower re-rupture rate and better performance on the heel-raise test in surgically treated patients suggest surgery may be beneficial in selected patients.
authors: Department of Orthopaedics, Malmö University Hospital, Lund University, Södra Förstadsgatan 101, 20502 Malmö, Sweden. dan.bergkvist@glocalnet.net
authors: Dan
authors: D
authors: Bergkvist
authors: Ingrid
authors: I
authors: Åström
authors: Per-Olof
authors: PO
authors: Josefsson
authors: Leif E
authors: LE
authors: Dahlberg
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D012737:Sex Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013548:Sweden; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult