title: The treatment of a rupture of the Achilles tendon using a dedicated management programme.
abstract: The Swansea Morriston Achilles Rupture Treatment (SMART) programme was introduced in 2008. This paper summarises the outcome of this programme. Patients with a rupture of the Achilles tendon treated in our unit follow a comprehensive management protocol that includes a dedicated Achilles clinic, ultrasound examination, the use of functional orthoses, early weight-bearing, an accelerated exercise regime and guidelines for return to work and sport. The choice of conservative or surgical treatment was based on ultrasound findings. The rate of re-rupture, the outcome using the Achilles Tendon Total Rupture Score (ATRS) and the Achilles Tendon Repair Score, (AS), and the complications were recorded. An elementary cost analysis was also performed. Between 2008 and 2014 a total of 273 patients presented with an acute rupture 211 of whom were managed conservatively and 62 had surgical repair. There were three re-ruptures (1.1%). There were 215 men and 58 women with a mean age of 46.5 years (20 to 86). Functional outcome was satisfactory. Mean ATRS and AS at four months was 53.0 (sd 14), 64.9 (sd 15) (n = 135), six months 67.8 (sd 16), 73.8 (sd 15) (n = 103) and nine months (72.4; sd 14) 72.3 (sd 13) (n = 43). The programme realised estimated cost savings exceeding £91,000 per annum. The SMART programme resulted in a low rate of re-rupture, a satisfactory outcome, a reduced rate of surgical intervention and a reduction in healthcare costs.
authors.affiliation: Morriston Hospital, ABMU Health Board, Orthopaedic Department, Swansea, SA6 6NL, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Hutchison
authors.affiliation: Morriston Hospital, ABMU Health Board, Orthopaedic Department, Swansea, SA6 6NL, UK.
authors.forename: C
authors.initials: C
authors.lastname: Topliss
authors.affiliation: University of Oxford & Morriston Hospital, Institute of Musculoskeletal Sciences, Swansea, UK.
authors.forename: D
authors.initials: D
authors.lastname: Beard
authors.affiliation: Morriston Hospital / Swansea University College of Medicine, Radiology Dept, Morriston Swansea, SA6 6NL, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Evans
authors.affiliation: Morriston Hospital, ABMU Health Board, Orthopaedic Department, Swansea, SA6 6NL, UK.
authors.forename: P
authors.initials: P
authors.lastname: Williams
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture; D013708:Tendon Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
keywords: Achilles tendon re-rupture; Achilles tendon rupture; SMART; functional orthosis