title: Functional Outcome of Percutaneous Achilles Repair: Improvements in Achilles Tendon Total Rupture Score During the First Year.
abstract: BACKGROUND
  Randomized studies have so far failed to show a difference in outcome between operative and nonoperative management of Achilles tendon rupture, provided that no rerupture occurs. Percutaneous Achilles repair has been suggested to result in superior patient satisfaction compared with open repair in patients with an acute Achilles tendon rupture, but there are no outcome data available with validated methods describing the progression of recovery during the first year.
  
  
  OBJECTIVE
  To evaluate the outcome of patients with a ruptured Achilles tendon, managed by percutaneous repair, during the first year following repair with a valid, reliable, and responsive outcome measure. Furthermore, the effects of time between injury and surgery, age, and complications on outcome were also evaluated.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A total of 73 patients (60 males and 13 females) with a mean age of 45.5 years were included. Patient age, length of time between injury and surgery, and complications were documented. Patients were evaluated using the Achilles tendon Total Rupture Score (ATRS) at 3, 6, 9, and 12 months following repair.
  
  
  RESULTS
  The median ATRS results at 3, 6, 9, and 12 months were 42.5, 73, 83, and 89, respectively. The number of patients who reported excellent or good scores (ATRS >84) at 3, 6, 9, and 12 months were 3%, 36%, 57%, and 69%, respectively. There were no significant differences in outcome at each time point for those patients undergoing early (≤48 hours) compared with late surgery or between those <65 and those >65 years of age. The complication rate was 13.5%. Patients who had a complication had a lower ATRS result at 3 months following surgery, but there were no differences after that time point.
  
  
  CONCLUSIONS
  The patients in the present study reported marked improvement in function between 3 and 6 months following surgery, with continuing but less steep improvement up to 1 year following surgery. The presence of a complication other than rerupture did not affect the end-stage outcome but did affect that at 3 months following surgery.
  
  
  CONCLUSIONS
  This study demonstrates improving scores with time over the first year following surgery, against which other treatment methods can be compared.
authors.affiliation: Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Carmont
authors.affiliation: Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA.
authors.forename: Karin Grävare
authors.initials: KG
authors.lastname: Silbernagel
authors.affiliation: Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK.
authors.forename: Antonia
authors.initials: A
authors.lastname: Edge
authors.affiliation: Department of Sports Medicine, University of Colorado Hospitals, Boulder, Colorado, USA.
authors.forename: Omer
authors.initials: O
authors.lastname: Mei-Dan
authors.affiliation: Department of Orthopaedic Surgery, Sahlgrenska University Hospital, MöIndal, Sweden.
authors.forename: Jón
authors.initials: J
authors.lastname: Karlsson
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
keywords: Achilles tendon; Achilles tendon Total Rupture Score; percutaneous repair