title: Acute Ultrasonography Investigation to Predict Reruptures and Outcomes in Patients With an Achilles Tendon Rupture.
abstract: BACKGROUND
  The optimal treatment for acute Achilles tendon ruptures is still an ongoing debate. Acute ultrasonography (US) investigation to measure the diastasis between the tendon ends has previously been used to classify acute Achilles tendon ruptures; however, no study has used US to predict reruptures and functional outcomes.
  
  
  OBJECTIVE
  To investigate whether acute US can be used to predict the risk of reruptures and outcomes after treatment of an acute Achilles tendon rupture.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  Forty-five patients (37 men, 8 women) with a mean age of 39 ± 9.2 years (range, 23-59 years) from a cohort of 97 patients participating in a randomized controlled study comparing surgical and nonsurgical treatment were included. US was performed within 72 hours from the index injury. Diastasis between the tendon ends was documented. Reruptures were documented, and the patients' functional outcomes were measured 12 months after injury.
  
  
  RESULTS
  Patients with a diastasis of >10 mm treated nonsurgically had a higher degree of rerupture. In the nonsurgically treated group, 3 of 4 patients with a diastasis of >10 mm suffered from rerupture (P< .001). Moreover, in the nonsurgical group, there was significantly worse outcomes in patients with a diastasis of >5 mm in terms of patient-reported outcomes using the Achilles tendon Total Rupture Score (ATRS) (P= .004) and heel-rise height at 12 months (P= .048) compared with the group with a lesser degree of tendon separation.
  
  
  CONCLUSIONS
  US may be a useful tool to predict the risk of rerupture and greater degree of functional deficit. It may be an important measure in a clinical treatment algorithm for deciding whether a patient will benefit from surgical intervention after an acute Achilles tendon rupture.
authors: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Sahlgrenska University Hospital, Mölndal, Sweden.
authors: Olof
authors: O
authors: Westin
authors: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Hallands Sjukhus, Kungsbacka, Sweden.
authors: Katarina
authors: K
authors: Nilsson Helander
authors: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
authors: Karin
authors: K
authors: Grävare Silbernagel
authors: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Sahlgrenska University Hospital, Mölndal, Sweden.
authors: Michael
authors: M
authors: Möller
authors: Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Peter
authors: P
authors: Kälebo
authors: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Sahlgrenska University Hospital, Mölndal, Sweden.
authors: Jón
authors: J
authors: Karlsson
keywords: Achilles tendon rupture; diastasis; rerupture; ultrasonography