Title : Functional outcome & correlation with ultrasound gap size of Achilles Tendon rupture treated non-operatively with boot and wedges
Abstract:
Background: There is significant controversy regarding the impact of gap size in Achilles tendon ruptures on treatment decisions. Some studies suggest that a gap size exceeding 1 cm adversely affects the final functional outcome in non-operative management of Achilles tendon injuries, while other studies indicate no such effect.
Objectives: This study aims to evaluate the functional outcomes following non-operative treatment of Achilles tendon ruptures using a boot and wedges. It specifically investigates the correlation between the ultrasound-determined gap size between the torn edges of the tendon and the final functional outcome. The central question is whether the gap size influences the choice of treatment modality.
Study Design & Methods: This study involved 32 patients presenting with acute Achilles tendon rupture between October 2020 and August 2022. Patients were treated non-operatively with a boot and wedges for up to 12 weeks, following a progressive loading program. Ultrasound was used to measure the gap size within two weeks of injury. Patients were followed for 12 months, with assessments including ATRS scores, single heel raise, and calf circumference difference. Pearson correlation coefficient was employed to analyse the relationship between variables.
Results: The mean age of the study group was 48.2 years (range: 28 to 87 years), comprising 25 males and 7 females. The average ATRS scores at 3, 6, and 12 months were 26.89, 53.21, and 76.4, respectively. The mean difference in calf circumference between the affected and unaffected sides was 1 cm. The average difference in single heel raise at 12 months was 1.66 cm. No re-ruptures or DVT incidents were observed. There was only a very weak correlation between gap size and 12-month ATRS scores (r = 0.073). Similarly, a very weak negative correlation was noted between heel raise difference and gap size at the 12-month follow-up. The calf circumference difference at 12 months exhibited a weak correlation with gap size (r = 0.79).
Conclusions: This study is the first to examine the correlation between gap size and functional outcomes, heel raise difference, and calf circumference difference. The findings suggest that the initial gap size does not significantly influence the final functional or anatomical outcome.
