30 min

OVERTIME with The Sports Docs: Achilles Tendon Injury Management The Sports Docs Podcast

    • Medicine

Well, we are excited to back for 2022 and kicking off with an Overtime episode. On today’s episode, we’re going to chat about treatment of Achilles tendon ruptures. We’ve seen this injury across many sports and in very prominent players – Kevin Durant, Klay Thompson, Brandon Brooks who tore both of his Achilles tendons one year apart. This can be a devastating injury for our athletes, so understanding the treatment options, post-op rehab and what return to sport looks like is very important.

We’ll start off with how to decide between non-op treatment and surgical repair and what those treatment protocols look like. Then, we’ll shift our focus to surgical treatment and compare standard open Achilles tendon repair to newer percutaneous repair techniques. After surgical repair, there is then a decision of traditional rehab versus accelerated rehab with early weightbearing. Lastly, we’ll finish up with a discussion on returning to sports after Achilles repair – how do we clear these athletes and how do they perform once they return to play?

We’re going to reference many articles from AJSM throughout our talk today. We’ll post the abstracts to our Instagram, which is thesportsdocspod – if you don’t already follow us you should! So if you’re interested in reading more about the individual studies you can find them there.

·       AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates
o   Level I, systematic review, 48 studies
o   Re-rupture rate: Surgical treatment 3.6%, Non-op 12.1%
o   Infection: SX 5.6%, non-sx 0%
o   Sural nerve injury: SX 2%, non-sx 0.3%
o   DVT/PE: SX 0.8%, non-sx 1.8%
·       AJSM 2018 – Svedman – Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/30169112/

·       AJSM 2021 – Attia – Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. https://pubmed.ncbi.nlm.nih.gov/34908499/
o   Level I, meta-analysis, 10 studies
·       AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates. https://pubmed.ncbi.nlm.nih.gov/33783229/

·       AJSM 2020 – Okoroha – Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial. https://pubmed.ncbi.nlm.nih.gov/32203675/
·       AJSM 2018 – Eliasson – The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/29965789/

·       AJSM 2017 – Trofa – Professional Athletes’ Return to Play And Performance After Operative Repair of a Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/28644678/

Well, we are excited to back for 2022 and kicking off with an Overtime episode. On today’s episode, we’re going to chat about treatment of Achilles tendon ruptures. We’ve seen this injury across many sports and in very prominent players – Kevin Durant, Klay Thompson, Brandon Brooks who tore both of his Achilles tendons one year apart. This can be a devastating injury for our athletes, so understanding the treatment options, post-op rehab and what return to sport looks like is very important.

We’ll start off with how to decide between non-op treatment and surgical repair and what those treatment protocols look like. Then, we’ll shift our focus to surgical treatment and compare standard open Achilles tendon repair to newer percutaneous repair techniques. After surgical repair, there is then a decision of traditional rehab versus accelerated rehab with early weightbearing. Lastly, we’ll finish up with a discussion on returning to sports after Achilles repair – how do we clear these athletes and how do they perform once they return to play?

We’re going to reference many articles from AJSM throughout our talk today. We’ll post the abstracts to our Instagram, which is thesportsdocspod – if you don’t already follow us you should! So if you’re interested in reading more about the individual studies you can find them there.

·       AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates
o   Level I, systematic review, 48 studies
o   Re-rupture rate: Surgical treatment 3.6%, Non-op 12.1%
o   Infection: SX 5.6%, non-sx 0%
o   Sural nerve injury: SX 2%, non-sx 0.3%
o   DVT/PE: SX 0.8%, non-sx 1.8%
·       AJSM 2018 – Svedman – Reduced Time to Surgery Improves Patient-Reported Outcome After Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/30169112/

·       AJSM 2021 – Attia – Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. https://pubmed.ncbi.nlm.nih.gov/34908499/
o   Level I, meta-analysis, 10 studies
·       AJSM 2021 – Seow – Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates. https://pubmed.ncbi.nlm.nih.gov/33783229/

·       AJSM 2020 – Okoroha – Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial. https://pubmed.ncbi.nlm.nih.gov/32203675/
·       AJSM 2018 – Eliasson – The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/29965789/

·       AJSM 2017 – Trofa – Professional Athletes’ Return to Play And Performance After Operative Repair of a Achilles Tendon Rupture. https://pubmed.ncbi.nlm.nih.gov/28644678/

30 min