Daniel M G Winson1, Rory MacNair2, Anne-Marie Hutchinson3, Nick J Owen4, Rhodri Evans2, Paul Williams5. 1. Trauma and Orthopaedic Department, Morriston Hospital, Swansea SA6 6NL, UK. Electronic address: danwinson@doctors.org.uk. 2. Radiology Department, Morriston Hospital, Swansea SA6 6NL, UK. 3. Physiotherapy Department, Morriston Hospital, Swansea SA6 6NL, UK. 4. Applied Biomechanics Department, Swansea University, Singleton Park, Swansea SA2 8PP, UK. 5. Trauma and Orthopaedic Department, Morriston Hospital, Swansea SA6 6NL, UK.
Abstract
INTRODUCTION: This biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program. METHODS: 19 patients (16M:3F) were enrolled and prospectively assessed using Achilles Repair Scores (ARS)/Achilles Tendon Rupture Scores (ATRS) (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length. RESULTS: Both ATRS and ARS improved between short- and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. Three patients failed the SMART protocol requiring surgical fixation. DISCUSSION: The SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.
INTRODUCTION: This biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program. METHODS: 19 patients (16M:3F) were enrolled and prospectively assessed using Achilles Repair Scores (ARS)/Achilles Tendon Rupture Scores (ATRS) (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length. RESULTS: Both ATRS and ARS improved between short- and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. Three patients failed the SMART protocol requiring surgical fixation. DISCUSSION: The SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.
Authors: Anna Nordenholm; Eric Hamrin Senorski; Katarina Nilsson Helander; Michael Möller; Roland Zügner Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-05-20 Impact factor: 4.114
Authors: Anna Nordenholm; Eric Hamrin Senorski; Olof Westin; Katarina Nilsson Helander; Michael Möller; Jón Karlsson; Roland Zügner Journal: J Orthop Surg Res Date: 2022-02-02 Impact factor: 2.359