Operative and Nonoperative Management of Achilles Tendon Ruptures in Active Duty Military Population

• Published in: Foot & ankle international 2016-03, Vol.37 (3), p.269-273
• Main Authors: Renninger, Christopher H., Kuhn, Kevin, Fellars, Todd, Youngblood, Scot, Bellamy, Joseph
• Format: Article
• Language: English
• Subjects: Achilles Tendon - injuries; Achilles Tendon - surgery; Adult; Exercise Therapy; Humans; Male; Military Personnel; Recurrence; Retrospective Studies; Return to Work - statistics & numerical data; Rupture - therapy; Tendon Injuries - rehabilitation; Tendon Injuries - surgery; United States
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100715615322

Background: The optimal management of Achilles tendon ruptures continues to be a subject of debate in orthopedics. These injuries are common in the active duty military population. The purpose of this study was to retrospectively compare the results of operative and nonoperative management of Achilles tendon ruptures in the active duty military population following the publication of a landmark level I study that has influenced practice patterns. Methods: All Achilles tendon injuries in active duty patients were identified at a single military institution from January 1, 2011, to January 1, 2014. Inclusion and exclusion criteria were applied and charts were reviewed. Demographic and treatment information were recorded along with return to duty status, deep vein thrombosis (DVT), rerupture, and other complication data. Rates of DVT, rerupture, other complications, and return to duty (including time to return) were then compared. Demographic data were described. Fifty-seven male patients met inclusion criteria with an average age of 31 years. There were 27 in the operative group and 30 in the nonoperative group. There were no significant differences in group demographics. Results: There were no DVTs in either treatment group. There were no wound complications in the operative group. There were no significant differences in the rates of rerupture, return to duty, or other complications. There were 2 reruptures in the nonoperative group. Both were treated nonoperatively. There was one rerupture in the operative group that was treated nonoperatively. All reruptures were partial tears. Two patients underwent repair with flexor hallucis longus augmentation. Both of these patients were initially managed nonoperatively. When available data on time to return to duty was analyzed, patients who underwent operative management returned to duty on average approximately one and a half months earlier (6.7 vs 8.2 months) than nonoperative patients (P = .04). In 2011, 12% of injuries were treated nonoperatively; in 2012, 57%; and in 2013, 84%. Conclusions: Similar to previously published work, this retrospective analysis found no significant difference in complication, DVT, or rerupture rates. The rate of rerupture in this study was slightly higher than previously published work in the era of functional rehabilitation, but the sample size was small. The data were limited with respect to functional outcome for comparison; however, the rate of return to active duty was not sig