SLR - August 2014 - Elizabeth Piselli

Predictors of Clinical Outcome After Acute Achilles Tendon Ruptures
Reference: Olsson N, Petzold M, Brorsson A, Karlsson J, Eriksson BI, Gravare Silbernagel K. Predictors of Clinical Outcome After Acute Achilles tendon Ruptures. The American Journal of Sports Medicine, 2014 42(6), 1448-55.
Scientific Literature Review
Reviewed By: Elizabeth Piselli, DPM
Residency Program: Montefiore Medical Center
Podiatric Relevance: When patients present with an acute Achilles tendon rupture it has previously been difficult to pick a treatment modality based on symptoms because there has been no literature on it. This study takes patients symptoms and functionality and weighs them against other variables such as age, sex and activity level to aide in individualizing treatment for patients.
Methods: Ninety-three patients (79M and 14F) were evaluated prospectively at three, six and 12 months after Achilles tendon rupture. Symptoms were evaluated using the Achilles tendon Total Rupture Score (ATRS). Function was evaluated using heel-rise height. The possible affecting factors were used as independent variables, those included: sex, age, BMI, physical activity level, symptoms and quality of life.
Results: Only male sex was used for the prediction models secondary to male and female results being contradictory in the first univariate analysis. They found treatment, age, BMI, physical activity level, heel rise height at 6 months and the ATRS score at three months were eligible for further analysis. Surgical treatment was associated with a higher heel rise height at six months, but the reverse was true at 12 months. Surgical treatment was also associated with a lower degree of symptoms. Increased age was a strong indicator of post-treatment reduced heel-rise height. BMI was also a strong predictor of greater degree of symptoms with every five unit higher BMI equating to a reduction of ten points on the ATRS.
Conclusions: This study shows that surgical versus non-surgical treatment of acute Achilles tendon rupture is a moderate predictor of post-treatment symptoms and a weak predictor of function. Increasing age and BMI were both strong predictors of greater degree of symptoms after a rupture. If a patient has a high BMI and increased age, one may consider surgical treatment to decrease symptoms after injury. 

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