Summary
By ultrasonographic evaluation, CSAs of the ruptured Achilles tendon in the operatively treated group were enlarged faster than that in the non-operatively treated group, and tendon repair scores in the operatively treated group were improved faster than that in the non-operatively treated group.
Abstract
Purpose
Recently, we examined repaired Achilles tendon healing after surgery with ultrasonography (Hiramatsu K et al. Orthop J Sports Med in press) and showed that the cross-sectional area (CSA) of repaired tendon reached maximum, and the internal morphology reached equilibrium at 6 months postoperatively. Treatment of acute Achilles tendon rupture (ATR) remains controversial, and the main choices are either surgical or non-surgical. Clinical outcome of ATR was comparable between two therapies. However, it is still unknown about the repair state of ruptured tendon, especially in early healing stage. The purpose of this study was to compare ruptured Achilles tendon healing using ultrasonography between operative and non-operative therapy focusing on the early stage of healing.
[Materials & Methods]
Thirty ruptured Achilles tendons (21 males and 8 female) were included in this study. Of these, 23 were treated operatively, and 7 were treated non-operatively. Characteristics of patients were shown in table 1. We evaluated tendon morphology by ultrasonography at 1, 2, 3, 4, and 6 months.
Two experienced technicians performed ultrasonographic evaluation using real-time scanner (Hitachi Aloka Medical, ProSound F75 Premier), provided by an 8-18 MHz linear array probe (UST-5415). The affected and unaffected tendons were scanned in both longitudinal and axial planes. Two sonographers and one orthopaedic surgeon made triplicate measurements.
Results
were evaluated by CSA and intratendinous molphology of the repaired tendon. CSA of the tendon was measured at the rupture site. The ratio of CSA (affected / unaffected) was calculated. Then, intratendinous molphology of the repaired tendon was evaluated with our original grading system modified Moller’s grading system (Moller et al, Knee Surg Sports Traumatol Arthrosc, 2002), in which aechoic tendon defect area with discontinuity of the fibrillar echo texture, intratendinous hyperechoic area, continuity of intratendinous fibrillar pattern, and peritendinous edema were evaluated. Collectively, scores of repaired tendons were summed and evaluated at ten points as maximum. The Mann-Whitney U-test was used to compare the CSA and the tendon repair score. A p-value of less than 0.05 was considered statistically significant.
Results
The percent increase of CSAs in the operatively treated group were significantly larger than that in the non-operatively treated group at 1,2,3, and 4 months, and were not significant at 6 months (Figure 1a). The tendon repair scores in the operatively treated group were significantly higher than that in the non-operatively treated group at all the period (Figure 1b).
Discussion
In this study, CSAs in the operatively treated group were enlarged faster and tendon repair scores were improved faster. These results indicated that repair state of operatively treated ruptured Achilles tendon was restored faster than that of non-operatively treated tendon in early healing stage.
Conclusions
By ultrasonographic evaluation, CSAs of the ruptured Achilles tendon in the operatively treated group were enlarged faster than that in the non-operatively treated group, and tendon repair scores in the operatively treated group were improved faster than that in the non-operatively treated group.