2023 ISAKOS Biennial Congress Paper
Calf Muscles Volume And Tendon Elongation After Acute Achilles Tendon Rupture. A Predefined Secondary Analysis In A Randomized Controlled Trial Investigating Treatment Selection Using The Copenhagen Achilles Rupture Treatment Algorithm (CARTA)
Kristoffer W. Barfod, MD, PhD, Virum DENMARK
Anders Brøgger Overgård, MD, Copenhagen DENMARK
Maria Swennergren Hansen, PT, PhD, Copenhagen DENMARK
Ibrahim El Haddouchi, Medical Student, Søborg DENMARK
Marianne Toft Vestmark, MD, PhD, Viborg DENMARK
Per Hölmich, DMSc, Prof., Copenhagen DENMARK
1. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, DENMARK
FDA Status Not Applicable
Summary
The aim of the present study was, in a randomized setup, to investigate if treatment selection by use of CARTA could reduce hypotrophy and tendon elongation. No indication was found that treatment selection by use of CARTA reduced calf muscle atrophy or tendon elongation when compared to surgical and non-surgical treatment.
Abstract
Background
Surgical treatment of acute Achilles tendon rupture substantially lowers the risk of re-rupture and has been claimed to reduce calf atrophy and elongation of the Achilles tendon compared to non-surgical treatment. The Copenhagen Achilles Rupture Treatment Algorithm (CARTA) was developed to provide evidence-based individualized treatment selection based ultrasonographic (US) evaluation of the rupture.
Purpose
The aim of the present study was, in a randomized setup, to investigate if treatment selection by use of CARTA could reduce hypotrophy and tendon elongation in comparison with 1) patients treated surgically, and 2) patients treated non-surgically.
Study design: Randomized controlled clinical trial
Methods
60 patients with an acute ATR were randomized in a 1:1:1 order to treatment selection based on CARTA (Intervention), surgical treatment (control) or non-surgical treatment (control). After one year MRI of both calves was performed and muscle volume and Achilles tendon length was measured. Results were presented as the ratio between the affected and the unaffected limbs: the Limb Symmetry Index (LSI).
Trial registration: NCT03525964.
Results
156 patients were assessed for eligibility, 60 patients were randomized and 54 provided data for the study: 19 in the group assigned treatment based on CARTA, 17 in the group assigned non-surgical treatment, and 18 in the group assigned surgical treatment. No statistically significant differences were found between the intervention group and the two control groups regarding muscle volume and tendon length. Also, no statistically significant differences were found between patients treated surgically and patients treated non-surgically. Comparison between the affected and the unaffected limb showed statistically significant muscle atrophy (25%-30%) and tendon elongation (Soleus 59%-76%, Gastrocnemius 8%-14%) in the affected limb in all three groups.
Conclusion
No indication was found that treatment selection by use of CARTA in the treatment of acute ATR reduced calf muscle atrophy or tendon elongation when compared to surgical and non-surgical treatment. Also, no indication was found that surgical treatment reduced calf muscle atrophy or tendon elongation.
Clinical relevance: The results are directly adaptable in the treatment of acute Achilles tendon rupture as they question the advantages of surgical treatment.
What is known about the subject: It is claimed that surgical treatment of acute Achilles tendon rupture reduces calf atrophy and tendon elongation. The Copenhagen Achilles Rupture Treatment Algorithm (CARTA) has been developed but needs adequate testing.
What this study adds to existing knowledge: The study questions whether surgical treatment of acute Achilles tendon rupture actually does reduce calf atrophy and tendon elongation. The same accounts for CARTA.