Midterm functional performance following open surgical repair of acute Achilles tendon rupture

IntroductionVarious impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair.Materials and MethodsThis cross-sectional study includes n=52 patients which were tested on average 3.5 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair=AR vs. conventional repair=CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis.ResultsAt an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10 degrees of plantarflexion compared to CR (13.9 vs. 29.9%, p<0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing.ConclusionIn summary, there are persisting functional deficits at>3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities.Level of evidence III, retrospective cohort study