Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;143(5):2455-2465.
doi: 10.1007/s00402-022-04457-7. Epub 2022 May 14.

Operative versus conservative treatment of acute Achilles tendon ruptures: preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound

Juana Kosiol  1 , Alexander Keiler  2 , Alexander Loizides  3 , Hannes Gruber  3 , Benjamin Henninger  3 , Andreas Bölderl  1 , Leonhard Gruber  3
Affiliations

Operative versus conservative treatment of acute Achilles tendon ruptures: preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound

Juana Kosiol et al. Arch Orthop Trauma Surg. 2023 May.

Abstract

Introduction: There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome.

Materials and methods: Surgically or conservatively treated patients with acute Achilles tendon rupture were retrospectively evaluated. Differences in tendon length and diameter with and without load were analysed using kinematic MRI, tendon perfusion, structural alterations, movement and scar tissue by means of grey-scale and contrast-enhanced ultrasound (CEUS). Intra- and interobserver agreement were recorded.

Results: No significant difference was detected regarding clinical outcome, B mode ultrasonography, contrast-enhanced sonography or MRI findings, although alterations in MRI-based measurements of tendon elasticity were found for both groups. Considerable elongation and thickening of the injured tendon were detected in both groups.

Conclusion: Both, conservative and surgical treatment showed comparable outcomes in our preliminary results and may suggest non-inferiority of a conservative approach.

Keywords: Achilles tendon; Acute Achilles tendon rupture; Clinical outcome; Conservative treatment; Contrast-enhanced ultrasound; Kinematic MRI; Operative treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interests.

Figures

Fig. 1
Fig. 1
MRI measuring technique. Measuring the length of the tendon from the insertion to the musculotendinous junction, the diameter of the tendon at its most bulky point and 5 cm above the insertion (a) using the localizer in the second layer to determine the tendon midline (b)
Fig. 2
Fig. 2
Demographics. Comparison of age, immobilisation duration, physiotherapy duration, sick leave duration and sports abstinence in participants having undergone conservative (C) or surgical treatment (S) after Achilles tendon rupture
Fig. 3
Fig. 3
Clinical examination. Comparison of clinical findings after conservative (light grey) and surgical treatment (dark grey) after Achilles tendon rupture
Fig. 4
Fig. 4
Functional outcome. Changes in thigh and calf circumference (Fig. 4a) and motion range deficits (Fig. 4b) compared to the healthy side as well as the result of Achilles Tendon Total Rupture Score (ATRS) (Fig. 4c) in participants having undergone conservative (C) or surgical treatment (S) after Achilles tendon rupture
Fig. 5
Fig. 5
Ultrasonographic examination. Comparison of dynamic B mode findings for force transmission (a), bridging scar (b), tendon mobility (c) and presence of adhesions (d) as well as intratendinous Doppler vascularisation (e) and presence of contrast enhancement (f)
Fig. 6
Fig. 6
Contrast-enhanced ultrasound. Comparison of contrast-enhanced ultrasound (CEUS) parameters time-to-peak (TTP) for injured Achilles tendons, surrounding fat and resulting TTP differences (a) and CEUS area-under-the-curves (AUC) for inflow (AUCup), outflow (AUCdown) and total observation period (AUCsum) in participants having undergone conservative (C) or surgical treatment (S) after Achilles tendon rupture (b)
Fig. 7
Fig. 7
Conservative versus surgical treatment in MRI. Comparison of MRI tendon length and diameter measurements in participants having undergone conservative (C) or surgical (S) treatment (a) and comparison of MRI tendon measurement ratios between injured (I) and healthy (H) sides in participants having undergone conservative (C) or surgical (S) treatment after Achilles tendon rupture (b)
Fig. 8
Fig. 8
Healthy versus injured tendons in MRI. Difference in Achilles tendon length and diameter at rest (a) and under tension (b) when comparing the injured (I) and the healthy (H) side
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sport Traumatol Arthrosc. 2016;24:3730–3737. doi: 10.1007/s00167-015-3544-5. - DOI - PubMed
    1. Bergkvist D, Astrom I, Josefsson PO, Dahlberg LE. Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients. J Bone Jt Surg Am. 2012;94:1229–1233. doi: 10.2106/jbjs.j.01601. - DOI - PubMed
    1. Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Jt Surg Br. 2011;93:1071–1078. doi: 10.1302/0301-620x.93b8.25998. - DOI - PubMed
    1. Zhang H, Tang H, He Q, et al. Surgical versus conservative intervention for acute Achilles tendon rupture: a PRISMA-compliant systematic review of overlapping meta-analyses. Med. 2015;94:e1951. doi: 10.1097/md.0000000000001951. - DOI - PMC - PubMed
    1. Fischer S, Colcuc C, Gramlich Y, et al. Prospective randomized clinical trial of open operative, minimally invasive and conservative treatments of acute Achilles tendon tear. Arch Orthop Trauma Surg. 2021;141:751–760. doi: 10.1007/S00402-020-03461-Z. - DOI - PubMed

LinkOut - more resources