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

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.

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

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

Clinical examination. Comparison of clinical findings after conservative (light grey) and surgical treatment (dark grey) after Achilles tendon rupture

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

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

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

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

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