PROMIS Outcomes After Operative vs Nonoperative Treatment of Achilles Rupture

Abstract

Background: Achilles tendon rupture is a common injury in the adult population. The role of operative and nonoperative management remains controversial. The purpose of this study is to evaluate and compare patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and nonoperative treatment of acute Achilles rupture.

Methods: Patients with Achilles ruptures were identified as either undergoing surgical repair or nonoperative functional rehabilitation. The primary outcomes were PROMIS physical function (PF), pain interference (PI), and depression scores. These were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method was used to determine the minimal clinically important difference (MCID), which was ½ SD of each PROMIS domain. These values were further used to calculate the percentage of patients who returned to population mean PROMIS scores at final follow-up. Secondary outcomes included deep vein thrombosis (DVT), wound healing, infections, and reruptures.

Results: A total of 216 patients were included (115 nonoperative, 101 operative). Patients treated operatively were younger (35.6 vs 45.1 years, P < .001), with slightly lower BMI (P = .011). Sex distribution among the groups were similar (P = .933). Both treatments improved PROMIS PF, PI, and depression scores. Although there was a trend toward achieving population means in PF earlier in the operative group, the groups equalized over time, with no statistically significant difference between treatment groups for the percentage of patients who were below, at, or above population mean PROMIS values at 6 months and final follow-up. There was no difference in rerupture rates or identified DVTs. However, there were increased wound issues in the operative group (P = .035), with 12.8% symptomatic scarring, 6% infections, 3% delayed healing, and 3% with palpable nodules, compared with 1 case of cellulitis in a nonoperative patient.

Conclusion: In our patients with an Achilles tendon rupture, on average, operative management was not associated with statistically meaningful differences in patient-reported physical function compared with nonoperative treatment. Surgery also comes at the cost of increased wound/complication rates and was associated with modestly slower improvement in pain and depression scores.

Level of evidence: Level III, retrospective cohort study.

Keywords: Achilles rupture; Achilles tendon; rehabilitation; surgery.