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Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice

Daniel M.G. Winson, Rory MacNair, Anne-Marie Hutchinson, Nicholas Owen Orcid Logo, Rhodri Evans, Paul Williams

The Foot, Volume: 46, Start page: 101724

Swansea University Author: Nicholas Owen Orcid Logo

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DOI (Published version): 10.1016/j.foot.2020.101724

Abstract

IntroductionThis biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treat...

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Published in: The Foot
ISSN: 0958-2592
Published: Elsevier BV 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa54942
first_indexed 2020-09-15T13:25:56Z
last_indexed 2021-04-28T03:19:29Z
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spelling 2021-04-27T16:03:17.8930347 v2 54942 2020-08-11 Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice 360b7822fd760c7d73a1b0ca5bce1c07 0000-0002-7067-8082 Nicholas Owen Nicholas Owen true false 2020-08-11 EAAS IntroductionThis biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program.Methods19 patients (16 M:3F) were enrolled and prospectively assessed using ARS/ATRS (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length.ResultsBoth ATRS and ARS improved between short and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. 3 patients failed the SMART protocol requiring surgical fixation.DiscussionThe SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.KeywordsTendoachillesConservativeChronicDelayedAbbreviationsTATendoachillesSMARTSwansea Morriston Achilles Rupture Treatment Journal Article The Foot 46 101724 Elsevier BV 0958-2592 Tendoachilles; Conservative; Chronic; Delayed 1 3 2021 2021-03-01 10.1016/j.foot.2020.101724 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University 2021-04-27T16:03:17.8930347 2020-08-11T10:22:47.7164133 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences Daniel M.G. Winson 1 Rory MacNair 2 Anne-Marie Hutchinson 3 Nicholas Owen 0000-0002-7067-8082 4 Rhodri Evans 5 Paul Williams 6 54942__19006__78a46fa7ec0148c3830a35db5ae63f54.pdf 54942.pdf 2021-01-08T16:29:14.0804953 Output 407137 application/pdf Accepted Manuscript true 2021-08-08T00:00:00.0000000 Released under the terms of a Creative Commons Attribution Non-Commercial No Derivatives License (CC-BY-NC-ND) true eng https://creativecommons.org/licenses/by-nc-nd/4.0/
title Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
spellingShingle Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
Nicholas Owen
title_short Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
title_full Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
title_fullStr Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
title_full_unstemmed Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
title_sort Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
author_id_str_mv 360b7822fd760c7d73a1b0ca5bce1c07
author_id_fullname_str_mv 360b7822fd760c7d73a1b0ca5bce1c07_***_Nicholas Owen
author Nicholas Owen
author2 Daniel M.G. Winson
Rory MacNair
Anne-Marie Hutchinson
Nicholas Owen
Rhodri Evans
Paul Williams
format Journal article
container_title The Foot
container_volume 46
container_start_page 101724
publishDate 2021
institution Swansea University
issn 0958-2592
doi_str_mv 10.1016/j.foot.2020.101724
publisher Elsevier BV
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences
document_store_str 1
active_str 0
description IntroductionThis biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program.Methods19 patients (16 M:3F) were enrolled and prospectively assessed using ARS/ATRS (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length.ResultsBoth ATRS and ARS improved between short and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. 3 patients failed the SMART protocol requiring surgical fixation.DiscussionThe SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.KeywordsTendoachillesConservativeChronicDelayedAbbreviationsTATendoachillesSMARTSwansea Morriston Achilles Rupture Treatment
published_date 2021-03-01T07:56:06Z
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