Comparison of midterm outcomes of patients with acute Achilles tendon rupture undergoing primary repair vs. augmented repair with a gastrocnemius turn-down flap

Abstract

Abstract Background To explore and compare the midterm outcomes in patients undergoing primary repair vs. augmented repair with a gastrocnemius turn-down flap for acute Achilles tendon rupture. Methods From April 2012 to April 2018, the clinical data of 113 patients with acute Achilles tendon rupture who were treated with primary repair or augmented repair with a gastrocnemius turn-down flap by the same surgeon were retrospectively reviewed. The patients’ preoperative and postoperative scores on the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society Ankle⁃Hindfoot (AOFAS) hindfoot score, the Victorian Institute of Sport Assessment⁃Achilles (VISA-A), the Achilles tendon total rupture score (ATRS), and the Tegner Activity Scale were examined and compared. The postoperative calf circumference of the involved side was measured. A Biodex isokinetic dynamometer was used to evaluate the plantarflexion strength on both sides. The time to return to life and exercise as well as the strength deficits in both groups were recorded. Finally, the correlation analyses between patient characteristics and treatment details with clinical outcomes were conducted. Results In total, 72 patients were included and completed the midterm follow-up. The 45 and 27 patients who were treated with primary repair and augmented repair were assigned to group A and B, respectively. The mean follow-up time was 51.3 months. No serious postoperative complications were reported. No significant between-group differences in any outcomes were observed. It was found that female sex was correlated with poorer VISA-A score (P < 0.01), complete paratendon closure was correlated with higher AOFAS score (P = 0.03), and short leg cast was correlated with higher ATRS score (P = 0.02). Conclusions Augmented repair with a gastrocnemius turn-down flap provided no advantage over primary repair for the treatment of acute Achilles tendon rupture. After surgical treatment, females tend to had poorer outcomes, while complete paratendon closure and short leg cast contribute to better results. Level of evidence Cohort study; Level of evidence, 3.