83: Dr. Bonnie Chien: Achilles Injuries (Part 2)

Welcome back to The Sports Docs Podcast!  In this episode, we’re going to continue our discussion with Dr. Bonnie Chien and focus on surgical treatment for Achilles tendon ruptures.Our conversation picks back up with an article from the March 2023 issue of AJSM titled “Outcomes and Complications of Open Versus Minimally Invasive Repair of Acute Achilles Tendon Ruptures.” This Level I meta-analysis included 10 RCTs and found no difference in AOFAS scores and rate of total complications, re-ruptures, deep infections, skin necrosis, wound dehiscence, adhesions or keloid scars. But there were some significant differences between the groups.Open repair was associated with significantly longer surgical time, higher risk of superficial infections and higher risk of ankle stiffness. Minimally invasive repair was associated with a higher rate of sural nerve injury, 3.4% compared to 0% in the open group.Next up is a level I RCT from the June 2020 issue of AJSM titled “Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair.” Patients were randomized to either a traditional rehab group with weightbearing at 6 weeks or an accelerated rehab group with graduated weightbearing starting at 2 weeks. All patients were found to have tendon lengthening after surgery with no significant differences found in overall lengthening between traditional and accelerated rehab groups. There were also no differences noted in ankle range of motion or outcome scores between the groups.We finished up with an article from the October 2017 issue of AJSM titled “Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.” This level III cohort study looked at return to play rates and performance among professional athletes after Achilles tendon repair in the NFL, NBA, MLB and NHL. The authors found that 30% of athletes with an isolated Achilles rupture were unable to return to play at all after surgical repair. Those that were able to return to play had significantly less play time, less game played and played significantly worse compared to their pre-op performance levels. NBA players were most affected.