FUNCTIONAL OUTCOME OF UNTREATED TENDO-ACHILLES RUPTURE IN THE OLDER PATIENT

Abstract

The purpose of this study was to investigate the functional outcome of a group of patients following completely neglected tendo-achilles ruptures.

Between July 2001 and July 2002 we identified 6 patients who presented to the Foot and Ankle Service in Oxford with 7 chronic untreated complete ruptures of the tendo-achilles. There were 4 males and 2 females and the average age was 65 years (range 52 to 79). The average time since injury was 12.2 months (range 7 to 24). None of them had undergone any modality of treatment for this condition. From the history, a definite acute injury was confirmed in each patient. All patients had a palpable defect in the tendo-achilles between 4 and 8 cm from the insertion and the defects measured from 10 to 32 mm. In all case the Thompson test confirmed ongoing discontinuity and single leg heel raise was not possible on the affected side. Each patient was assessed using the scoring system of Leppilahti and concentric and eccentric power were assessed using the Kin-Com Dynamometer. The results indicate an average Leppilahti score of 65/100 with 1 excellent, 0 good, 3 fair and 2 poor. The isokinetic strength measurements demonstrated that plantar flexor power was on average 36% weaker than the normal side. These differences were most marked at the higher test speeds, which were on average 16% weaker than at the lowest test speed in the affected leg. Five out of 6 patients were pain free, with only one reporting mild pain. Objective testing demonstrated no differences in the range of movement between the injured and the normal side. All patients were satisfied with the outcome; however, most had some reservations, which related to ongoing weakness that prevented recreational activity.

Conclusion: At one year after injury the completely neglected tendo-achilles rupture in the older population is likely to be pain-free, to have full active ankle movement and to recover two-thirds of the power of plantar flexion compared to the unaffected limb. Ongoing weakness will prevent recreational activity but has minimal affect on activities of daily living including stair-climbing ability. We have established a benchmark of the natural history of this condition in the older patient against which the results of surgical treatment can be compared.