A Comparative Analysis of Outcomes Using PROMIS After Operative vs Non-operative Treatment of Achilles Rupture

Abstract

Category: Sports; Ankle Introduction/Purpose: Achilles tendon rupture is a common injury in the adult population. The role of operative and non-operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture. Methods: Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P< 0.05. Results: 216 patients were included (115 Nonoperative, 101 Operative). Patients treated operatively were statistically younger than those treated surgically (35.6±12.3 vs 45.1±15; p< 0.001) with lower BMI (27.8±4.3 vs. 29.5±5.3; p=0.004). Sex distribution among the groups were similar (p=0.933). Both treatment groups improved PROMIS PF, PI, and depression scores (p < 0.001). The mean PF improvement is significantly greater in the operative group (13.2±13.9 vs. 9.5±12.5; p=0.042). There is no statistical difference in the Achilles tendon re-rupture rate between both treatment groups (operative: 2% vs. 4.3%; p=0.344). There was no difference in mean PROMIS PI change (p=0.134) and PROMIS depression (p=0.201). There is no difference in the number of patients that achieve MCID for PF, PI, depression among both treatment groups at the 6-months follow-up period. Conclusion: In patients with Achilles tendon rupture, operative management may lead to statistically significant improvements in patient-reported physical function. However, nonoperative management was associated with similar overall rates of rerupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Both operative and nonoperative management of Achilles tendon rupture are successful treatment options and lead to significant improvement in physical function, pain interference, and depression PROMIS scores. However, there may still be some benefit to performance and function with operative intervention.