Surgical Trends in the Treatment of Acute Achilles Ruptures

Abstract

Category: Sports Introduction/Purpose: Historically, nonoperative treatment of acute Achilles tendon ruptures was felt to have significant re-rupture rates. With improved functional rehabilitation, recent studies have shown decreased rates of tendon re-rupture. Recent randomized control trials circa 2010 have shown no difference in re-ruptures between early functional rehabilitation and surgical repair. The goal of this study was to evaluate trends in surgical treatment of Achilles ruptures, based on data obtained from the American Board of Orthopaedic Surgery (ABOS), in response to evolving level I evidence. Methods: All operative cases submitted by part II applicants from 2003 to 2015 for primary board certification by the American Board of Orthopaedic Surgery (ABOS) were retrospectively reviewed. Isolated primary Achilles tendon repairs for acute ruptures were identified by ICD-9 and CPT code. Surgeon information including fellowship training and geographic region, and patient information including age, sex, and complications were collected. Results: Out of 1,118,457 cases, there were 4792 Achilles repairs (0.43%) with 510 complications (10.6%). The rate of Achilles repairs increased from 2006 to 2010, when rates peaked at 0.57% of all collected cases (Figure 1). Since 2010, there has been a decrease in rates back to pre-2006 values. The changing rates appear to be largely driven by non-fellowship trained orthopaedic surgeons. The rates of sports and foot and ankle fellowship trained surgeons had mild increases in 2006 and decreases in 2010, but overall have slightly increased. The rate for patients greater than 65 have decreased from 2002 to 2004. Since then, there have been yearly variations, with minimal overall change. Examination of regional differences demonstrate the greatest change in the Northeast. All regions had increased rates in 2006 and decreased rates in 2010, with the exception of the Northwest and South regions, who showed little overall change. Conclusion: Surgical trends for Achilles ruptures corresponded closely to high impact level 1 publications in the literature in 2005 and 2010, suggesting evidence-based responsiveness in newly trained orthopaedic surgeons. These trends are less pronounced in the Northwest and South regions and for sports and foot and ankle specialists.