Postoperative Noncompliance following Repair of Acute Achilles Tendon Ruptures

Abstract

Category: Trauma; Ankle; Hindfoot; Sports Introduction/Purpose: Patient compliance with postoperative instructions is an important aspect of the orthopaedic surgery treatment regimen and can be a substantial deciding factor in achieving good outcomes. The postoperative period following acute Achilles tendon repairs requires diligent patient compliance in order to achieve optimal outcomes. The purpose of this study was to report the incidence of postoperative noncompliance and determine independent predictive factors of noncompliance following surgical management of acute Achilles tendon ruptures. Methods: A retrospective review of patients undergoing primary open repair of acute Achilles tendon ruptures with a single fellowship-trained orthopaedic foot & ankle surgeon at a single surgical location from 2010-2017 was performed. Patients 21 days from the date of injury, those whose repair required a V-Y advancement, or those with bilateral tendon ruptures were excluded. Patient records were reviewed for collection of patient data and postoperative chart notes were reviewed to document instances of noncompliance. Instances were subcategorized into non- accidental or accidental. Multivariable regression analysis was performed to determine independent predictors of noncompliance. Regression coefficients with 95% confidence intervals [95% CI] and p-values were reported for significant findings. Mann-Whitney U tests were used to compare Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports scores and Visual Analog Scale (VAS) pain scores between compliant and noncompliant groups. Results: Of 232 patients meeting the inclusion criteria, 19 (8.2%) patients had 21 documented instances of noncompliance during the first 12 postoperative weeks, with 7/21 (33.3%) occurring during the first 2 postoperative weeks, 8 (38.1%) between weeks 3- 6, and 6 (28.6%) between weeks 7 and 12. Sixteen of the 21 (76.2%) instances of noncompliance were determined to be non- accidental, while 5 (23.8%) were accidental. Multivariable analysis demonstrated male sex (0.10 [0.00, 0.19]; p=0.0498) to be an independent predictor of non-accidental noncompliance. Age, BMI, a history of depression or diabetes, mechanism of injury, and timing of surgery following injury were not predictive of postoperative compliance. At mean 4.7 (range, 2.0-8.3) years postoperatively, the groups did not differ in FAAM-ADL (p=0.4311), FAAM-Sports (p=0.4258), or VAS pain (p=0.5050) scores. Conclusion: Postoperative noncompliance following surgical Achilles tendon repair occurs in nearly 1 out of every 12 patients, based on our cohort. Males, who make up the majority of Achilles tendon ruptures, have increased rates of non-accidental noncompliance. Patient noncompliance is an issue for orthopaedic surgeons of all subspecialties, and further investigations of incidence and risk factors should take place across a variety of commonly performed surgeries.