Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Insertional Achilles tendon injuries present unique challenges in orthopedic and sports medicine. Surgical repair options include direct tendon repair or reconstruction using a graft, each with its own set of benefits and risks. Although this condition typically affects an older population, we are seeing a decrease in the age of this population with recreational sports becoming popular thus inducing further injuries and stress. The purpose of this study is to evaluate the patient demographics that receive a repair with graft for insertional Achilles tendinitis (IAT).
Methods:
This was a retrospective multi-surgeon single institution cohort study reviewing the demographics of patients who had a surgical repair for IAT. Demographics, medical history, surgical details, and patient-reported outcomes were recorded. We excluded patients with a BMI over 30. Patient-reported outcomes were assessed using the Foot and Ankle Ability Measure Visual Analog Scale (FAAM-VAS) score.
Results:
753 patients were identified (557 without vs 196 with graft). Individuals receiving a graft were older (45.5 vs 40.0 years, p< 0.001). They also had a higher BMI (26.8 vs. 26.0, p=0.010) and CCI (0.82 vs. 0.42, p< 0.001). The reinforcement group had a higher proportion of females (24.0% vs. 16.7%, p=0.035) and experienced significantly longer time to surgery (58.8 vs. 21.4 days, p< 0.001). Preoperative physical therapy and steroid injections were more common in the reinforcement group (p < 0.001). There were no significant differences in revision, readmission, or the need for additional treatments. Postoperative function, measured by the Delta FAAM VAS score, showed greater improvement in the non-reinforcement group (-18.30 vs. -1.39, p=0.033).
Conclusion:
Our findings indicate that age, sex, BMI, CCI, and exhaustion of conservative treatments influence a surgeon’s decision when implementing a graft in an IAT repair.