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Delayed Achilles tendon rupture presentation: Non-operative management may be the SMART choice
The Foot, Volume: 46, Start page: 101724
Swansea University Author: Nicholas Owen
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DOI (Published version): 10.1016/j.foot.2020.101724
IntroductionThis biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treat...
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IntroductionThis biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Patients were treated using the Swansea Morriston Achilles Rupture Treatment protocol (SMART), which is a physiotherapy led non-operative treatment program.Methods19 patients (16 M:3F) were enrolled and prospectively assessed using ARS/ATRS (PROMS), Ankle ROM and isokinetic peak torque for plantarflexion of the ankle. MRI scans of both the injured and uninjured TA were performed to compare both AP diameter and length.ResultsBoth ATRS and ARS improved between short and long-term follow-up. The mean difference in plantar torque between the injured and uninjured leg was 21.9%. There was no significant difference in ankle plantarflexion or dorsiflexion. There was no significant difference in length of the injured and uninjured TA on MRI. 3 patients failed the SMART protocol requiring surgical fixation.DiscussionThe SMART protocol can be an effective method of treatment even in younger and active patients especially if delay to treatment is less than 12 weeks. It may still be preferable for patients with a large gap size or high functional demand to elect for surgical intervention, but clinicians should consider the SMART protocol as an alternative to surgery and discuss it with some patients as a viable alternative.KeywordsTendoachillesConservativeChronicDelayedAbbreviationsTATendoachillesSMARTSwansea Morriston Achilles Rupture Treatment
Tendoachilles; Conservative; Chronic; Delayed
Faculty of Science and Engineering