Hewitt Michael A, Stark Samuel D, Vlasak Alexander L, Kalma Jeremy J, Buckley Sara E, Drexelius Katherine D, Metzl Joshua A, Hunt Kenneth J
Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Orthop J Sports Med. 2025 Aug 22;13(8):23259671251365622. doi: 10.1177/23259671251365622. eCollection 2025 Aug.
Achilles tendon ruptures pose a challenging recovery for patients, and complications after surgical repair are often associated with poor patient outcomes. The optimal timing for surgery remains a topic of debate and has not been extensively studied.
To determine whether the time from Achilles rupture injury to surgical repair is associated with postoperative complication rates and long-term patient-reported outcomes (PROs).
Cohort study; Level of evidence, 3.
Patients undergoing surgical treatment for an Achilles rupture between 2016 and 2022 were retrospectively reviewed. Patients were stratified based on time-to-surgery (acute: 0-6 days, subacute: 7-13 days, delayed: 14-41 days, and chronic: 42+ days) and operative technique (open vs percutaneous). Surgical complications were assessed using clinical notes, while PROs-including Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF, PROMIS Pain Interference (PI), and Foot and Ankle Single Assessment Numeric Evaluation (FA SANE)-were collected via a digital survey. A minimum clinical follow-up of 3 months was required for inclusion in the complication analysis, and a minimum survey follow-up of 6 months was required for inclusion in the PRO analysis.
Complications were assessed in 350 patients: 116 acute (33%), 131 subacute (37%), 78 delayed (22%), and 25 chronic (7%). A total of 64 complications occurred in 56 patients (16%): 14 minor wound complications (4%), 8 major wound complications (2.3%), 13 reruptures (3.7%), 15 deep vein thromboses (4.3%), 3 sural nerve injuries (0.9%), and 9 cases of neuropathic pain (2.6%). There was no clinically meaningful difference in complication rates among the time-to-surgery cohorts. PROs were available for 146 patients (42%), with a mean follow-up of 23.8 ± 15.6 months and a similar distribution of time to surgery (33% acute, 44% subacute, 17% delayed, and 6% chronic). The mean postoperative PROMIS PF scores were highest in the acute group and decreased in later time-to-surgery groups ( = .016). No significant differences were found between groups with respect to PROMIS PI or FA SANE scores.
The timing of surgical intervention after an Achilles tendon rupture did not significantly affect the overall postoperative complication rate. However, patients treated within the first week reported higher PF scores at the follow-up.
跟腱断裂给患者的恢复带来挑战，手术修复后的并发症往往与患者预后不良相关。手术的最佳时机仍是一个有争议的话题，尚未得到广泛研究。
确定从跟腱断裂损伤到手术修复的时间是否与术后并发症发生率及患者长期报告结局（PROs）相关。
队列研究；证据等级，3级。
对2016年至2022年间接受跟腱断裂手术治疗的患者进行回顾性分析。根据手术时间（急性：0 - 6天，亚急性：7 - 13天，延迟：14 - 41天，慢性：42天及以上）和手术技术（开放手术与经皮手术）对患者进行分层。使用临床记录评估手术并发症，同时通过数字调查收集PROs，包括患者报告结局测量信息系统身体功能（PROMIS PF）、PROMIS疼痛干扰（PI）以及足踝单项评估数字评分（FA SANE）。纳入并发症分析的患者需至少有3个月的临床随访，纳入PRO分析的患者需至少有6个月的调查随访。
对350例患者进行了并发症评估：116例急性（33%），131例亚急性（37%），78例延迟（22%），25例慢性（7%）。56例患者（16%）共发生64例并发症：14例轻微伤口并发症（4%），8例严重伤口并发症（2.3%），13例再次断裂（3.7%），15例深静脉血栓形成（4.3%），3例腓肠神经损伤（0.9%），9例神经性疼痛（2.6%）。手术时间队列之间的并发症发生率无临床意义上的差异。146例患者（42%）有PROs数据，平均随访23.8 ± 15.6个月，手术时间分布相似（33%急性，44%亚急性，17%延迟，6%慢性）。急性组术后PROMIS PF平均得分最高，在手术时间较晚的组中得分降低（P = 0.016）。在PROMIS PI或FA SANE得分方面，各组之间未发现显著差异。
跟腱断裂后手术干预的时机对总体术后并发症发生率没有显著影响。然而，在第一周内接受治疗的患者在随访时报告的PF得分较高。
