Rerupture and Deep Infection Following Treatment of Total Achilles Tendon Rupture

Background: The incidence of total Achilles tendon rupture has increased, but we are not aware of any reports on the incidence of reruptures or deep infections following treatment. The outcome after successful treatment is good, but that after complications has not been well documented. Methods: A group of 409 patients with a complete Achilles tendon rupture was treated at a university hospital orthopaedic unit between 1979 and 2000. Twenty-three reruptures (prevalence, 5.6%) and nine deep infections (prevalence, 2.2%) occurred in twenty-nine patients. We retrospectively reviewed the records of these patients to determine the overall incidence of ruptures, reruptures, and deep infections and to record the known risk factors for these major complications. We analyzed the final clinical outcome for twelve patients with a rerupture and seven patients with a deep infection at a mean of 4.1 years after the initial treatment. Results: The annual incidence of reruptures (per 100,000 inhabitants) increased from 0.25 in 1979-1990 to 1.0 in 1991-2000, and that of deep infections increased from 0 in the 1980s to 0.63 in the 1990s. The ratio of complications to primary ruptures did not change. The patients with deep infections were significantly older, received corticosteroid medication more often, had sustained the tendon injury during everyday activities more often, and had a longer delay before treatment than the patients with simple reruptures. At 4.1 years after the primary treatment, eight of twelve patients in the rerupture group had a satisfactory clinical outcome and the overall average isokinetic plantar flexion strength deficit in that group was only 10%. In contrast, two of the patients in the infection group had a fair clinical outcome and five had a poor outcome, and the average isokinetic plantar flexion strength deficit in that group was 35%. Conclusions: The incidence of Achilles tendon reruptures and deep infections has increased. The outcome is satisfactory after a simple rerupture without infection, but the results after a deep infection are often devastating.