Oslo Sports Trauma Research Center

Intoduction

Rupture of the midsubstance of the Achilles tendon typically occurred in a 30-40 year-old male recreational athlete. The most common treatment is surgical suturing the rupture tendon end to end, despite this a certain proportion of the patients do have post-injury problems. In order to prevent this kind of injury exact knowledge of the risk factors is needed and in this area there is certainly a lack of knowledge today. A new study published in the February issue of Scandinavian Journal of Medicine & Science in Sports it is shown that this injury indicate a risk of 176 times to also have a contralateral rupture. If this increased risk is linked to specific sports activities or it is genetic factor involved is unknown today.

An achilles rupture on one side increases the risk of contralateral rupture 176 times!

The study was done as a cohort study among the patients submitted to theAkershusUniversityHospitalfrom September 1990 to April 1997. This hospital is responsible for providing acute surgical care for 320 000 people. All patients (168) were treated by a standard surgical procedure by end to end suture of the rupture tendon. Postoperatively a cast was used for 6 weeks while the patients using crutches. After removal of the cast gradually weight bearing was introduced until recovered of normal daily activities. Sports demanding explosive muscle power were avoided for 6 months.

Four years later a self reporting form was mailed to the patients about the injury, postinjury problems, recovering sports activities, scar problems etc. The respond of this questionnaire was 92 %.

The results demonstrate that this kind of injury is more frequent among male athletes and often occurred during indoor ball games demanding forceful short runs. About half of the patients are suffering form some kind of problems after this kind of injury despite surgical treatment and it is hard to regain the same athletic activity as previously. In comparison about one quarter had some kind of Achilles problems preinjury. The most striking results was the high frequency of contralateral rupture even though this was short time observation study (4 years), ten patients were treated for the same injury on the contralateral side. This is a significant increased risk of 176 times in comparison with the general population risk. Further studies are needed to reveal if different rehabilitation procedure focusing both sides can reduce this risk.

The principal investigator for this study was Asbjørn Årøen at the Oslo Sports Trauma Research Center and Department of Orthopaedics Akershus University Hospital who did the data collection in cooperation with Dan Helgø. Odd Granlund and professor Roald Bahr, the chair of the Oslo Sports Trauma Research Center did a major contribution in analysing and writing up this study for publication.