Association of Surgical Timing With Complications and Patient-Reported Outcomes After Achilles Tendon Repair

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 (P = .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.