Management and Functional Outcomes After Postoperative Achilles Tendon Infection: A Retrospective Case Series

Achilles tendon repairs and reconstructions have historically been associated with high infection rates because of poor vascularity. However, newer surgical infection control strategies can reduce morbidity associated with infection. We hypothesized that with appropriate treatment and management of these infections, patients can reach high levels of physical function with minimal pain comparable to those without postoperative infection.

Chart review was conducted for all patients who underwent Achilles tendon surgery at our institution between 2011 and 2020. We identified patients who experienced postoperative wound infection requiring return to the operating room. Clinical outcomes, antibiotic type, and duration were recorded. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were sent to all patients at a minimum of 1 year postoperatively.

A total of 1148 patients underwent Achilles tendon surgery, of whom 23 patients (2.0%) experienced a postoperative wound infection requiring surgical intervention. Ten patients who presented from outside institutions with an existing Achilles infection were included for management/outcome descriptions but excluded from risk-factor incidence analyses because of missing index-procedure details, increasing the overall cohort to 33. Among 604 acute repairs, 8 patients (1.32%) developed infections, compared with 15 of 544 chronic tendinopathy cases (2.75%). In chronic cases, graft use was associated with higher infection rate (8.96% vs 0.73%, P < .0001). Patients with postoperative infection demonstrated significantly worse in physical function (46.9 vs 51.6, P = .01) and pain interference (52.1 vs 48.1, P = .03) PROMIS scores. No other PROMIS domains showed significant difference between the 2 cohorts. By 18 months postoperatively, 26 of the 33 patients (78.78%) could toe-walk on the affected side with little to no difficulty.

Early, aggressive management yields good recovery after postoperative infection; however, residual deficits in function and pain persist compared with uninfected peers in our cohort at 2-year follow-up.