Same Diagnosis, Different Outcomes: Clinical Impact of Tear Level and Gap Distance in Achilles Tendon Ruptures

Although various surgical techniques are applied in the treatment of Achilles tendon ruptures, the impact of rupture localization, particularly the distance from the insertion point on functional outcomes remains unclear. This study aims to investigate the relationship between rupture level, surgical timing, techniques, and patient-reported outcomes.

This retrospective study analyzed 32 patients (30 males, 2 females; median age 45 years, IQR (Interquartile Range): 35-55) who underwent surgical repair for acute Achilles tendon rupture between January 2021 and December 2023. Patients were classified based on rupture location (proximal > 6 cm vs. distal ≤ 6 cm from calcaneal insertion), surgical timing(early ≤ 7 days vs. delayed > 7 days), and technique (open vs. percutaneous). Primary outcomes included Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores at minimum 6-month follow-up. Second- ary outcomes included return to activity, complications, and patient satisfaction.

Complete rupture location data was available for 17 patients. Patients with distal ruptures showed numerically higher functional scores compared to proximal ruptures (ATRS: 88.1 ± 7.5 vs. 80.4 ± 11.2, p = 0.117; AOFAS: 93.5 ± 4.0 vs. 86.7 ± 7.8, p = 0.089), though these differences did not reach statistical significance. The observed effect size was moderate to large (Cohen's d = 0.808 for ATRS, d = 1.067 for AOFAS). Overall functional outcomes were favorable with median ATRS score of 87 (IQR: 80-92) and AOFAS score of 92 (IQR: 88-96). Clinical success rates indicated that 78.1% of patients achieved good or satisfactory results (ATRS ≥ 80 points) and 90.6% achieved AOFAS scores ≥ 85. No differences were observed between open and percutaneous repair techniques (ATRS: 84.2 ± 10.1 vs. 86.5 ± 9.2, p = 0.57). Early surgery (≤ 7 days) showed a trend toward higher scores compared to delayed surgery (ATRS: 86.0 ± 9.5 vs. 80.2 ± 11.8, p = 0.31), though this difference was not statistic- ally significant. No major complications or re-ruptures occurred during follow-up.

Distal Achilles tendon ruptures may be associated with higher functional outcomes, though larger studies are needed to confirm this finding. Both open and percutaneous repair tech- niques appear to provide satisfactory results. Early surgical intervention within 7 days may be benefi- cial, though the evidence suggests rather than confirms this advantage. These findings could be con- sidered in location-specific treatment planning and suggest that contemporary surgical approaches may be effective for Achilles tendon rupture repair.