PURPOSE This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients. METHODS Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation. RESULTS Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: - 6.9° (5.5), acute: - 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury. CONCLUSIONS Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair. LEVEL OF EVIDENCE III.

中文翻译：

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跟腱断裂后早期和晚期修复的强度和临床结果没有差异。


目的 这项回顾性研究旨在确定延迟就诊患者的患者报告和功能结果，这些患者在跟腱断裂损伤后 14 天才接受治疗，并通过微创手术修复，并与一组性别和年龄的患者进行比较。 - 匹配的急性表现患者。根据文献中报告的延迟就诊后的结果，假设自我报告的结果、肌腱伸长、足跟抬高性能、恢复比赛能力和并发症发生率均低于急性治疗患者。方法 通过足够大的切口进行修复，以允许肌腱末端活动，芯线修复由近端改良的 Bunnell 缝合线和远端 Kessler 缝合线以及圆周运行缝合线增强组成。结果 9 名患者在破裂后 21.8 (14.9) 天（范围 14-42 天）就诊。延迟就诊的发生率估计为十分之一。修复后 12 个月时，延迟治疗的患者 ATRS 评分中位数（范围）为 90 (69-99)，而急性就诊患者的 ATRS 评分为 94 (75-100) 0.66 (1.7) (0-5) 天。组间无显着差异：ATRA [平均 (SD) 延迟：- 6.9° (5.5)，急性：- 6° (4.7)]，脚跟抬高高度指数 [延迟：79% (20)，急性：74 % (14)]，或脚跟抬起重复指数[延迟：77% (20)，急性：71% (20)]。在延迟就诊组中，两名患者出现伤口感染，一名患者出现医源性腓肠神经损伤。结论 跟腱断裂后 2 周以上就诊的患者可以通过微创修复成功治疗。证据水平 III.