RETHINKING INFECTION AFTER ACHILLES TENDON REPAIR: A MORE JUDICIOUS APPROACH

Arthur Meuris, Laura Bessems, Timothy Peperstraete, Jolien Onsea, Harm Hoekstra, Willem-Jan Metsemakers

Faculty of Medicine, KU Leuven, Leuven, Belgium • Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium

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466 Patients treated for ATR (2015–2024)
236 Treated surgically (50.6%)
17/236 Postoperative infections (7.2%)
0/17 Reruptures

BACKGROUND

Achilles tendon rupture is a common injury, and operative repair remains an established treatment option in selected patients. Postoperative infection is relatively uncommon, but may lead to impaired wound healing, tendon compromise and repeated surgery [1,2].

Previous experience from our institution showed that wound complications and infection are a relevant burden after open Achilles tendon repair [3]. Evidence guiding the optimal extent and timing of tendon reconstruction after infection remains limited [4,5].

AIM

To evaluate the incidence, microbiological characteristics, management and clinical outcomes of postoperative infection following operative repair of ATR over a 10-year period at a tertiary referral centre.

METHODS

Retrospective single-centre cohort study of postoperative infections following operative Achilles tendon repair over a 10-year period (2015–2024).

Outcomes included infection eradication, treatment burden, rerupture and subsequent Achilles tendon reconstruction. Treatment before referral was analysed separately for referred patients.

INFECTION CHARACTERISTICS

15/17 male (88.2%)
7/17 referrals
Mean age: 49.2 years
Median onset: 4 weeks [IQR 2–6]

MICROBIOLOGY

Culture status:
13/17 positive
8/13 monomicrobial
5/13 polymicrobial
1/17 negative
3/17 not documented

S. aureus: n=7
Coagulase-negative staphylococci: n=4
Enterobacterales: n=4
Streptococcus spp.: n=2
Anaerobic bacteria: n=2

NON-REFERRED PATIENTS (n=10)

Management pathway:
Surgical treatment (n=9)
Thorough debridement
Tendon and/or removal of all foreign-material + No immediate tendon reconstruction (n=6)
Conservative treatment with targeted antibiotics

Outcomes:
9/10 Infection eradication
0/10 Reruptures

One (1/10) patient was managed non-operatively with conservative therapy.

REFERRED PATIENTS (n=7)

Management pathway:
Surgically treated at our centre (n=4)
Thorough debridement
Tendon and/or removal of all foreign-material + No immediate tendon reconstruction (n=4)
Conservative treatment with targeted antibiotics

Outcomes:
4/4 Infection eradication
0/4 Reruptures

Three (3/7) patients had undergone surgical treatment before referral and were subsequently managed conservatively at our centre.

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CONCLUSION & CLINICAL IMPACT

Despite a substantial treatment burden, infection eradication was achieved in 13/14 evaluable patients (92.9%). Our findings suggest that thorough debridement and complete foreign-material removal, followed by conservative treatment with targeted antibiotic therapy and without immediate tendon reconstruction, can achieve reliable infection control with a low risk of rerupture and without the need for subsequent reconstruction.

TAKE-HOME MESSAGE

Thorough debridement and complete foreign-material removal, followed by conservative management without immediate tendon reconstruction, is a viable strategy in patients with infection after Achilles tendon repair.

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REFERENCES

1. Ochen Y, et al. BMJ. 2019;364:k5120.
2. Attia AK, et al. Am J Sports Med. 2019.
3. Van Maele M, et al. Injury. 2018;49:1947–1952.
4. Winters B, et al. Foot Ankle Int. 2019;40:71S–73S.
5. Bowers MW, et al. Foot Ankle Orthop. 2019;4:2473011419846943.

ATR = Achilles tendon rupture.

Contact: Arthur Meuris (arthur.meuris@student.kuleuven.com)