Achilles tendon rupture:current clinical practice, imaging and outcome

Achilles tendon rupture is a sports injury that results in significant impairments. Despite multiple randomized studies, the optimal treatment strategy for Achilles tendon rupture is still topic of debate. In this thesis Dams focuses on clinical practice, imaging and outcome of Achilles tendon rupture. Dams shows significant variation in care among treating Dutch surgeons. Clinical practice does not (yet) adhere to current scientific evidence. The role of imaging in clinical practice and scientific research is evaluated. Imaging provides supplemental information and is useful as an adjunct for diagnosis and monitoring treatment-progress. The use of novel imaging techniques to study tendon structure, such as ultrasound tissue characterization (UTC), is insufficiently reported. A multicenter prospective cohort study with 50 patients was initiated to evaluate the outcome concerning tendon structure, function and activities and participation. Additionally, this study establishes the responsiveness of the only valid and reliable injury-specific outcome measure, the Achilles Tendon total Rupture Score (ATRS-NL). Dams confirms significant deficits in tendon function and sport participation. Despite this, patients report adequate outcome, suggesting an adaptation to the impairments of injury. Additionally, psychological factors such as motivation, psychological readiness and kinesiophobia evolve during recovery and are associated with sport participation and performance. Finally, UTC shows inferior tendon structure, persisting up to one year after injury. Dams suggests an interaction between tendon structure and function explaining the long-term impairments. The results and insights from this research will be used for further research and improving the care of Achilles tendon rupture