Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture

Annukka Saarensilta; Robin Juthberg; Gunnar Edman; Paul W Ackermann

doi:10.1177/23259671221077679

Effect of Surgeon Experience on Long-Term Patient Outcomes in Surgical Repair of Acute Achilles Tendon Rupture

Orthop J Sports Med. 2022 Feb 28;10(2):23259671221077679. doi: 10.1177/23259671221077679. eCollection 2022 Feb.

Authors

Annukka Saarensilta¹, Robin Juthberg¹, Gunnar Edman^{2

3}, Paul W Ackermann^{1

4}

Affiliations

¹ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
² Research and Development, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden.
³ Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden.

Abstract

Background: The effect of surgeon experience on patient outcomes after surgical Achilles tendon rupture (ATR) repair has so far been unknown.

Purpose: To examine whether patient-reported and functional outcomes as well as adverse events after surgical ATR repair differ between orthopaedic specialist surgeons and resident surgeons.

Study design: Cohort study; Level of evidence, 3.

Methods: We retrospectively analyzed data from 295 patients treated with surgical ATR repair with standardized techniques. The level of surgeon experience (specialist vs resident) and number of adverse events (rerupture, infection, and deep venous thrombosis) were recorded. Patient-reported and functional outcomes were assessed 12 months postoperatively using the validated Achilles tendon total rupture score (ATRS) and the heel-rise test, respectively. Analysis of covariance was used to compare differences in outcomes between specialist surgeons and resident surgeons. Pearson chi-square or Fisher exact test was used for analysis of adverse events.

Results: The mean ATRS at 12 months for patients operated on by resident surgeons was significantly higher compared with specialist surgeons (85.9 [95% CI, 80.3-91.5] vs 77.8 [95% CI, 73.8-81.9]; P = .028). In addition, the lateral difference (operated vs unoperated side) in mean total concentric work and number of heel-rise repetitions at 12 months was smaller in patients operated on by resident surgeons (P = .011 and 0.015, respectively). The number of adverse events did not differ significantly between the 2 groups.

Conclusion: Resident surgeons achieved patient-reported and functional outcomes at least as good as those of specialist surgeons in surgical ATR repair, with a similar risk of adverse events.

Keywords: Achilles tendon; Achilles tendon total rupture score; deep venous thrombosis; heel-rise test; infection; patient-reported outcome; postoperative complications; rupture.