Achilles Tendon Repairs in Adolescent and Young Adult Athletes <25 Years Old: A Retrospective Multicenter Case Series

Background: The outcomes of Achilles tendon tears have been minimally investigated in adolescents and young adults, with sparse literature-based evidence to guide management. Purpose/Hypothesis: The purpose of this study was to describe the demographics, presentation, treatment, complications, and long-term functional follow-up including patient-reported outcomes (PROs), and return-to-sport (RTS) rates of adolescent and young adult athletes with Achilles tendon ruptures. It was hypothesized that despite high activity demands, perioperative complication rates would be low and RTS rates high. Study Design: Case series; Level of evidence, 4. Methods: Records were reviewed of all patients aged <25 years treated at 1 of 2 pediatric tertiary care centers for an Achilles tendon tear or laceration between 2004 and 2018. Demographics, imaging, treatment, and clinical follow-up data were retrospectively collected. Patients ultimately managed without surgery were rare and excluded. Patients with >1 year of clinical follow-up or those who responded to prospective patient outreach for PRO collection were investigated for clinical outcomes, utilizing the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale (TAS), and questions about reinjury and RTS. Results: Of the 38 patients identified, 24 (63%; mean age, 18.9 years; range, 10.4-22.8 years; 42% male) were analyzed for clinical outcomes. A total of 22 patients (92%) had complete tears, 2 had partial tears. Twenty patients (83%) returned questionnaires at a median 6.3 years (IQR, 3.4-9.7 years) while the other 4 patients were seen in clinic at a median of 1.2 years (IQR, 1.0-1.8 years) following injury. The median postoperative ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (IQR, 4-8). Median FAOS scores were excellent for symptoms (91), pain (100), activities of daily living (100), and sports (98) and good for quality of life (88). The 6-month RTS probability was 47% (95% CI, 19%-66%) and at 12 months was 95%. The median time to RTS for partial tears was 5.6 months versus 6.6 months for complete tears ( P = .05). Seven patients (29%) experienced a perioperative complication including 3 cases of delayed wound healing (13%) and 1 tendon retear (4%), which underwent revision repair. Conclusion: Adolescent and young adult athletes surgically treated for high-grade Achilles injuries had favorable long-term outcomes, low rerupture rates, and median RTS timing (~6 months) similar to that reported in adult studies.