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14 Individual treatment selection for acute achilles tendon rupture based on the copenhagen achilles length measurements (CALM)
  1. Kristoffer Weisskirchner Barfod1,
  2. Maria Swennergren Hansen2,
  3. Håkon Sandholdt1,
  4. Anders Boesen1,
  5. Per Holmich1,
  6. Anders Troelsen3,
  7. Morten Tange Kristensen2
  1. 1Sports Orthopedic Research Center – Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  2. 2Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denamrk
  3. 3Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark


Background Acute Achilles tendon rupture (ATR) can be treated operatively or non-operatively. An evidence based selection tool is needed to guide choice of treatment.

Purpose To investigate if treatment selection in patients with ATR can be guided by Amlang’s ultrasound classification (AmC) or the Copenhagen Achilles Length Measurement (CALM).

Methods The study was performed as a prospective cohort study. Patient were 18 to 70 years and treated non-operatively. AmC and CALM were performed at baseline and correlated to outcome at 1 year. The primary outcome was the Achilles tendon Total Rupture Score (ATRS). Secondary outcomes were: heel-rise-work test, re-rupture rate and CALM at 1 year. ROC analysis was performed to determine a cut off for acceptable elongation of CALM at baseline given that elongation at 1 year was not to exceed 10%. Identifier: NCT02062567.

Results CALM was performed at baseline in 130 patients and AmC in 109. AmC showed no statistically significant correlation to any outcome parameter. CALM at baseline correlated to CALM at 1 year r=0.214 (p<0.01). The ROC model had AUC=0.67. An elongation of 7% at baseline had a sensitivity of 0.77 and specificity of 0.50.

Conclusions Elongation of the Achilles tendon at baseline measured with CALM was weakly correlated to elongation at 1 year follow up suggesting that CALM at base line can predict elongation at one year. A cut off of 7% elongation at baseline would have caught 77% of patients who ended up with an elongation above 10% at 1 year.

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