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Journal Article


Reb CW, McDonald E, Shakked RJ, Winters BS, Pedowitz DI, Raikin SM, Daniel JN. Foot Ankle Spec. 2019; ePub(ePub): 1938640019843316.


Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND).


(Copyright © 2019, SAGE Publishing)






BACKGROUND: This study evaluated when patients' brake response time (BRT) recovers after right Achilles repair.

METHODS: Institutional review board-approved prospective study of 60 patients. Assessments included visual analogue scale pain (VAS) score, Achilles Tendon Total Rupture Score (ATRS), and a driver readiness survey. Emergent brake pedal operation was simulated at 6 weeks postoperatively and repeated until patients achieved a passing BRT.

RESULTS: Fifty-seven patients completed the study. At 6 weeks, 54 of 59 (91.5%) patients had a passing BRT with a mean of 0.60 seconds (SD 0.08 seconds). Five (8.5%) patients had a failing BRT with a significantly higher mean of 0.95 seconds (SD 0.13 seconds, P =.01). At first testing, all patients were ambulating in a walking boot with removable heel wedges. Those who passed were using significantly fewer wedges (mean 1.9 vs 2.6 wedges, P =.04). Mean VAS pain scores (Passed: 1.1, SD 1.57, vs Failed: 2.8, SD 3.35, P =.32) were not significantly different. The mean ATRS was significantly lower among those who passed (63.7, SD 16.7, vs 85.4, SD 11.1, P =.01. Three patients repeated testing at a mean 7.3 weeks (range 6.7-8). All achieved passing times (mean 0.68 seconds, range 0.55 to 0.77 seconds). The driving readiness survey was 100% sensitive but 31.3% specific for passing BRT. Its positive predictive value was 80%, and its negative predictive value was 100%.

CONCLUSION: BRT normalizes around 6 to 7 weeks after open right Achilles tendon repair. The ATRS and driver readiness questionnaire corresponded to achieving a passing BRT. LEVELS OF EVIDENCE: Prognostic Level II: Prospective Cohort Study.

Language: en


Achilles surgery; brake reaction time; drive; driving; outcome studies


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