Merkel et al developed a scoring system for comparing outcomes from different surgical techniques to correct a ruptured Achilles tendon.
Categories for evaluation:
(1) load or weight bearing capacity
(2) pain
(3) functional capacity
|
Category for Load (Weight) Bearing Capacity |
Point Assignment |
Maximum Points |
|
standing continuously on both toes |
1.33 points for each second |
40 |
|
standing continuously on toes of ruptured tendon side |
2 points for each second |
60 |
|
number of times can stand on toes (starting with the heel on the floor) on the side with ruptured tendon |
3 points for each time the patient can stand on toes |
60 |
|
difference in maximum torque between normal side and side with ruptured tendon |
deduct 14 points for each 10% difference |
140 |
|
difference in work performance between the normal side and the side with the ruptured tendon |
10 points for each 10% difference |
100 |
maximum points for weight bearing category: 400
|
Category for Pain |
Point Assignment |
Maximum Points |
|
pain at rest |
no pain 90 points; pain from time to time 45 points; intense pain 0 points |
90 |
|
pain on weight bearing |
yes 0 points; no 60 points |
60 |
|
pain at the end of maximal dorsal or plantar flexion by the examiner |
yes 0 points; no 60 points |
60 |
|
distance to first appearance of pain while walking over uneven ground |
< 1 km 0 points; 1 – 5 km 45 points; > 5 km 90 points |
90 |
maximum points for pain category: 300
|
Category for Functional Capacity |
Point Assignment |
Maximum Points |
|
difference in active dorsal flexion between the normal side and the side with the ruptured tendon |
deduct 3 points for each degree of difference |
45 |
|
difference in active plantar flexion between the normal side and the side with the ruptured tendon |
deduct 3 points for each degree of difference |
45 |
|
difference between active and passive dorsal flexion on the side with the ruptured tendon |
deduct 5 points for each degree of difference |
45 |
|
difference between active and passive plantar flexion on the side with the ruptured tendon |
deduct 5 points for each degree of difference |
45 |
|
difference in the maximum kinetic movement dimension (kinetischen Bewegungsausmaß) between the normal side and the side with the ruptured tendon |
deduct 25 points for each 10% difference |
120 |
where:
• I am not quite sure what "kinetischen Bewegungsausmaß" translates to. The category is associated with use of a Dynamometer. It could be full range of motion. Alternatively it could deal with a isokinetic measurement.
maximum points for functional capacity: 300
total score =
= (points for weight bearing) + (points for pain) + (points for functional capacity)
Interpretation:
• minimum total score: 0
• maximum total score: 1000
• The higher the score, the more normal the function on the side with the ruptured tendon.
• A surgical procedure consistently giving higher scores would be the preferred method. In this study the different surgical approaches gave roughly similar scores.
Specialty: Surgery, orthopedic
