Acute Achilles Tendon Ruptures: An Update on Treatment

Kadakia, Anish R.; Dekker, Robert G.; Ho, Bryant S.

doi:10.5435/jaaos-d-15-00187

Cited by 71 publications

(73 citation statements)

References 42 publications

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“…[21][22][23][24] Poor vascularisation negatively affects the inflammation that is essential for the restoration of the mechanical and biological properties of tendons during the healing process. 25,26 Ageing tenocytesthe dominant cell type in tendonstend not to be able to facilitate the proper differentiation of progenitor cells, resulting in ineffective healing. This leads to scar formation rather than tendon tissue regeneration, which results in reduced tensile strength.…”

Section: Healing Of the Tendon (Repair And Regeneration)mentioning

confidence: 99%

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

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Background Achilles tendon rupture (ATR) has a long healing period, which is challenging for patients and clinicians. Platelet-rich plasma (PRP) is an autologous concentration of platelets thought to improve tendon function recovery. Although preliminary research has indicated positive effects, there is, as yet, no evidence of clinical efficacy from adequately powered robust clinical trials. Objectives The objectives were to determine the clinical efficacy of PRP in patients with acute ATR using an objective mechanical muscle–tendon function measure and patient-reported outcome measures (PROMs), and to determine which PRP components contribute to its mechanism. Design This was a multicentre, parallel-group, participant- and outcome assessor-blinded randomised controlled trial (RCT) comparing PRP with placebo. Two embedded substudies investigated the PRP’s quality and composition and its effects on healing tendon tissues. Setting This trial was set in trauma and orthopaedic surgery departments in 19 NHS hospitals in England and Wales. Participants Adults with acute ATR presenting within 12 days of injury to be treated non-surgically were eligible. Patients with platelet dysfunction or leg functional deficiency were excluded. Interventions Participants were randomised 1 : 1 to the PRP injection group or the placebo group (dry needle in the rupture gap) by central computer-based randomisation using minimisation, stratified by centre and age. Main outcome measures The primary outcome measure was the Limb Symmetry Index (LSI) of work during the heel-rise endurance test at 24 weeks. Secondary outcomes measures, collected at 4, 7, 13 and 24 weeks, were repetitions, maximum heel-rise height, Achilles tendon Total Rupture Score (ATRS), quality of life (as measured using the Short Form questionnaire-12 items version 2), pain and participant goal attainment. Needle biopsies of the affected tendon zone were taken under ultrasound guidance at 6 weeks from 16 participants from one centre. Whole blood was analysed for cell count. PRP was analysed for cell count, platelet activation and growth factor concentration. The primary analysis was intention to treat. Results A total of 230 participants were randomised: 114 to the PRP group (103 treated) and 116 to the placebo group (all treated). One participant withdrew after randomisation but before the intervention. At 24 weeks, 201 out of 230 participants (87.4%) completed the primary outcome and 216 out of 230 participants (93.9%) completed the PROMs. The treatment groups had similar participant characteristics. At 24 weeks, there was no difference in work LSI (mean difference –3.872; 95% confidence interval –10.454 to 2.710; p = 0.231), ATRS, pain or goal attainment between PRP- and placebo-injected participants. There were no differences between the groups in any PROM at any time point or in complication rates, including re-rupture and deep-vein thrombosis. There was no correlation between work LSI and platelet activation in PRP, or erythrocyte, leucocyte or platelet counts in whole blood or PRP. Biopsies showed similar cellularity and vascularity between groups. Conclusions This trial design and standardised PRP preparation gives the first robust RCT evidence about PRP’s role in managing ATR, which suggests that PRP offers no patient benefit. Equally robust evidence to investigate PRP application in tendon and soft tissue injuries is required. The 24-month follow-up will be completed in April 2020. Trial registration Current Controlled Trials ISRCTN54992179. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. The trial was supported by the NIHR Biomedical Research Centre, Oxford, and the NIHR Fellowship programme.

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Section: Healing Of the Tendon (Repair And Regeneration)mentioning

confidence: 99%

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

et al. 2019

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“…3,5 Operative management tends to reduce the risk of repeat rupture, compared to nonoperative treatment; however, the potential for surgical complications, including wound infection, sensory disturbance, and adhesions favors nonoperative treatment. 3,4,6 Nonoperative treatment consists of referral to a functional rehabilitation program, without which outcomes are, on the whole, less favorable than with surgery. 3,6 Surgery is preferred if functional rehabilitation is unavailable, 6 months of conservative management fails, or there is avulsion injury.…”

Section: Strength Of Recommendation (Sor)mentioning

confidence: 99%

“…3,4,6 Nonoperative treatment consists of referral to a functional rehabilitation program, without which outcomes are, on the whole, less favorable than with surgery. 3,6 Surgery is preferred if functional rehabilitation is unavailable, 6 months of conservative management fails, or there is avulsion injury. 3,4,6 Injury to the syndesmosis stability to the ankle joint, the tibiofibular syndesmosis comprises:…”

Section: Strength Of Recommendation (Sor)mentioning

confidence: 99%

Painful foot or ankle? Don't overlook these 5 injuries

Роман¹

2020

The Journal of Family Practice

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“…In addition, the Achilles tendon is located at the superficial position, which lacks soft tissue protection, with the postoperative wound infection rate of as high as 21.6% [5] . As a result, most scholars have advocated to repair the Achilles tendon through the minimally invasive technique at present [6] . In China, the modified Bunnell suture proposed by Ma and Griffith is the commonly adopted minimally invasive suture method [7] , however, such method will result in relatively high damage to the sural nerve [8] .…”

Section: Introductionmentioning

confidence: 99%

A New Minimally Invasive Technique for Repairing Achilles Tendon Rupture:A Biomechanical Study

Zhao

Xiong

et al. 2019

Preprint

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IntroductionThe incidence of Achilles tendon rupture shows a gradually increasing trend, which is mainly managed by minimally invasive treatment due to its advantages, such as low wound infection rate. At present, the firmness of the commonly applied minimally invasive suture method for Achilles tendon remains controversial. Our research group has developed a novel suture method for Achilles tendon, which has achieved favorable clinical outcomes. Therefore, this experiment aimed to explore the optimal approach to repair Achilles tendon rupture through comparing the biomechanical strength of the commonly used Achilles tendon suture methods currently.Materials and methods 6 fresh frozen human cadaveric Achilles tendon specimens were sutured by three kinds of technique, and were tested through the cyclical loading after repair. Results Results of cyclical loading showed that, the repair using the new technique was stronger after 10 cycles, 1000 cycles, and rupture. Moreover, the new technique had displayed superior anti-deformation strength to that of the Ma-Griffith technique. ConclusionsOur experimental results demonstrate that, the new technique proposed by our research group can attain comparable biomechanical properties to those of the Krachow technique. However, the sample size in this study is small, and further clinical trials are warranted.Key word Achilles Tendon rupture suture method biomechanical

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Acute Achilles Tendon Ruptures: An Update on Treatment

Cited by 71 publications

References 42 publications

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

Painful foot or ankle? Don't overlook these 5 injuries

A New Minimally Invasive Technique for Repairing Achilles Tendon Rupture:A Biomechanical Study

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