Functional Outcome of Acute Achilles Tendon Rupture With and Without Operative Treatment Using Identical Functional Bracing Protocol

Lim, Che Siu; Lees, David; Gwynne‐Jones, David

doi:10.1177/1071100717728687

Cited by 33 publications

(26 citation statements)

References 35 publications

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“… 36 Lim et al reported a mean ATRS score of 85 in both groups. 44 No significant difference was found in either study. We did not pool functional outcome data owing to a wide variety in ATSR score reports and insufficient information to convert data.…”

Section: Resultsmentioning

confidence: 69%

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Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Ochen

Beks

Heijl

et al. 2019

BMJ

235

223

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ObjectivesTo compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates from randomised controlled trials and observational studies.DesignSystematic review and meta-analysis.Data sourcesPubMed/Medline, Embase, CENTRAL, and CINAHL databases were last searched on 25 April 2018 for studies comparing operative versus nonoperative treatment of Achilles tendon ruptures.Study selection criteriaRandomised controlled trials and observational studies reporting on comparison of operative versus nonoperative treatment of acute Achilles tendon ruptures.Data extractionData extraction was performed independently in pairs, by four reviewers, with the use of a predefined data extraction file. Outcomes were pooled using random effects models and presented as risk difference, risk ratio, or mean difference, with 95% confidence interval.Results29 studies were included—10 randomised controlled trials and 19 observational studies. The 10 trials included 944 (6%) patients, and the 19 observational studies included 14 918 (94%) patients. A significant reduction in re-ruptures was seen after operative treatment (2.3%) compared with nonoperative treatment (3.9%) (risk difference 1.6%; risk ratio 0.43, 95% confidence interval 0.31 to 0.60; P<0.001; I2=22%). Operative treatment resulted in a significantly higher complication rate than nonoperative treatment (4.9% v 1.6%; risk difference 3.3%; risk ratio 2.76, 1.84 to 4.13; P<0.001; I2=45%). The main difference in complication rate was attributable to the incidence of infection (2.8%) in the operative group. A similar reduction in re-rupture rate in favour of operative treatment was seen after both early and late full weight bearing. No significant difference in re-rupture rate was seen between operative and nonoperative treatment in studies that used accelerated functional rehabilitation with early range of motion (risk ratio 0.60, 0.26 to 1.37; P=0.23; I2=0%). No difference in effect estimates was seen between randomised controlled trials and observational studies.ConclusionsThis meta-analysis shows that operative treatment of Achilles tendon ruptures reduces the risk of re-rupture compared with nonoperative treatment. However, re-rupture rates are low and differences between treatment groups are small (risk difference 1.6%). Operative treatment results in a higher risk of other complications (risk difference 3.3%). The final decision on the management of acute Achilles tendon ruptures should be based on patient specific factors and shared decision making. This review emphasises the potential benefits of adding high quality observational studies in meta-analyses for the evaluation of objective outcome measures after surgical treatment.

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Section: Resultsmentioning

confidence: 69%

“… 29 30 31 32 This resulted in the final inclusion of 29 studies for analyses in this systematic review and meta-analysis—10 RCTs and 19 observational studies. 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 …”

Section: Resultsmentioning

confidence: 99%

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Ochen

Beks

Heijl

et al. 2019

BMJ

235

223

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“…It would be considered logical to repair the Achilles tendon in comparable tension with the noninjured side. 23,27,35,40,43 Since ruptured tendons elongate during healing and rehabilitation, and lengthening leads to poor function, 14,18,22,47 they would benefit from being repaired in increased plantarflexion. Repairing in greater tightness to the contralateral side is commonly performed 15,19,21,26,29,42,45 ; however, to the best of our knowledge, this is the first study providing data to support the influence of tightness of repair on functional (heel-rise) performance.…”

Section: Discussionmentioning

confidence: 99%

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Carmont

Zellers

Brorsson

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose: To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair. Study Design: Cohort study; Level of evidence, 3. Methods: From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI. Results: A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was –4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI ( R 2 = 0.19; P < .001; n = 120). Conclusion: Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.

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“…The trend for the past decade due to new data to support it, is functional rehabilitation, showing lower rerupture rates when compared with traditional nonweightbearing and casting. [9][10][11][12][13][14][15] Nonoperative rerupture rates vary depending on study and rehabilitation protocol. The most recent meta-analysis by Ochen et al, 16 in 2019, found a nonoperative rerupture rate of 3.9% utilizing a functional rehabilitation protocol, versus the previous findings of 9% to 13% with a mix of functional protocols or plantar cast immobilization.…”

Section: Levels Of Evidence: Level Iii: Evidence Obtained From Well-dmentioning

confidence: 99%

Systematic Review of Nonoperative Functional Protocols for Acute Achilles Ruptures Utilizing a Formal Rehabilitation Protocol Showing Lowest Rerupture Rates

Harrington

Breedlove

Sharpe

2020

Foot & Ankle Specialist

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Aim. To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. Method. Relevant articles were searched in PubMed, CINAHL Plus, and Cochrane Library using keyword combinations: nonoperative AND/OR Achilles rupture AND functional AND/OR protocol or functional AND/OR rehabilitation. To be included in the full analysis, the studies had to have detailed functional protocols with physical therapy program details and outcome scores of rupture rates and/or Achilles Tendon Rupture Score (ATRS). We ultimately found 7 articles that fit our inclusion criteria for analysis. All of them had rerupture rates, and 4 had ATRS scores and functional protocols with mention of formal physical therapy programs. Results. Lowest rerupture rates were found in strict functional rehabilitation protocols that were full weightbearing in boot immediately at full equinus or 30° plantar flexed. They started active range of motion at 5 to 8 weeks and started formal physical therapy at 10 weeks. Levels of Evidence: Level III: Evidence obtained from well-designed non-experimental descriptive studies

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Functional Outcome of Acute Achilles Tendon Rupture With and Without Operative Treatment Using Identical Functional Bracing Protocol

Abstract: Level II, prospective comparative study.

Cited by 33 publications

References 35 publications

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis

Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture

Systematic Review of Nonoperative Functional Protocols for Acute Achilles Ruptures Utilizing a Formal Rehabilitation Protocol Showing Lowest Rerupture Rates

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