Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged &lt;45 years

Liu, Huixin; Li, Dengke; luo, zixuan; Li, Yansen; Zhang, Fengqi

doi:10.1186/s12891-020-03588-5

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…Patients report mean scores of 31-56 at three months [10,11,13] and 54-87 at six months [11,[32][33][34][35][36][37][38][39][40][41][42][43][44]. One year after the rupture, the mean score has been reported to be 74-91 [11,24,32,33,35,36,[38][39][40][42][43][44][45][46][47][48][49][50][51][52][53][54][55], and it does not appear to appreciably improve further thereafter [14,15,24,39,42,46,47,[56][57][58][59]…”

Section: Patient-reported Outcome Measuresmentioning

confidence: 99%

Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review

Hoeffner

Svensson

Bjerregaard

et al. 2022

Translational Sports Medicine

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Persistent muscle weakness, tendon elongation, and incomplete return to preinjury level are frequent sequelae after acute Achilles tendon rupture, and evidence-based knowledge of how to best rehabilitate the injury is largely absent in the literature. The objective of this review is to illuminate and discuss to what extent an Achilles tendon rupture affects muscle, tendon, and function when assessed with the Achilles tendon total rupture score (ATRS), muscle strength, muscle cross-sectional area, tendon length, and the heel-rise test. The patient-reported outcome measures (PROM) data in the literature suggest that the recovery takes longer than 6 months (ATRS, 70 out of 100), that one-year postinjury, the ATRS only reaches 82, and that this does not appear to noticeably improve thereafter. Loss of muscle mass, strength, and function can in some cases be permanent. Over the first 6 months postinjury, the tendon undergoes elongation, which appears to be negatively correlated to heel-rise function. More recently, there has been some interest in how muscle length and excursion is related to the reduced function. The available literature indicates that further research is highly warranted and that efforts to restore normal tendon length may improve the likelihood of returning to preinjury level after an Achilles tendon rupture.

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Section: Patient-reported Outcome Measuresmentioning

confidence: 99%

Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review

Hoeffner

Svensson

Bjerregaard

et al. 2022

Translational Sports Medicine

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“…Recent evidence has found that distinct surgical variations and variations in postoperative protocols result in different degrees of tendon elongation [8, 18, 27, 30, 40, 72, 86]. Further, post-treatment tendon elongation has been associated with lower patient-reported outcomes scores and reduced plantarflexion strength [28, 79, 91]. For these reasons, surgeons must largely rely on direct RCT evidence of patient-reported outcomes rather than pooled comparisons when putting the findings of our study into context.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence has found that distinct surgical variations and variations in postoperative protocols result in different degrees of tendon elongation [8,18,27,30,40,72,86]. Further, post-treatment tendon elongation has been associated with lower patient-reported outcomes scores and reduced plantarflexion strength [28,79,91] Similarly, return to work and sport analyses were not performed because of very low evidence quality and poor assessment of the endpoints in question. Inconsistency in returnto-sport reporting has been previously noted by other researchers [3,44,66], although studies have found no difference between open repair, MIS repair, and functional rehabilitation [23,60,66].…”

Section: Limitationsmentioning

confidence: 99%

What Is the Best Evidence to Guide Management of Acute Achilles Tendon Ruptures? A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Meulenkamp¹,

Woolnough

Cheng

et al. 2021

Clin Orthop Relat Res

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Background Uncertainty exists regarding the best treatment for acute Achilles tendon ruptures. Simultaneous comparison of the multiple treatment options using traditional study designs is problematic; multiarm clinical trials often are logistically constrained to small sample sizes, and traditional meta-analyses are limited to comparisons of only two treatments that have been compared in head-to-head trials. Network meta-analyses allow for simultaneous comparison of all existing treatments utilizing both direct (head-to-head comparison) and indirect (not previously compared head-to-head) evidence. Questions/purposes We performed a network meta-analysis of randomized controlled trials (RCTs) to answer the following questions: Considering open repair, minimally invasive surgery (MIS) repair, functional rehabilitation, or primary immobilization for acute Achilles tendon ruptures, (1) which intervention is associated with the lowest risk of rerupture? (2) Which intervention is associated with the lowest risk of complications resulting in surgery? Methods This study was conducted with methods guided by the Cochrane Handbook for Systematic Reviews of Interventions and is reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for incorporating network meta-analysis. Five databases and grey literature sources (such as major orthopaedic meeting presentation lists) were searched from inception to September 30, 2019. Included studies were RCTs comparing treatment of acute Achilles tendon ruptures using two or more of the following interventions: primary immobilization, functional rehabilitation, open surgical repair, or MIS repair. We excluded studies enrolling patients with chronic ruptures, reruptures, and preexisting Achilles tendinopathy as well as studies with more than 20% loss to follow-up or less than 6 months of follow-up. Nineteen RCTs (1316 patients) were included in the final analysis. The mean number of patients per study treatment arm was 35 ± 16, mean age was 41 ± 5 years, mean sex composition was 80% ± 10% males, and mean follow-up was 22 ± 12 months. The four treatment groups were compared for the main outcomes of rerupture and complications resulting in operation. The analysis was conducted using random-effects Bayesian network meta-analysis with vague priors. Evidence quality was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation methodology. We found risk of selection, attrition, and reporting bias to be low across treatments, and we found the risk of performance and detection bias to be high. Overall risk of bias between treatments appeared similar. Results We found that treatment with primary immobilization had a greater risk of rerupture than open surgery (odds ratio 4.06 [95% credible interval {CrI} 1.47 to 11.88]; p < 0.05). There were no other differences between treatments for risk of rerupture. Minimally invasive surgery was ranked first for fewest complications resulting in surgery and was associated with a lower risk of complications resulting in surgery than functional rehabilitation (OR 0.16 [95% CrI 0.02 to 0.90]; p < 0.05), open surgery (OR 0.22 [95% CrI 0.04 to 0.93]; p < 0.05), and primary immobilization (OR < 0.01 [95% CrI < 0.01 to 0.01]; p < 0.05). Risk of complications resulting in surgery was no different between primary immobilization and open surgery (OR 1.46 [95% CrI 0.35 to 5.36]). Data for patient-reported outcome scores and return to activity were inappropriate for pooling secondary to considerable clinical heterogeneity and imprecision associated with small sample sizes. Conclusion Faced with acute Achilles tendon rupture, patients should be counseled that, based on the best-available evidence, the risk of rerupture likely is no different across contemporary treatments. Considering the possibly lower risk of complications resulting in surgery associated with MIS repair, patients and surgeons must balance any benefit with the potential risks of MIS techniques. As treatments continue to evolve, consistent reporting of validated patient-reported outcome measures is critically important to facilitate analysis with existing RCT evidence. Infrequent but serious complications such as rerupture and deep infection should be further explored to determine whether meaningful differences exist in specific patient populations. Level of Evidence Level I, therapeutic study.

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“…The open and the percutaneous techniques are both safe and effective in repairing the ruptured AT, and both afford the same degree of restoration of clinical, ultrasound, and isokinetic patterns [ 57 ]. Nevertheless, the main advantages of percutaneous repair include reduced cutaneous complications, use of analgesics, and operation times; day surgery procedures; fewer deep infections; faster recovery, enhancing overall patient compliance with improved of AOFAS scores; and lower healthcare costs [ 41 , 55 , 58 , 59 , 60 ]. As Ma and Griffith and Tenolig satisfied most of these advantages in our patient groups, another implication of this study is that they can be considered preferable to open repair in managing subcutaneous ruptures of AT also in non-professional sports practicing adults, confirming the results of previous reports [ 57 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig

et al. 2021

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Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical–functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical–functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle–Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical–functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

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Modified Bunnell suture repair versus bundle-to-bundle suture repair for acute Achilles tendon rupture: a prospective comparative study of patients aged <45 years

Cited by 5 publications

References 30 publications

Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review

Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review

What Is the Best Evidence to Guide Management of Acute Achilles Tendon Ruptures? A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig

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