Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Myhrvold, Ståle Bergman; Brouwer, Espen Femmo; Andresen, Tor K M; Rydevik, Karin; Amundsen, Madeleine; Grün, Wolfram; Butt, Faisal Shafique; Valberg, Morten; Ulstein, Svend; Hoelsbrekken, Sigurd Erik

doi:10.1056/nejmoa2108447

Cited by 86 publications

(89 citation statements)

References 288 publications

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“…As mentioned in the background, several RCT:s have aimed to compare surgical and non-surgical treatment. Our results, showing no difference in self-reported outcome between surgical or non-surgical treatment are consistent with the most recent published [ 4 , 6 ]. However, there is a large difference in size between the treatment groups with almost 70% treated non-surgical which is of importance to keep in mind while drawing conclusions.…”

Section: Discussionsupporting

confidence: 93%

“…Studies have reported inconsistent results, leading to several paradigm shifts in primary treatment decisions over the last few decades [ 4 , 5 ]. Myhrvold et al [ 6 ] recently reported that surgery did not provide better self-reported outcome compared to non-surgical treatment following a randomized controlled trial. Even though there is a lack of consensus on how best to treat ATR patients, there are advantages and disadvantages to both treatment options.…”

Section: Introductionmentioning

confidence: 99%

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Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study

Larsson

Brorsson

Carling

et al. 2022

BMC Musculoskelet Disord

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Introduction The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders. Aims The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients. Methods Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men. Results A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS. Conclusion To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study

Larsson

Brorsson

Carling

et al. 2022

BMC Musculoskelet Disord

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“…e incidence reaches 31/100 000/year and has been reported to be on the rise [5][6][7][8][9]. Despite the fact that a rather sizeable number of people suffer this injury, evidenced based knowledge of how to best rehabilitate following a rupture remains unclear, and this lack of knowledge likely contributes to the reports of persistent muscle weakness, tendon elongation, and incomplete return to recreational preinjury level [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], and for high level athletes, a rupture of the Achilles tendon can be career ending [20,26]. In this review, we will focus on effects of Achilles tendon rupture on tendon and muscle structure and function without distinguishing between conservative and surgical treatment approach, since similar effects are observed with both forms of initial injury management [14,22,25].…”

Section: Introductionmentioning

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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“…Treatment of Achilles tendinitis depends on how severe your pain and symptoms are and if there is weakness 11 . Non-operative care is first line approach for treating Achilles tendinitis 12 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Achilles Tendinopathy in Female Nurses in Lahore-Pakistan

Javed¹,

Amjad²,

Mehmood³

et al. 2022

PJMHS

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Background: The Achilles tendon is the largest & longest tendon in the body. Although Achilles tendinopathy is chiefly a runner’s problem but can affect other populations exposed to a prolonged standing position. Aim: To assess the prevalence of Achilles tendinopathy in nurses due to long standing position and its association with other factors resulting in symptoms. Study design: Cross-sectional study. Methodology: The information was gathered using a standardized VISA-A scale. The study's sample size was 110 subjects. The VISA A questionnaire had eight items for assessing the condition. Over the course of six months, data was collected from female nurses in Lahore. The data from the questionnaire was organized. Data was analyzed by SPSS software, version 19 as qualitative variables were expressed as mean ± SD. Frequencies and percentages were calculated for individual items. Results: In this study, 39(35.5%) nurses have mild pain, 49(44.5%) nurses have moderate pain & 21(19.1%) nurses have severe pain after walking on flat ground for 30 minutes. The Cross tabulation of Visa- A scale showed that there was a weak or frail relationship between Achilles tendinopathy and prolong standing position. Conclusion: We concluded that there is a weak or frail relationship in Achilles tendinopathy in nurses due to prolong standing position. Most of the population falls in between no pain to mild pain. Keywords: Achilles tendinopathy, Nurses, VISA-A questionnaire and Pakistan

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Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Cited by 86 publications

References 288 publications

Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study

Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study

Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review

Prevalence of Achilles Tendinopathy in Female Nurses in Lahore-Pakistan

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