Updates in Management of Achilles Tendon Rupture: Simple Literature Review (original) (raw)
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The ruptured Achilles tendon: a current overview from biology of rupture to treatment
MUSCULOSKELETAL SURGERY, 2013
The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.
Injury, 2008
There is still controversy regarding the optimal surgical technique and post-operative treatment of acute Achilles tendon ruptures. We evaluated a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight bearing. A consecutive group of 163 patients was prospectively followed during a 6 year period (1998-2004) in one university hospital and five teaching hospitals. Data were collected during the outpatient department visits at 1, 3, 5, and 7 weeks, 4 months and 12 months after the intervention. Outcome parameters were the incidence of re-rupture, other complications, the functional outcome and the period of sick leave concerning work and sport. The patient group consisted of 128 men (79%) and 35 women (21%). The mean operating time was 41 min. In 9 patients (5.5%) a major complication occurred, necessitating 5 surgical re-interventions (2 for re-ruptures, 2 for infections and 1 for tendon necrosis). Fifteen patients (9.2%) suffered from dysfunction of the sural nerve. The median time of returning to work was 28 days (range 1-368) and the median time of returning to sport was 167 days (range 31-489). The majority of patients (150; 92%) were satisfied with the results. Minimally invasive Achilles tendon repair in combination with a functional rehabilitation program is a safe and quick procedure with a low rate of re-rupture and a high level of patient satisfaction.
Operative treatment of acute Achilles tendon ruptures: An institutional review of clinical outcomes
Injury, 2007
Purpose: To retrospectively review the clinical outcome and incidence of postoperative complications after open end-to-end repair of acute Achilles tendon ruptures. Methods: Seventy consecutive patients (74 open Achilles tendon repairs) operated on between 1989 and 2002 were identified for inclusion in this investigation. The medical records were reviewed and patients were contacted for a follow up interview in order to survey their post-operative function. Outcome scores were calculated based on the Boyden outcome and AOFAS ankle-hindfoot scoring systems.
Interventions for the treatment of acute Achilles’ tendon ruptures
Cochrane Database Syst Rev, 2004
Fourteen trials involving 891 patients were included. Several of the studies had poor methodology and inadequate reporting of outcomes. Open operative treatment compared with non-operative treatment (4 trials, 356 patients) was associated with a lower risk of rerupture (relative risk (RR) 0.27, 95% confidence interval (CI) 0.11 to 0.64), but a higher risk of other complications including infection, adhesions and disturbed skin sensibility (RR 10.60, 95%CI 4.82 to 23.28). Percutaneous repair compared with open operative repair (2 studies, 94 patients) was associated with a shorter operation duration, and lower risk of infection (RR 10.52, 95% CI 1.37 to 80.52). These figures should be interpreted with caution because of the small numbers involved. Patients splinted with a functional brace rather than a cast post-operatively (5 studies, 273 patients) tended to have a shorter in-patient stay, less time off work and a quicker return to sporting activities. There was also a lower complication rate (excluding rerupture) in the functional brace group (RR 1.88 95%CI 1.27 to 2.76). Because of the small number of patients involved no definitive conclusions could be made regarding different operative techniques (1 study, 51 patients), different non-operative treatment regimes (2 studies, 90 patients), and different forms of post-operative cast immobilisation (1 study, 40 patients).
Surgical interventions for treating acute Achilles tendon ruptures
Cochrane Database Syst Rev, 2010
BACKGROUND: There is a lack of consensus on the best management of the acute Achilles tendon rupture. Treatment can be broadly classified into surgical (open or percutaneous) and non-surgical (cast immobilisation or functional bracing). OBJECTIVES: To evaluate the relative effects of surgical versus non-surgical treatment, or different surgical interventions, for acute Achilles tendon ruptures in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (1966 to 20th July 2009), EMBASE (1966 to 2009 week 29), CINAHL (1983 to July 2007) and reference lists of articles. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing surgical versus non-surgical treatment or different surgical methods for acute Achilles tendon ruptures in adults. DATA COLLECTION AND ANALYSIS: Two review authors independently selected potentially eligible trials; trials were then assessed for quality using a 10-item scale. Where possible, data were pooled. MAIN RESULTS: Twelve trials involving 844 participants were included. One trial tested two comparisons.Quality assessment revealed a poor level of methodological rigour in many studies, particularly with regard to concealment of allocation and the lack of assessor blinding.Open surgical treatment compared with non-surgical treatment (6 trials, 536 participants) was associated with a statistically significant lower risk of rerupture (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.21 to 0.77), but a higher risk of other complications including infection (RR 4.89, 95% CI 1.09 to 21.91), adhesions and disturbed skin sensibility (numbness). Functional status including sporting activity was variably and often incompletely reported, including frequent use of non standardised outcome measures, and the results were inconclusive.Open surgical repair compared with percutaneous repair (4 trials, 174 participants) was associated with a higher risk of infection (RR 9.32, 95% CI 1.77 to 49.16). These figures should be interpreted with caution because of the small numbers involved. Similarly, no definitive conclusions could be made regarding different tendon repair techniques (3 trials, 147 participants). AUTHORS' CONCLUSIONS: Open surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with non-surgical treatment, but produces significantly higher risks of other complications, including wound infection. The latter may be reduced by performing surgery percutaneously.
Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play
Journal of Functional Morphology and Kinesiology
The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades. Achilles tendon tears necessitate a prolonged recovery time, sometimes leaving long-term functional limitations. Treatment options include conservative treatment and surgical repair. There is no consensus on which is the best treatment for ATRs, and their management is still controversial. Limited scientific evidence is available for optimized rehabilitation regimen and on the course of recovery after ATRs. Furthermore, there are no universally accepted outcomes regarding the return to play (RTP) process. Therefore, the aim of this narrative review is to give an insight into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP.
J Bone Joint Surg Am, 2012
Acute Achilles tendon rupture is a relatively common injury resulting in substantial morbidity in young, active patients. It occurs most frequently in male individuals, and the incidence is thought to be increasing1. There has been a lack of consensus among orthopaedic surgeons regarding the best management of this injury. Treatment can be broadly divided into surgical (open or percutaneous) and nonsurgical (cast immobilization or functional bracing).
Background: The aim of this paper was to report the functional and clinical results of subcutaneous Achilles tendon rupture repairs through two surgical plasty techniques, with a mean follow-up of 2 years. Patients and methods: This study carries out a retrospective analysis of 27 patients presenting a subcutaneous rupture of Achilles tendon who enderwent surgical treatment between January 2012 and December 2016. Surgical treatment was carried out using the Chigot-Lynn technique for 19 patients and the Bosworth-Lynn technique for the remaining 8 patients. Functional and clinical results were evaluated according to McComis criteria and patient satisfaction. Results: Clinical measurement of the of ankle motion range revealed average flexion of 15 ° and an average extension of 40 °. Amyotrophy of the triceps surae muscle was found in all patients, with an average 2 cm. Residual pain was found in four patients. Average sick leave was 4 months. 8 patients had resumed sport at their previous level of training, 3 patients had returned to lower levels of sport, and one patient had abandoned their sporting activity. The results were considered highly satisfactory or satisfactory by 24 patients, good by two patients and poor by one patient. Conclusion: Chronic ruptures of the Achilles tendon remain a therapeutic challenge for the orthopaedic surgeon. Surgery with a reinforcement plasty must be proposed to patients who are active or have sports activities. Surgical repair reduce iterative ruptures and ensure the best functional recovery.
Achilles tendon rupture: surgical versus non-surgical treatment
Accident and Emergency Nursing, 2004
To ascertain the treatment method of choice for Achilles tendon rupture, which results in the most favourable functional outcome. Methods: A comprehensive literature search was performed to retrieve relevant English language articles comparing surgical with non-surgical treatment. Results: The literature search identified five prospective randomised controlled trials, three of which compare surgical with non-surgical treatment, one which compares functional early mobilisation with cast immobilisation after surgical repair and one which compares functional and cast immobilisation in non-surgical management of Achilles tendon rupture. Conclusion: Surgical treatment of Achilles tendon rupture is associated with a significantly lower incidence of re-rupture and therefore is the treatment method of choice. Non-surgical treatment may be acceptable for patients who refuse surgery or who are unfit for surgery. Functional early mobilisation appears to be associated with an improved functional outcome and should be considered in preference to plaster cast immobilisation where appropriate.