(2017) 10:7280. sharing sensitive information, make sure youre on a federal PubMed Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, et al. The benefit of surgery may be higher long-term calf strength, though even this is debated in various studies. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. There were eight studies that reported the result of return to sport among patients receiving ATR repair. So, we performed this systematic review to analyze the effectiveness of different currently used nonoperative therapy for IAT. (A) Forest plot of re-rupture rate. (2012) 94:213643. Detailed information about the re-rupture rate is shown in Figure 2A. Figure 2. ATR results in loss of motor ability as well as absence from patients' occupation so that a different time period is an essential assessment index. doi: 10.1053/j.jfas.2013.03.001, 45. Sports Health. Effects of rigid plaster casts and functional casts. The ESWT in 3 of them applied low-energy shockwave treatments, and the other 2 groups used high-energy shockwave treatments. Collectively, a novel recommendation of more than just considering re-rupture and conservative treatment with similar functional recovery as well as a lesser complication on ATR might be considered if patients' status were suitable. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. Forest plot of secondary outcome measure indicating period of absence from work and ATRS. Detailed information about deep vein thrombosis is displayed in Figure 3B. A histological and biomechanical study. Figure 4. However, the exact etiology and pathogenesis remain unclear. Biomed Res Int. Am J Sports Med. FOIA Achilles tendon (AT), a combination of the tendinous portion of gastrocnemius and soleus muscles to form the strongest tendon in the human body, is frequently injured mainly in the young to middle age active population of society, with the average age ranging from 37 to 44 years (1, 2). Makulavicius A, Martin Oliva X, Mazarevicius G, Klinga M, Uvarovas V, Porvaneckas N, et al. XZ and SW designed the study. (29) while 21 days was the longest period reported by Nistor et al. 2017;38(10):11609. 2012;29(9):799814. 12) The estimated incidence ranges from 11 to 37 per 100,000 population. PubMed Conservative treatment was found to be capable of having similar functional outcomes with surgical treatment. https://doi.org/10.2214/AJR.09.3255. Eccentric exercises were reported to decrease local pain by strengthening the calf muscle, lengthening of the myotendinous unit, and decreasing neovascularization in the region. Clin Orthop Relat Res. 2/8/2021 6:43:49 AM . Specifically, for deep vein thrombosis, more cases occurred in the conservative treatment group, but thromboprophylaxis is only reported in four included studies (11, 27, 31, 33), which may confuse the result. J Clin Epidemiol. Furia et al. and transmitted securely.
PDF Achilles Tendon Repair Post-Op Rehabilitation Protocol BackgroundExcellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture.PurposeTo describe a new nonoperative treatment protocol for Achilles tendon ruptu. Please enable it to take advantage of the complete set of features! A living systematic review with network meta-analysis of 29 randomised controlled trials; 2020. Detailed information about the overall complication rate is shown in Figure 3A. 8600 Rockville Pike The studies were published from 2003 to 2020. A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. (26) and Costa et al. Main complications that occurred after ATR treatment were deep vein thrombosis, adhesion of scar to the underlying tendon, the sural nerve injury, and superficial and deep infection. Keating JF, Will EM. https://doi.org/10.1053/j.jfas.2018.11.005. PubMed Future research with a specific focus on comorbidities other than re-rupture is necessary, and it will provide more clues for surgeons or physicians to make an optimal decision. (1981) 63:3949. doi: 10.5603/FM.a2015.0067, 52. doi: 10.2106/00004623-200510000-00008, 11. Till now, the optimal treatment for ATR patients is mainly based on expert consensus and on the basis of judgment from the chief clinician. A prospective randomised study of comparison between surgical and non-surgical treatment. Secondary outcomes consisted of complication rate (defined as complication occurred after treatment except for re-rupture), deep vein thrombosis, adhesion of scar to the underlying tendon, sural nerve injury, superficial infection, deep infection, period of absence from work, functional scores of Achilles Tendon Rupture Score (ATRS) (16), and mean of dorsiflexion and plantarflexion. Int J Sports Phys Ther. and Cetti et al., while high risk was assessed in Fischer et al. Federal government websites often end in .gov or .mil. This meta-analysis was conducted and performed under the instruction of Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) checklists (1214). A prospective randomized study and review of the literature. (2017) 56:123643. A fixed model would be adopted when I2 <50% while the random effect model was employed once I2 > 50%. Bethesda, MD 20894, Web Policies A nationwide registry study of 33,160 patients. Two authors independently extracted both baseline demographics with all outcomes data, and disagreements were resolved by discussion in a routine meeting to prevent the occurrence of test-qualified pooling (15). volume16, Articlenumber:233 (2021) Two groups failed in previous nonoperative management (including injection of a local anesthetic and/or a corticosteroid, physiotherapy and/or use of orthotics or a heel lift) before eccentric training. Int J Surg Case Rep. (2017) 37:1068. doi: 10.1007/s00167-015-3544-5, 3. Br J Sports Med. Twenty-three studies (containing 35 groups) were eligible for the final review. 01:55 An acute Achilles' tendon rupture is one of the most common musculoskeletal injuries, with an annual incidence of 5 to 50 events per 100,000 persons, and may result in severe disability.. compared three therapies (cryoultrasound therapy, laser therapy CO2, and t.e.ca.r. (2007) 35:20338. Functional outcomes were defined as period of absence from work and ATRS score, and the pooled result revealed a similar outcome between the surgical and conservative treatment group. compared three therapies (cryoultrasound therapy, laser therapy CO2, and t.e.ca.r. https://doi.org/10.1136/bjsm.2007.042044. Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. (PRP and home exercises) [27], were all suggested to be effective, but they were all reported by individual study and lacked generalized evidence. A systematic review of literature and meta-analysis. Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Accelerated Rehabilitation in Non-operative Management of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis. Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S. The use of prolotherapy in the sacroiliac joint. HW generated the synthesis of the results. (2018) 118:13456. 2002;36(3):1735discussion 6-7. https://doi.org/10.1136/bjsm.36.3.173. Achilles tendinitis. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. For the sake of its specificity in ambulation and activity, appropriate management of ATR is essential. These results were similar to those of cases that received single ESWT (73.7%), but much higher than those of eccentric exercises alone (45.6%). Nonoperative treatment of insertional Achilles tendinopathy: a systematic review. (2010) 9:Cd003674. have taken re-rupture rate, deep vein thrombosis, return to sport, ankle range of motion, and related score into consideration, while adhesion, sural nerve injury, period of absence from work, and infection are added in our study.
PDF Non-Operative Achilles Rupture Rehabilitation Guideline - Sanford Health Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion achilles tendinosis. Although more evidence is in support of eccentric exercises than the other interventions for mid-portion/non-insertional Achilles tendinopathy, eccentric exercises did not result in a high satisfaction rate for IAT. Lasers Med Sci. (2016) 44:240614. 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. showed that soft tissue treatment (Astym) plus eccentric exercise improved the function during both short- and long-term follow-up periods [23]. Maffulli N, D'Addona A, Gougoulias N, Oliva F, Maffulli GD. The detailed information of baseline characteristics of each RCTs is shown in Table 2. demonstrated that both ESWT and PRP therapy were effective and safe, and there were no significant differences between two groups in VAS, VISA-A, or satisfaction rate [27]. Received: 18 September 2020; Accepted: 11 January 2021; Published: 18 February 2021. (2007) 35:4216. Mosser P, Kelm J, Anagnostakos K. Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture. doi: 10.1016/j.jclinepi.2009.06.005, 14. J Foot Ankle Surg. therapy) in athletes affected by insertional tendonitis and found that every patient benefited from all the treatments [12]. Objectives To 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 fr. Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses. Metz R, Verleisdonk EJ, van der Heijden GJ, Clevers GJ, Hammacher ER, Verhofstad MH, et al. Bone Joint J. Outcomes of functional weight-bearing rehabilitation of Achilles tendon ruptures. The optimal treatment and rehabilitation strategy for Achilles tendon ruptures is still under debate. P values are extracted from the original studies or calculated from the reported data. Satisfactory results were recorded in 4 groups, and the total satisfaction rate was 74.3% (84/113). Knee Surg Sports Traumatol Arthrosc. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. In 2 groups who failed in the previous nonoperative management, the mean declined value was 1.95 versus 3.48 in the other 5 groups. Article Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. A meta-analysis of randomized, controlled trials. Would you like email updates of new search results? so that unclear risk was obtained. Other combination treatments, including Notarnicola et al. Five groups were evaluated with satisfactory results, and 101 out of 137 (73.7%) patients were satisfied with the outcome. Patients with bilateral symptoms were enrolled in 5 studies. Introducing levels of evidence to the journal. IAT is regarded as a distinct clinical entity which is often accompanied with metabolic diseases and is difficult to manage, and the treatment and prognosis of IAT are not totally the same to those of mid-portion/non-insertional Achilles tendinopathy. Foot (Edinburgh, Scotland). doi: 10.1177/0363546507307503, 30. If, in the opinion of the physical therapist, scar mobilization was indicated, appropriate modalities will be added. This site needs JavaScript to work properly. The PRISMA flowchart of this meta-analysis is displayed in Figure 1. (2015) 97-b:67580. This research paper was supported, in part, by the Natural Science Foundation of Hubei Province (2017CFB568). Inadequate blinding of assessment was not clearly declared in Nistor et al. Forest plot of secondary outcome measure indicating complication. Aim: Lowest rerupture rates were found in strict functional rehabilitation protocols that were full weightbearing in boot immediately at full equinus or 30 plantar flexed. https://doi.org/10.1177/1941738116631498. (2009) 62:100612. doi: 10.1177/0363546513503282, 12. Consequently, thromboprophylaxis is necessary after ATR treatment and intermittent pneumatic compression has been reported to be highly effective in reducing deep vein thrombosis in ATR patients (43).
DOCX Alaska Native Tribal Health Consortium BMJ. 13,14,15) Men are 2 to 12 times more prone to Achilles tendon rupture than women. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. Published by Elsevier Inc. All rights reserved. Conclusion: Surgical treatment revealed significance in reducing the re-rupture rate but was associated with a higher complication rate, while conservative treatment showed similar outcomes with a lower complication rate. For mean dorsiflexion, the surgical treatment group was similar to the conservative treatment group (two studies, 204 participants, Z = 0.32, P = 0.75, I2 = 51%, RR: 0.62, 95% CI: 3.23 to 4.46). https://doi.org/10.1007/s00167-010-1374-z. rupture rate with non-operative management. Any discrepancy was resolved by discussing it until a consensus was reached. Overall, 47 of 103 (45.6%) patients thought the outcome was excellent/good, while the others considered it as fair/poor. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. An official website of the United States government. J Bone Joint Surg Am Vol. Method: We comprehensively searched PubMed, Embase, Cochrane, and ClinicalTrial.gov and retrieved all RCTs comparing surgical and conservative treatment on ATR for further analysis.
Delayed Achilles tendon rupture presentation: Non-operative - PubMed Background: The Achilles tendon is the strongest tendon in human and is frequently injured, mainly in the young to middle age active population. Epub 2022 Aug 25. Conclusion After 17 years of prospective evaluation, our non-operative treatment protocol for acute rupture of the Achilles tendon leads to good functional outcome, high patient satisfaction and . So, whether eccentric exercises are suitable for IAT is still open for debate. 19. https://doi.org/10.1007/s001670000189. The original contributions generated in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding authors. Google Scholar. In addition, in scenario of returning to sport, patients who recover to the same level as pre-treatment was pooled, which might describe the efficacy of treatment distinctly. Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, et al.
PDF ACHILLES RUPTURE: NONOPERATIVE PROTOCOL - South Bend Orthopaedic Associates doi: 10.1302/0301-620X.93B8.25998, 34. Saxena A, Ramdath S Jr, O'Halloran P, Gerdesmeyer L, Gollwitzer H. Extra-corporeal pulsed-activated therapy ("EPAT" sound wave) for Achilles tendinopathy: a prospective study. 2004;86(4):6138. Besides, a prospective cohort study from Fahlstrm et al. 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. This study followed the PRISMA 2009 checklist as provided in Additional file 1. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment strategy is still debated. Foot Ankle Int. found that conventional physical therapy consisting of gastrocnemius, soleus and hamstring stretches, ice, and use of heel lifts and night splints with or without eccentric training were both effective and showed no significant difference [22].
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