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Clinics in Orthopedic Surgery Mar 2020There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation... (Review)
Review
There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation in the treatment of ruptured Achilles tendons. Hence, conservative treatment is preferred by a growing number of surgeons seeking to treat the condition without the risk of complications from surgery. However, operative treatment is still considered as a more reliable treatment option for acute Achilles tendon rupture. In this review article, we provide an overview of recent treatment strategies for acute rupture of the Achilles tendon.
Topics: Achilles Tendon; Humans; Rupture; Tendon Injuries; Treatment Outcome
PubMed: 32117532
DOI: 10.4055/cios.2020.12.1.1 -
Medicina (Kaunas, Lithuania) Sep 2022Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been... (Review)
Review
Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been written on the topic, no actual consensus exists on the best treatment. We aimed to collect the highest quality of evidence on the subject and to produce a document to which to refer, from the diagnosis to the final treatment. Inclusion criteria were systematic reviews discussing Achilles tendon rupture, concerning either diagnostic criteria, classification, or treatment; English language; clearly stated inclusion and exclusion criteria for patients' selection. Thirteen systematic reviews were included in the study. A strong consensus exists about the higher risk of re-rupture associated with non-operative treatment and a higher risk of complications associated with surgical repair. The combination of minimally invasive repair and accelerated functional rehabilitation seems to offer the best results in the treatment of Achilles tendon rupture.
Topics: Achilles Tendon; Acute Disease; Ankle Injuries; Humans; Minimally Invasive Surgical Procedures; Rupture; Tendon Injuries; Treatment Outcome
PubMed: 36143872
DOI: 10.3390/medicina58091195 -
BMJ (Clinical Research Ed.) Jan 2019To compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture... (Meta-Analysis)
Meta-Analysis
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 from randomised controlled trials and observational studies.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed/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 CRITERIA
Randomised controlled trials and observational studies reporting on comparison of operative versus nonoperative treatment of acute Achilles tendon ruptures.
DATA EXTRACTION
Data 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.
RESULTS
29 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; I=22%). Operative treatment resulted in a significantly higher complication rate than nonoperative treatment (4.9% 1.6%; risk difference 3.3%; risk ratio 2.76, 1.84 to 4.13; P<0.001; I=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; I=0%). No difference in effect estimates was seen between randomised controlled trials and observational studies.
CONCLUSIONS
This 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.
Topics: Achilles Tendon; Female; Humans; Male; Observational Studies as Topic; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Rupture
PubMed: 30617123
DOI: 10.1136/bmj.k5120 -
Revue Medicale de Liege May 2018Ruptured abdominal aortic aneurysm is a cardiovascular emergency associated with a 30 day mortality as high as 70 %. However, recent progresses in the management of... (Review)
Review
Ruptured abdominal aortic aneurysm is a cardiovascular emergency associated with a 30 day mortality as high as 70 %. However, recent progresses in the management of these patients have improved the results. From a surgical point of view, endovascular methods such as balloon occlusion and endovascular repair (EVAR) in patients with suitable anatomy are recommended in order to reduce mortality.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Cardiac Surgical Procedures; Endovascular Procedures; Humans
PubMed: 29926569
DOI: No ID Found -
The American Journal of Sports Medicine Aug 2018Treatment strategies for Achilles tendon rupture vary considerably, and clinical outcome may depend on the magnitude of tendon elongation after surgical repair. The aim... (Randomized Controlled Trial)
Randomized Controlled Trial
The Ruptured Achilles Tendon Elongates for 6 Months After Surgical Repair Regardless of Early or Late Weightbearing in Combination With Ankle Mobilization: A Randomized Clinical Trial.
BACKGROUND
Treatment strategies for Achilles tendon rupture vary considerably, and clinical outcome may depend on the magnitude of tendon elongation after surgical repair. The aim of this project was to examine whether tendon elongation, mechanical properties, and functional outcomes during rehabilitation of surgically repaired acute Achilles tendon ruptures were influenced by different rehabilitation regimens during the early postsurgical period.
HYPOTHESIS
Restricted early weightbearing that permits only limited motion about the ankle in the early phase of tendon healing limits tendon elongation and improves functional outcome.
STUDY DESIGN
Randomized controlled trial; Level of evidence, 1.
METHODS
75 consecutive patients with an acute Achilles tendon rupture were included. They underwent surgical repair, and tantalum beads were placed in the distal and proximal parts of the tendon; thereafter, the patients were randomized into 3 groups. The first group was completely restricted from weightbearing until week 7. The second group was completely restricted from weightbearing until week 7 but performed ankle joint mobilization exercises. The first and second groups were allowed full weightbearing after week 8. The third group was allowed partial weightbearing from day 1 and full weightbearing from week 5. All patients received the same instructions in home exercise guidelines starting from week 9.
RESULTS
The rehabilitation regimen in the initial 8 weeks did not significantly influence any of the measured outcomes including tendon elongation. Achilles tendon elongation and tendon compliance continued for up to 6 months after surgery, and muscle strength, muscle endurance, and patient-reported functional scores did not reach normal values at 12 months.
CONCLUSION
Differences in rehabilitation loading pattern in the initial 8 weeks after the repair of an Achilles tendon rupture did not measurably alter the outcome. The time to recover full function after an Achilles tendon rupture is at least 12 months. Registration: NCT02422004 ( ClinicalTrials.gov identifier).
Topics: Achilles Tendon; Adolescent; Adult; Aged; Ankle; Biomechanical Phenomena; Early Ambulation; Exercise Therapy; Follow-Up Studies; Humans; Middle Aged; Movement; Muscle Strength; Patient Reported Outcome Measures; Rupture; Treatment Outcome; Weight-Bearing; Young Adult
PubMed: 29965789
DOI: 10.1177/0363546518781826 -
Acta Ortopedica Mexicana 2021The rupture of the Achilles tendon is one of the most frequent of the lower limb, the increase in its incidence invites to evaluate its associated characteristics that...
INTRODUCTION
The rupture of the Achilles tendon is one of the most frequent of the lower limb, the increase in its incidence invites to evaluate its associated characteristics that act as triggers or as risk factors.
METHODS
Descriptive, retrospective, cross-sectional study, based on clinical history data, using mean, standard deviation and percentages.
RESULTS
We evaluated 49 patients: males 83.7%, administrative profession 46.9%, sport injury 61.2% (soccer 38.8%). 75.5% were acute injuries, affecting the left tendon (57.1%). The most referred symptom is sudden pain (95.9%) and the most common sign is Thompson's (89.8%). Ultrasonography was used in 42.9%. 95.5% received treatment by open surgery and spinal anesthesia 85.1%. Intraoperatively they reported complete rupture 95.7%, at 2-5 cm insertion 66%, 98% of them had no associated injuries. The repair was simple tenorrhaphy with Kessler's point (51%) and Vycril as suture material (95.7%). Immobilization was performed with warm-pedium plaster (98%) for a period of 6-8 weeks (91.9%). Surgical waiting was 3.6 days and hospital stay 4.9 days.
CONCLUSIONS
Achilles tendon rupture occurred more frequently in sedentary males between 29-48 years, acute presentation in sports activity, affecting the left tendon. Most were complete ruptures located between 2-5 cm from its insertion, performing simple tenorrhaphy.
Topics: Achilles Tendon; Cross-Sectional Studies; Humans; Male; Retrospective Studies; Rupture; Tendon Injuries
PubMed: 34921533
DOI: No ID Found -
British Journal of Sports Medicine Nov 2017Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction or exercise therapy alone.
METHODS
Exploratory analysis of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559). Relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation visits, graft/contralateral ACL rupture, non-ACL surgery and ACL treatment strategy) and 5-year Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, sport/recreation and quality of life (QOL) scores were explored using multivariable linear regression. Estimates were adjusted for sex, age, body mass index, preinjury activity level, education and smoking.
RESULTS
For all participants (n=118), graft/contralateral ACL rupture, non-ACL surgery and worse baseline 36-item Short-Form Mental Component Scores were associated with worse outcomes. Treatment with exercise therapy alone was a prognostic factor for knee symptoms compared with early reconstruction plus exercise therapy (regression coefficient 10.1, 95% CI 2.3 to 17.9). Baseline meniscus lesion was associated with worse sport/recreation function (-14.4, 95% CI -27.6 to -1.3) and osteochondral lesions were associated with worse QOL (-12.3, 95% CI -24.3 to -0.4) following early reconstruction plus exercise therapy. In the same group, undergoing additional non-ACL surgery and worse baseline KOOS scores were prognostic for worse outcome on all KOOS subscales. Following delayed reconstruction, baseline meniscus damage was a prognostic factor for pain (14.3, 95% CI 0.7 to 27.9). Following exercise therapy alone, undergoing non-ACL surgery was prognostic for worse pain.
CONCLUSIONS
Treatment-dependent differences in prognostic factors for 5-year outcomes may support individualised treatment after acute ACL rupture in young active individuals.
TRIAL REGISTRATION NUMBER
Current Controlled Trials ISRCTN84752559.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Exercise Therapy; Female; Follow-Up Studies; Humans; Male; Patient Reported Outcome Measures; Prognosis; Rupture; Time Factors; Treatment Outcome; Young Adult
PubMed: 28515057
DOI: 10.1136/bjsports-2016-097124 -
Journal of Medicine and Life Sep 2014Iatrogenic tracheobronchial ruptures most frequently occur during tracheal intubation, but they can also be produced during tracheobronchial endoscopy or thoracic... (Review)
Review
Iatrogenic tracheobronchial ruptures most frequently occur during tracheal intubation, but they can also be produced during tracheobronchial endoscopy or thoracic surgery. The clinical presentation can be brutal, with respiratory failure, cervical emphysema, pneumothorax and hemoptysis. There are also less symptomatic presentations. The diagnosis is confirmed by bronchoscopy. The therapeutic approach can be differentiated, surgical or conservative, although the criteria are not universally accepted. This article aims to review the indications and therapeutic options.
Topics: Bronchi; Endoscopy; Humans; Iatrogenic Disease; Incidence; Intubation, Intratracheal; Rupture; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Trachea
PubMed: 25408752
DOI: No ID Found -
Anaesthesia Jan 2013Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower... (Review)
Review
Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management.
Topics: Anesthesia; Anesthesia, Conduction; Anesthesia, General; Emergency Medical Services; Endovascular Procedures; Humans; Postoperative Care; Rupture; Vascular Diseases; Vascular System Injuries
PubMed: 23210558
DOI: 10.1111/anae.12048 -
The Journal of the American Academy of... Jun 2007Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has... (Review)
Review
Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and most series have had a relatively small number of patients. Surgical repair results project 58% to 85% rate of return to function and sports activity, near normal strength, and decreased pain.
Topics: Adult; Algorithms; Braces; Humans; Magnetic Resonance Imaging; Middle Aged; Muscle, Skeletal; Physical Examination; Rupture; Thigh
PubMed: 17548884
DOI: 10.5435/00124635-200706000-00004