Abstract
BackgroundThe best treatment for acute Achilles tendon ruptures remains controversial. No cohort studies have compared different immobilisation durations after open surgery. This retrospective cohort study aimed to determine the optimal duration of immobilisation after this surgery.MethodsA total of 266 patients with acute Achilles tendon rupture were divided into 4 groups (A, B, C, and D) according to immobilisation duration of 0, 2, 4, and 6 weeks, respectively. All patients underwent the same suture technique with a similar rehabilitation protocol and were examined clinically at 2, 4, 6, 8, 10, 12, 14, 16, 24, and 48 weeks, with a final follow-up at a mean of 22.3 months postoperatively. The primary outcome was the time of return to light sports activity (LSA). Secondary outcomes included range of motion (ROM) and single-legged heel rise height (SHRH). Data on operation time, complications, visual analogue pain scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and Achilles tendon Total Rupture score (ATRS) were also collected. Demographic baseline data were analysed using one-way analysis of variance; outcome parameters were analysed using Kruskal-Wallis H test, and complications were analysed using Fisher’s exact test. Statistical significance was considered at P ≤ 0.05.ResultsVAS scores decreased significantly, reaching 0 in all groups after 12 weeks. The AOFAS and ATRS scores were significantly different between the groups from weeks 2 to 12 (P<0.001) and weeks 2 to 16 (P<0.001), respectively. All the mean scores showed better results in group B than in the other groups. In terms of recovery time of ROM, SHRH, and LSA, groups A and B were significantly faster than groups C and D (P<0.001). There were 13 (13/266, 4.9%) complications: 5 superficial infections, 3 deep venous thrombosis, and 5 trauma-related re-ruptures. On the last follow-up, all complications had recovered. There were no significant differences in complications between the groups.ConclusionsImmobilisation for 2 weeks after this open surgery is the best choice for early rehabilitation and weight-bearing while minimising pain and other complications.
Highlights
The best treatment for acute Achilles tendon ruptures remains controversial
It is important to safely shorten the immobilisation duration when starting early functional rehabilitation such that patients can go back to work or normal life as soon as possible. The purpose of this cohort study was to determine the optimal duration of immobilisation after open surgery to repair an Achilles tendon rupture (ATR). Study design This retrospective cohort study aimed to determine the optimal duration of immobilisation after open surgery to repair an ATR
No significant differences were found between the groups with regard to sex, age, body mass index, distance from the rupture site to Achilles tendon insertion site, gap distance of the rupture site, and operation time (Table 2)
Summary
The best treatment for acute Achilles tendon ruptures remains controversial. Achilles tendon rupture (ATR) is a common injury with an increasing incidence. It most frequently occurs in 30–50-year-old men who periodically participate in recreational sports [1, 2] such as badminton (42%), volleyball (18%), soccer (10%), tennis (8%), or indoor hockey (6%) [3]. It occurs predominately in men, with a reported male-to-female ratio ranging from 2:1 to 12:1 [4, 5]. Different suture techniques in open surgery have been reported [10,11,12]. Mandelbaum et al [17] showed that full weightbearing is allowed in 2 to 3 weeks after strengthening of the suturing
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