Sebastian Fischer1, Christin Colcuc2, Yves Gramlich3, Thomas Stein4,5, Ahmed Abdulazim6, Stephanie von Welck3, Reinhard Hoffmann3. 1. Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany. dr.sebastian.fischer@me.com. 2. Department of Trauma and Orthopaedic Surgery, Evangelical Hospital Bethel Bielefeld, Bielefeld, Germany. 3. Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany. 4. Department of Sporttraumatology- Knee- and Shoulder- Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany. 5. Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany. 6. Department of Orthopedics, Universitätsspital Basel, Basel, Switzerland.
Abstract
INTRODUCTION: The acute Achilles tendon rupture (AATR) is a common injury of great importance in an increasingly active society. When early functional treatment is established, recent literature shows comparable rates of re-rupture in conservative and surgical treatments of AATR. However, there is no study comparing the outcome using a dynamometer. The aim of this study is to evaluate the results of patients with AATR treated conservatively and surgically using a dynamometer. In addition, the data are compared to evaluation of the Achilles tendon with ultrasound. MATERIALS AND METHODS:Between 2012 and 2015, 90 patients (mean age 41 years, male-to-female ratio 81:9) with AATR were enrolled in a prospective, randomized, and monocentric study. Thirty patients were assigned to each of the three different treatment groups. Group OPEN received a conventional open suture of the Achilles tendon, group MIN received a minimally invasive suture and patients in group CONS were treated conservatively. Follow-up treatment was the same for all patients regardless of the group they were assigned to. Plantar flexion force was assessed using a dynamometer (Biodex® System 3 Pro, Biodex Medical Systems). Further evaluation included a physical test and ultrasound of the Achilles tendon. RESULTS:Sixty-nine patients were available for a 24-month follow-up. In each of the OPEN and MIN groups, there was one re-rupture. In the CONS group, there were two re-ruptures. A positive correlation between the Biodex® dynamometer measurement and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AH) could be found in all groups. Nevertheless, there were no significant differences between the treatment groups after 2 years. On sonography, all patients showed isolated structure loosening and a significantly thickened cross-sectional area compared with the non-injured opposite side, without differences between the groups. There was no correlation between the Biodex® measurement and sonographic outcome. CONCLUSION: At 24-month follow-up, no significant difference can be found in patients with AATR treated operatively or conservatively. It is, therefore, important to inform patients with AATR regarding the respective advantages and disadvantages of the individual treatment strategies. LEVEL OF EVIDENCE: Randomized controlled trial; level 1.
RCT Entities:
INTRODUCTION: The acute Achilles tendon rupture (AATR) is a common injury of great importance in an increasingly active society. When early functional treatment is established, recent literature shows comparable rates of re-rupture in conservative and surgical treatments of AATR. However, there is no study comparing the outcome using a dynamometer. The aim of this study is to evaluate the results of patients with AATR treated conservatively and surgically using a dynamometer. In addition, the data are compared to evaluation of the Achilles tendon with ultrasound. MATERIALS AND METHODS: Between 2012 and 2015, 90 patients (mean age 41 years, male-to-female ratio 81:9) with AATR were enrolled in a prospective, randomized, and monocentric study. Thirty patients were assigned to each of the three different treatment groups. Group OPEN received a conventional open suture of the Achilles tendon, group MIN received a minimally invasive suture and patients in group CONS were treated conservatively. Follow-up treatment was the same for all patients regardless of the group they were assigned to. Plantar flexion force was assessed using a dynamometer (Biodex® System 3 Pro, Biodex Medical Systems). Further evaluation included a physical test and ultrasound of the Achilles tendon. RESULTS: Sixty-nine patients were available for a 24-month follow-up. In each of the OPEN and MIN groups, there was one re-rupture. In the CONS group, there were two re-ruptures. A positive correlation between the Biodex® dynamometer measurement and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AH) could be found in all groups. Nevertheless, there were no significant differences between the treatment groups after 2 years. On sonography, all patients showed isolated structure loosening and a significantly thickened cross-sectional area compared with the non-injured opposite side, without differences between the groups. There was no correlation between the Biodex® measurement and sonographic outcome. CONCLUSION: At 24-month follow-up, no significant difference can be found in patients with AATR treated operatively or conservatively. It is, therefore, important to inform patients with AATR regarding the respective advantages and disadvantages of the individual treatment strategies. LEVEL OF EVIDENCE: Randomized controlled trial; level 1.
Authors: David N Garras; Steven M Raikin; Suneel B Bhat; Nicholas Taweel; Homyar Karanjia Journal: Clin Orthop Relat Res Date: 2012-04-27 Impact factor: 4.176
Authors: Julia Spoendlin; J Bradley Layton; Mallika Mundkur; Christian Meier; Susan S Jick; Christoph R Meier Journal: Drug Saf Date: 2016-12 Impact factor: 5.606
Authors: Olivier C Dams; Inge H F Reininga; Jan L Gielen; Inge van den Akker-Scheek; Johannes Zwerver Journal: Injury Date: 2017-09-18 Impact factor: 2.586
Authors: Olof Westin; Katarina Nilsson Helander; Karin Grävare Silbernagel; Michael Möller; Peter Kälebo; Jón Karlsson Journal: Orthop J Sports Med Date: 2016-10-14
Authors: A J Bayliss; A M Weatherholt; T T Crandall; D L Farmer; J C McConnell; K M Crossley; S J Warden Journal: J Musculoskelet Neuronal Interact Date: 2016-06-01 Impact factor: 2.041
Authors: Juana Kosiol; Alexander Keiler; Alexander Loizides; Hannes Gruber; Benjamin Henninger; Andreas Bölderl; Leonhard Gruber Journal: Arch Orthop Trauma Surg Date: 2022-05-14 Impact factor: 3.067
Authors: J F Maempel; T O White; S P Mackenzie; C McCann; N D Clement Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-01-12 Impact factor: 4.342