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Cao Y, Gao S, Cui Z, Fu Y, Bai L, Si G, Fan J, Lv Y, Zhou F. Comparison of different immobilisation durations following open surgery for acute achilles tendon rupture: a prospective cohort study. J Orthop Surg Res 2024; 19:497. [PMID: 39169350 PMCID: PMC11337624 DOI: 10.1186/s13018-024-04970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair. METHODS This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected. RESULTS The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences. CONCLUSIONS Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications. TRIAL REGISTRATION ClinicalTrials.gov (NCT04663542).
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Affiliation(s)
- Yuan Cao
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Shan Gao
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Zengzhen Cui
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Yuliang Fu
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Liangyu Bai
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Gao Si
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Jixing Fan
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China
| | - Yang Lv
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China.
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan N Rd, Hai Dian Qu, Bei Jing Shi, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Hai Dian Qu, Bei Jing Shi, 100191, China.
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Saab M, Beldame J, Charpail C, Kaba A, Mainard D, Caubère A, Maynou C, Bredicianu R, Ghorbani A, Giunta JC, Coursier R, Thoreux P, Laboute E. Clinical and functional outcomes of 405 Achilles tendon ruptures after a minimum follow-up of 1 year. Orthop Traumatol Surg Res 2024:103886. [PMID: 38615885 DOI: 10.1016/j.otsr.2024.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results. HYPOTHESES There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols. METHODS This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review. RESULTS Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07). CONCLUSIONS This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes. LEVEL OF EVIDENCE III; retrospective comparative, non-randomized.
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Affiliation(s)
- Marc Saab
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France.
| | - Julien Beldame
- Institut de la cheville et du pied, clinique Blomet, 75015 Paris, France; Clinique Megival, 76550 Saint-Aubin-sur-Scie, France
| | - Christel Charpail
- SOS pied-cheville, clinique du sport, 33700 Merignac, France; Centre Achille, 34070 Montpellier, France
| | - Arnaud Kaba
- Centre hospitalier de Dunkerque, 130, avenue Louis-Herbeaux, 59240 Dunkerque, France
| | - Didier Mainard
- CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Alexandre Caubère
- Hôpital d'instruction des armées Saint-Anne, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Carlos Maynou
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France
| | - Rares Bredicianu
- Centre hospitalier de Sarrebourg, 25, avenue General-de-Gaulle, 57400 Sarrebourg, France
| | - Ali Ghorbani
- Medipole Garonne, 45, rue de Gironis, 31036 Toulouse, France
| | | | - Raphaël Coursier
- Hôpital Saint-Vincent, boulevard de Belfort, 59000 Lille, France
| | - Patricia Thoreux
- Hôpital Hôtel-Dieu-APHP-université Sorbonne Paris Nord, 75004 Paris, France
| | - Eric Laboute
- CERS, groupe Ramsay Santé, 83, avenue du Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
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Hammad ME, Fayed AM, Ayoub MA, Emran AM. Early satisfactory results of percutaneous repair in neglected achilles tendon rupture. BMC Musculoskelet Disord 2023; 24:446. [PMID: 37268932 DOI: 10.1186/s12891-023-06561-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE This investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes. METHODS This is a retrospective review of a cohort of patients (n = 24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 and 2019. Included patients were adults with closed injuries, presented 4-10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference. RESULTS The mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P < 0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P < 0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis. CONCLUSION Percutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.
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Affiliation(s)
- Mostafa Elsebai Hammad
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt.
| | - Aly Maher Fayed
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
| | - Mostafa Ahmed Ayoub
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
| | - Ali Mahmoud Emran
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
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Deng Z, Li Z, Shen C, Sun X, Wang T, Nie M, Tang K. Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:2047-2053. [PMID: 35767039 DOI: 10.1007/s00402-022-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/19/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. It is important to evaluate whether early functional weight-bearing rehabilitation program after minimally invasive repair results in an earlier return to pre-injury activity but increases the risk of re-rupture. MATERIALS AND METHODS This was a prospective randomized controlled trial involving 68 AATR patients undergoing minimally invasive surgery. 34 patients were enrolled in early weight‑bearing mobilization accelerated rehabilitation group (AR group); 34 patients were enrolled in the traditional rehabilitation (TR) group. Outcomes measures included American Orthopaedic Foot and Ankle Society Score (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS) score before surgery and 3, 6, and 12 months after surgery, incidence rate of Achilles tendon re-rupture and total complications, length of hospital stay, time return to work and sports. RESULTS There was no significant difference in preoperative basic data between the two groups. However, AOFAS score and ATRS score were better in AR group than TR group at 3 months postoperatively (92.4 ± 3.5 vs 88.3 ± 4.5, P < 0.01; 91.1 ± 4.4 vs 88.9 ± 3.4, P = 0.03, respectively), the mean length of hospital stay (4.7 ± 1.5 vs 7.6 ± 2.0 days, P < 0.01) and time return to work (4.5 ± 1.0 vs 7.5 ± 1.6 weeks, P < 0.01) were shorter in AR group than in TR group. No statistical significance was calculated in patient-reported outcomes during the rest of the follow-up time and complications. CONCLUSION Early accelerated rehabilitation with weight-bearing in patients with AATR after minimally invasive surgery results in better early functional outcomes and shows similar security and feasibility. REGISTRATION NO ChiCTR2100043398.
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Affiliation(s)
- Zhibo Deng
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Zhi Li
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Chen Shen
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Xianding Sun
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Ting Wang
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Mao Nie
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China
| | - Kaiying Tang
- Center for Joint Surgery, Department of Orthopedic, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road No.76, Yuzhong District, Chongqing, 400010, China.
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Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM). J Clin Med 2022; 11:jcm11123335. [PMID: 35743407 PMCID: PMC9225029 DOI: 10.3390/jcm11123335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. MATERIAL Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. METHODS A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). RESULTS Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). CONCLUSIONS Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group.
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