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AAOS: Surgery Doesn't Improve Achilles Tendon Recovery
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| | Action Points
<LI class=APP>Explain to interested patients that there is no consensus on the most appropriate treatment strategy -- either surgical or nonsurgical -- for an acute Achilles tendon rupture.
<LI class=APP> oint out that this study showed both approaches to be equally effective.
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
NEW ORLEANS -- Surgical and nonsurgical treatment were equally effective for patients with acute rupture of the Achilles tendon, a randomized trial showed.
Patient-reported functional outcomes and rates of re-rupture did not differ significantly between the two groups through 12 months, according to Katarina Nilsson Helander, MD, of Kungsbacka Hospital in Sweden.
Both groups reported increased physical activity over time, although they were still below pre-injury levels at one year, she reported at the American Academy of Orthopaedic Surgeons meeting here.
Nilsson Helander and her colleagues undertook the study because the optimal treatment approach for an Achilles tendon rupture -- either surgical or nonsurgical -- has long been debated.
The study involved 97 patients with first-time midsubstance ruptures (mean age 41, 80% male), most of whom were injured playing sports. Racquet sports accounted for half of those.
Within 72 hours of injury, the 97 patients were randomized to surgery (48) or no surgery (49), followed by two weeks in a firm cast and then six weeks in an adjustable brace that allowed some movement of the foot.
The surgical intervention involved an open, end-to-end suture using the modified Kessler suture technique.
All underwent identical rehabilitation programs, with weight-bearing allowed when tolerated in both groups after six to eight weeks.
Through one year, re-rupture occurred in 12% of the nonsurgical group and 4% of the surgical group, which was not a significant difference (P=0.377).
There were some complications in the surgical group, including one contracture of the tendon, two wound infections (one deep and one superficial), and two nerve disturbances.
Thirteen patients had concerns about the scar -- 10 for cosmetic reasons and three for scar contracture and pain.
Patients reported symptoms and activity levels using the Achilles tendon Total Rupture Score (ATRS). Both groups improved significantly over time, with no between-group differences at either six months (P=0.870) or one year (P=0.441).
The intensity and frequency of physical activity was assessed using the Physical Activity Scale (PAS). Again, both groups improved over time, with no between-group differences at either time point (P>0.05 for both).
Patients in both groups had reduced scores at one year compared with pre-injury levels.
Function in the surgical group improved more quickly than that in the nonsurgical group.
Patients who received surgery performed significantly better on tests of heel-rise work, heel-rise height, hopping, and concentric power at six months (P<0.05 for all).
However, by 12 months, the two groups had similar function and differed only in heel-rise work (P=0.012).
At one year, there continued to be functional limitations in the injured leg compared with the uninjured leg, regardless of treatment group.
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发表于 2010-5-20 22:04:27