scholarly journals Achilles Tendon Repair- A Systematic Review of Overlapping Meta-Analyses

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Eoghan Hurley ◽  
Youichi Yasui ◽  
Arianna Gianakos ◽  
Dexter Seow ◽  
Joseph Kromka ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Wound Infection ◽  
Operative Treatment ◽  
Meta Analysis ◽  
Tendon Repair ◽  
Clinical Results ◽  
Infection Rates ◽  
Functional Rehabilitation ◽  
Achilles Tendon Repair ◽  
Meta Analyses

Category: Sports Introduction/Purpose: Acute Achilles tendon ruptures (ATR) are a common sports-related injury with an incidence of between 8-37 per 100,000 per year. While there are several meta-analyses published on the optimal treatment of ATR based on randomized control trials, the reported outcomes conflict between each meta-analysis due to different methodologies. The aim of this study is to systematically review the clinical results represented in meta-analyses in the current literature on acute ATR. Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines to identify meta-analyses on Achilles tendon repair. Clinical results, including the re-rupture rates, wound infection rates and overall complication rates were analyzed. Level of evidence (LOE) and methodological quality of evidence (MQOE), using the AMSTAR score, were evaluated. A statistically significant difference (SSD) was defined as p < 0.05. Each meta-analysis was categorized into one of the following subgroupings: 1) Operative vs Non-Operative Treatment (with Conservative Rehabilitation) [OC vs NOC], 2) Operative vs Non-Operative Treatment (with Functional Rehabilitation) [OF vs NOF], 3) Conservative Rehabilitation vs Functional Rehabilitation (with Operative Treatment) [OC vs OF], and 4) Open vs. Percutaneous Repair (with Conservative Rehabilitation) [OC vs POC]. Results: Four studies compared OC and NOC. Re-rupture rates ranged from 3.1-6.4% in OC and 10.0-13.0% in NOC. Two of these studies showed statistical significance in favour of OC. There was no SSD was seen in other complications. Three studies compared OF and NOF. Re-rupture rates ranged from 3.8-5.0% in OF and 6.0-11.9% in NOF, no study showed a SSD. There was no SSD in other complications. Three studies compared OF and OC. Re-rupture rates ranged from 2.13-3% in OF and 1.1-2.1% in OC, no study showed a SSD. Four studies compared OC and PSC. Re-rupture rates ranged from 2.2-4.4% in OC and 1.1-2.1% in PSC, no study showed a SSD. In all included studies there was SSD in wound infection rates, in favour of PSC. Conclusion: Overall there exists a large volume of high quality meta-analyses on Achilles tendon repair. The re-rupture rates were lower in operative treatment in all studies, even when early functional rehabilitation was used. However, while early functional rehabilitation may allow early mobility but the rehabilitation method can be demanding. Although there was no difference between percutaneous and open repair on the re-rupture rate, there was an overall reduction in wound infection after percutaneous repair. The results within this study can help determine the optimal treatment for patients.

scholarly journals Co-Morbidities Are Associated with Increased Cost, Infection Rates, and Duration of Treatment after Primary Achilles Tendon Repair

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0000
Author(s):  
Malcolm E. Dombrowski ◽  
Christopher D. Murawski ◽  
Youichi Yasui ◽  
Antonia F. Chen ◽  
John G. Kennedy ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Infection Rates ◽  
Duration Of Treatment ◽  
Achilles Tendon Repair

Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair

2015 ◽  
Vol 26 (3) ◽  
pp. 846-853 ◽  
Author(s):  
Mareen Braunstein ◽  
Sebastian F. Baumbach ◽  
Wolfgang Boecker ◽  
Mike R. Carmont ◽  
Hans Polzer
Keyword(s):  
Achilles Tendon ◽  
Tendon Repair ◽  
Minimal Invasive ◽  
Functional Rehabilitation ◽  
Rehabilitation Protocol ◽  
Achilles Tendon Repair

Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair

2018 ◽  
Vol 12 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Harry M. Lightsey ◽  
Peter C. Noback ◽  
Jon-Michael E. Caldwell ◽  
David P. Trofa ◽  
Justin K. Greisberg ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Achilles Tendon ◽  
Tendon Repair ◽  
Athletic Activity ◽  
Functional Rehabilitation ◽  
Achilles Tendon Repair ◽  
Rehabilitation Protocols ◽  
Substantial Progress ◽  
Retrospective Comparative Study ◽  
Teaching Programs

Background: Substantial progress has been made in characterizing the benefit of early functional rehabilitation following Achilles tendon repair (ATR). However, standardized ATR rehabilitation guidelines have yet to be produced. Furthermore, as patients increasingly use the Internet to independently retrieve health care content, access to standardized, clinically effective rehabilitation protocols is necessary. Methods: Online ATR physical therapy protocols from US academic orthopaedic programs were reviewed. A comprehensive scoring rubric was designed after reviewing all identified protocols and was used to assess each protocol for both the presence of various rehabilitation components as well as when those components were introduced. Results: Twenty-two of 155 US academic orthopaedic programs published postoperative Achilles rehabilitation protocols online, with a total of 27 individual protocols available for review. Twenty-one protocols (78%) recommended immediate postoperative splinting. Only one protocol recommended short-leg casting. Twenty-six protocols (96%) advised immediate nonweightbearing with progression to weightbearing as tolerated at an average of 3.0 weeks (range, 1-8 weeks) and to full weightbearing at an average of 7.3 weeks (range, 2-12 weeks). Active plantarflexion and dorsiflexion to neutral were included by most protocols (93%) at an average of 3.9 (range, 0-9) weeks and 3.4 (range, 0-8) weeks, respectively. There was considerable variability in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Fourteen protocols (52%) recommended return to training after meeting certain athletic activity criteria. Conclusion: The purpose of this investigation was to evaluate the quality, variability, and patient accessibility of publicly available rehabilitation protocols for ATR provided by US orthoapedic teaching programs. To this end, we found that a minority of US academic orthopaedic programs publish ATR rehabilitation protocols online. While a trend away from traditional ankle casting is apparent, many programs have not adopted the accelerated weightbearing and controlled mobilization techniques that have been shown to produce better functional outcomes and greater patient satisfaction. There is also a substantial degree of variability in both the composition and timing of rehabilitation components across physical therapy protocols. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals TA Rupture Assessment Analysis – are Our "GOLD-Standards“ of Tendon Repair Valid?

2020 ◽  
Author(s):  
Simone Frunz ◽  
Markus Knupp ◽  
Beat Goepfert ◽  
Lukas Iselin
Keyword(s):  
Achilles Tendon ◽  
Failure Mode ◽  
Operative Treatment ◽  
Suture Material ◽  
Testing Machine ◽  
Tendon Repair ◽  
Suture Technique ◽  
Achilles Tendon Repair ◽  
Rupture Pattern

Abstract Background: Current studies showed that operative treatment has advantages in comparison to conservative treatment for acute Achilles tendon ruptures. The gold standard therapy in our clinic is the operative treatment with the four strand Adelaide suture. The goal of this study is to evaluate which suture material (a) B Braun; MonoMax, b) Ethicon; PDS CTX) is more appropriate for Achilles tendon suture.Methods: Ten pairs of fresh frozen Achilles tendons were obtained from human donors aged 41 – 85. The tendons were fixed on a testing machine and loaded until failure. The goal of this setup was to create a natural rupture pattern. The ruptured tendons were sutured either with BB or PDS and again loaded until failure.The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Results: The ruptures occurred on different locations. The maximal forces in the sutured tendons occurring at the rupture were for the BB-suture between 144 N and 232 N (Mean 197 (SD 67) N) and for the PDS-suture between 158 N and 226 N (Mean 194(SD 70) N). The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Conclusion: Due to the failure mode we are not able to evaluate which suture material is better to use for the Achilles tendon repair with the Adelaide suture. Either the Adelaide suture is not an appropriate suture technique for Achilles tendon repair or the natural rupture pattern has in comparison to the in vitro rupture patterns constructed by sharp dissection a bigger influence on the pullout strength of suture techniques than we thought. This would mean that probably the data from most in vitro studies are not applicable for daily life.

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