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Tuesday, Mar 11, 2014, 8:00 AM - 3:00 PM
Management of Acute Achilles Tendon Rupture: A Meta-analysis of Outcomes
+Ankle and Pilon (Trauma)
Foot / Ankle
, MB, BS, MRCS RCSEng
Muhammad Ali Shah
, MBBS, MSc
J Martin Bland
, FRCS (Ortho), FRCS, MSc, MB, PhD, ChB
INTRODUCTION: With a more active growing population, the incidences of acute Achilles ruptures are on the rise. The treatment options are either non-operative or operative with early or delayed rehabilitation. There still remains controversy regarding best treatment options with regards to outcomes. In order to aid return to pre-injury sporting activities, the functional outcome following any treatment option is a paramount parameter that would lead to a right choice of a patient centred acute injury management protocol. A detailed meta-analysis was carried out to address this controversy.
METHODS: English randomized control trials (RCT) measuring outcomes of acute tendon Achilles were included were included via search of multiple databases by four independent reviewers (EMBASE, MEDLINE and Cochrane Central Register and hand searches). Key words and Boolean linkage used were “Achilles tendon rupture” AND “management” OR “repair” OR “treatment” AND “functional outcomes”. A total of 722 initial hits were obtained but with strict inclusion criteria checklist, only seven RCTs were relevant and included. Primary outcome measure was validated functional outcome (three, six, 12 and 24 months). Range of movement and re-rupture rates were reported too.
RESULTS: A total of 716 patients from seven RCTs were meta-analyzed (N370 operative repair and N346 non-operative repair). Operative repair of ATR showed significant difference in functional outcome at three months (p=0.0048) but this was not significant at six, 12 and 24 months although the pooled effects still favored operative repair (p=0.16; p=0.19; p=0.3). Only two studies reported range of movement at three months; there was no significant difference between treatments for both dorsiflexion and plantar flexion (p=0.55). At six months and 12 months, the range of movement remained similar following operative and non-operative repairs. There was significant difference in re-rupture rates with operative repair having fewer incidences of re-ruptures (p=0.003).
DISCUSSION AND CONCLUSION: There is no statistically significant difference between the different treatment modalities of acute Achilles tendon rupture with regards to functional outcome and range of movement at six, 12 and 24 months. Although operative repair demonstrated better functional outcome at three months, this became insignificant once the patient was fully back to mobilization. Operative repair however still produces fewer incidences of re-rupture rates.
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