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Surgical interventions for treating acute Achilles tendon ruptures

Rupture of the Achilles tendon is common and said to be increasing. It typically occurs in males in their 30s and 40s who play sport intermittently. People present with severe pain in the tendon, at the back of the ankle. Signs include a palpable gap at the rupture site, and marked weakness of ankle plantar‐flexion (movement so toes point downwards). Options for management include non‐surgical interventions (plaster of Paris, bracing or splinting) or surgical repair of the tendon. Following either method of treatment, the ankle may be immobilised for up to 12 weeks (in a cast, allowing no movement at the ankle and variable weight‐bearing), or mobilised early (in a brace, allowing movement at the ankle and partial to full weight‐bearing).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture

Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review

INTRODUCTION: This review provides a comprehensive description of clinical, functional outcomes, and complications after open and minimally invasive surgery for Achilles tendon ruptures.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

A systematic review of early rehabilitation methods following a rupture of the Achilles tendon

OBJECTIVES: Rupture of the Achilles tendon is a debilitating injury. Advances have led to the development of immediate weight bearing rehabilitation. A range of early rehabilitation methods exist, but further research is required into this new area. The first stage in the investigation of a complex intervention is to identify its defining components. The aim of this review was to systemically identify and summarise, from clinical studies, the individual components that define immediate weight bearing rehabilitation protocols for the treatment of acute Achilles tendon rupture's.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence

PURPOSE: The aim of this study was to evaluate, in a meta-analysis, the clinical effectiveness of operative treatment for acute Achilles tendon rupture (AATR) compared with nonoperative treatment.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis

BACKGROUND: There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture-operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Surgical versus nonsurgical treatment of acute achilles tendon rupture: A meta-analysis of randomized trials.

BACKGROUND: Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis

Whether Achilles tendon rupture benefits from surgery or conservative treatment remains controversial. Moreover, the outcome can be influenced by the rehabilitation protocol. The goal of the present meta-analysis was to compare the rerupture rate after surgical repair of the Achilles tendon followed by weightbearing within 4 weeks versus conservative treatment with weightbearing within 4 weeks. In addition, a secondary analysis was performed to compare the rerupture rates in patients who started weightbearing after 4 weeks. Seven randomized controlled trials published from 2001 to 2012, with 576 adult patients, were included. The primary outcome measure was the rerupture rate. The secondary outcomes were minor and major complications other than rerupture. In the early weightbearing group, 7 of 182 operatively treated patients (4%) experienced rerupture versus 21 of 176 of the conservatively treated patients (12%). A secondary analysis of the patients treated with late weightbearing showed a rerupture rate of 6% (7 of 108) for operatively treated patients versus 10% (11 of 110) for conservatively treated patients. The differences concerning the rerupture rate in both groups were not statistically significant. No differences were found in the occurrence of minor or major complications after early weightbearing in both patient groups. In conclusion, we found no difference in the rerupture rate between the surgically and nonsurgically treated patients followed by early weightbearing. Weightbearing after 4 weeks also resulted in no differences in the rupture rate in the surgical versus conservatively treated patients. However, surgical treatment was associated with a twofold greater complication rate than conservative treatment.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence

PURPOSE: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over traditional immobilization. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to compare functional rehabilitation to immobilization in the treatment of ATR.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The utility of clinical measures for the diagnosis of Achilles tendon injuries: a systematic review with meta-analysis

OBJECTIVE: To summarize and evaluate the current diagnostic accuracy of clinical measures used to diagnose Achilles tendon injuries.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Accelerated rehabilitation following Achilles tendon repair after acute rupture — development of an evidence-based treatment protocol

The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials

The authors concluded that open surgical repair of acute Achilles tendon ruptures resulted in significantly lower re-rupture rates than non-operative management but had higher rates of deep infections, non-cosmetic scar complaints and sural nerve dysfunctions. Uncertainty over review methods and synthesis, between-study differences and unclear re-rupture results suggest that the conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis

The authors concluded that early functional rehabilitation protocols improved patient satisfaction in comparison with standard immobilisation regimens, with no difference in re-rupture rates. However, further research is required to confirm these findings. There were limitations to this review but, overall, the authors' cautious conclusions appear appropriate

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Injection treatment for painful Achilles tendons in adults

The Achilles tendon connects the calf muscles to the heel bone. Painful and stiff Achilles tendons are common overuse injuries in people undertaking sports, such as running, but also occur for other reasons in inactive people. The underlying cause is an imbalance between the damage and repair processes in the tendon. Painful Achilles tendons are often disabling and can take a long time to get better. Many treatments exist for this condition and this review set out to find out whether treatment with an injection, with a variety of agents, decreases pain and allows people to return to their previous activities.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Tendon injury and fluoroquinolone use: a systematic review

BACKGROUND: Fluoroquinolone antibiotics are commonly used to treat infections and are prescribed by general practitioners, medical specialists and surgeons. Tendon injury has been associated with the use of these medications but the risk associated with newer fluoroquinolones has not been established.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Venous Thromboembolism Prophylaxis in Orthopedic Surgery [Internet]

This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2012
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A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction

The authors concluded that in primary anterior cruciate ligament reconstruction, bone-patellar tendon-bone (BPTB) autograft was favoured over BPTB allograft for outcomes of graft rupture and hop test only. This finding was sensitive to the method of sterilisation of the autograft. Due to lack of quality assessment and small numbers of included participants, the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Platelet‐rich therapies for musculoskeletal soft tissue injuries

Muscle, ligament and tendon injuries frequently occur during activities such as sports, and may be due to tissue degeneration. These injuries are more frequent in particular parts of the body, such as the tendons located in the shoulder, elbow, knee and ankle.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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