Acute Achilles Tendon Rupture

Metz, R.; Verleisdonk, Egbert-Jan M. M.; Heijden, Geert J. M. G. van der; Clevers, G. J.; Hammacher, E. R.; Verhofstad, M.H.J.; Werken, Christiaan van der

doi:10.1177/0363546508319312

Cited by 183 publications

(38 citation statements)

References 30 publications

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“…1 The most recent trials comparing surgical repair with non-operative treatment have found no dif erence in functional outcome; therefore, non-operative treatment is increasingly preferred by clinicians and patients. [2][3][4] Traditionally, patients with an Achilles rupture have been treated with serial plaster casts over several weeks. The cast provides maximum protection for the tendon as it heals, but immobilisation might increase calf muscle atrophy, ankle joint stifness, gait abnormalities, and the risk of blood clots.…”

Section: Introductionmentioning

confidence: 99%

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation

et al. 2020

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Background Patients with Achilles tendon rupture who have non-operative treatment have traditionally been treated with immobilisation of the tendon in plaster casts for several weeks. Functional bracing is an alternative non-operative treatment that allows earlier mobilisation, but evidence on its effectiveness and safety is scarce. The aim of the UKSTAR trial was to compare functional and quality-of-life outcomes and resource use in patients treated nonoperatively with plaster cast versus functional brace. Methods UKSTAR was a pragmatic, superiority, multicentre, randomised controlled trial done at 39 hospitals in the UK. Patients (aged ≥16 years) who were being treated non-operatively for a primary Achilles tendon rupture at the participating centres were potentially eligible. The exclusion criteria were presenting more than 14 days after injury, previous rupture of the same Achilles tendon, or being unable to complete the questionnaires. Eligible participants were randomly assigned (1:1) to receive a plaster cast or functional brace using a centralised web-based system. Because the interventions were clearly visible, neither patients nor clinicians could be masked. Participants wore the intervention for 8 weeks. The primary outcome was patient-reported Achilles tendon rupture score (ATRS) at 9 months, analysed in the modified intention-to-treat population (all patients in the groups to which they were allocated, excluding participants who withdrew or died before providing any outcome data). The main safety outcome was the incidence of tendon re-rupture. Resource use was recorded from a health and personal social care perspective. The trial is registered with ISRCTN, ISRCTN62639639.

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Section: Introductionmentioning

confidence: 99%

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation

et al. 2020

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“…However, it is in keeping with the worldwide trend towards non-operative treatment of acute rupture of the Achilles tendon, as per the recent evidence base, which suggests little functional advantage of surgery. 8,9 Only 46 patients were excluded because they were unable to adhere to trial procedures or complete questionnaires, most commonly because they could not read written English, which was used in the follow-up questionnaires. Thirty-seven patients were excluded because they had suffered a previous Achilles tendon injury, which was likely to have affected their baseline, pre-injury function.…”

Section: Chapter 5 Discussionmentioning

confidence: 99%

“…More recent trials comparing surgical repair and non-operative treatment have found no difference in functional outcome. 8,9 As surgery carries considerable costs, and carries considerable risks to the patient in terms of complications, 7 there is an increasing trend towards non-operative treatment. However, some surgeons have been reluctant to advocate non-operative treatment because of concerns about the lack of evidence to guide early rehabilitation for this group of patients, 10 specifically whether or not functional bracing is safe and effective if the tendon has not been not surgically repaired.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Plaster cast versus functional bracing for Achilles tendon rupture: the UKSTAR RCT

Costa

Achten

Wagland

et al. 2020

Health Technol Assess

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Background Achilles tendon rupture affects > 11,000 people each year in the UK, leading to prolonged periods away from work, sports and social activities. Traditionally, the ruptured tendon is held still in a plaster cast for ≥ 8 weeks. Functional bracing is an alternative treatment that allows patients to mobilise earlier, but there is little evidence about how bracing affects patients’ recovery. Objectives To measure the Achilles Tendon Rupture Score, quality of life, complications and resource use of patients receiving non-operative treatment for an Achilles tendon rupture treated with plaster cast compared with those treated with functional bracing. Design This was a multicentre, randomised, pragmatic, two-group superiority trial. Setting The setting was 39 NHS hospitals. Participants A total of 540 adult patients treated non-operatively for Achilles tendon rupture were randomised from July 2016 to May 2018. Exclusion criteria included presenting after 14 days, having had previous rupture and being unable to complete questionnaires. Interventions A total of 266 participants had a plaster cast applied, with their toes initially pointing to the floor. The cast was changed over 8 weeks to bring the foot into a walking position. A total of 274 patients had a functional brace that facilitated immediate weight-bearing. The foot position was adjusted within the brace over the same 8-week period. Main outcome measures Achilles Tendon Rupture Score is patient reported and assesses symptoms and physical activity related to the Achilles tendon (score 0–100, with 100 being the best possible outcome). The secondary outcomes were quality of life, complications and resource use at 8 weeks and at 3, 6 and 9 months. Results Participants had a mean age of 48.7 years, were predominantly male (79%) and had ruptured their tendon during sports (70%). Over 93% of participants completed follow-up. There was no statistically significant difference in Achilles Tendon Rupture Score at 9 months post injury (–1.38, 95% confidence interval –4.9 to 2.1). There was a statistically significant difference in Achilles Tendon Rupture Score at 8 weeks post injury in favour of the functional brace group (5.53, 95% confidence interval 2.0 to 9.1), but not at 3 or 6 months post injury. Quality of life showed the same pattern, with a statistically significant difference at 8 weeks post injury but not at later time points. Complication profiles were similar in both groups. Re-rupture of the tendon occurred 17 times in the plaster cast group and 13 times in the functional brace group. There was no difference in resource use. Conclusions This trial provides strong evidence that early weight-bearing in a functional brace provides similar outcomes to traditional plaster casting and is safe for patients receiving non-operative treatment of Achilles tendon rupture. The probability that functional bracing is cost-effective exceeds 95% for the base-case imputed analysis, assuming a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. On average, functional brace is associated with lower costs (–£103, 95% confidence interval –£290 to £84) and more quality-adjusted life-years (0.015, 95% confidence interval –0.0013 to 0.030) than plaster cast. Limitations Some patients declined to participate in the trial, but only a small proportion of these declined because they had a preference for one treatment or another. Overall, 58% of eligible patients agreed to participate, so the participants are broadly representative of the population under investigation. Future work Although the UK Study of Tendo Achilles Rehabilitation provides guidance with regard to early management, rehabilitation following Achilles tendon rupture is prolonged and further research is required to define the optimal mode of rehabilitation after the initial cast/brace has been removed. Trial registration Current Controlled Trials ISRCTN62639639. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 8. See the NIHR Journals Library website for further project information.

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“…1,[4][5][6] Treatment options include surgical repair or conservative treatment, although there is no consensus on these treatment options, and re-rupture is the main concern for acute Achilles tendon injuries. It has previously been reported that the re-rupture rate ranged from 1.7% to 8.0% in a surgically treated group, [7][8][9][10] whereas this rate ranged from up to 4.0% to 20.8% [7][8][9][10][11] in patients treated conservatively.…”

Section: Introductionmentioning

confidence: 92%

<p>Doxycycline-Embedded Nanofibrous Membranes Help Promote Healing of Tendon Rupture</p>

Weng¹,

Lee²,

Ho³

et al. 2020

IJN

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Background: Despite recent advancements in surgical techniques, the repair of tendon rupture remains a challenge for surgeons. The purpose of this study was to develop novel doxycycline-loaded biodegradable nanofibrous membranes and evaluate their efficacy for the repair of Achilles tendon rupture in a rat model. Materials and Methods: The drug-loaded nanofibers were prepared using the electrospinning process and drug release from the prepared membranes was investigated both in vitro and in vivo. Furthermore, the safety and efficacy of the drug-loaded nanofibrous membranes were evaluated in rats that underwent tendon surgeries. An animal behavior cage was employed to monitor the post-surgery activity of the animals. Results: The experimental results demonstrated that poly(D,L-lactide-co-glycolide) (PLGA) nanofibers released effective concentrations of doxycycline for more than 40 days post-surgery, and the systemic plasma drug concentration was low. Rats receiving implantation of doxycycline-loaded nanofibers also showed greater activities and stronger tendons post-operation. Conclusion: Nanofibers loaded with doxycycline may have great potential in the repair of Achilles tendon rupture.

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Acute Achilles Tendon Rupture

Abstract: There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.

Cited by 183 publications

References 30 publications

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation

Plaster cast versus functional bracing for Achilles tendon rupture: the UKSTAR RCT

<p>Doxycycline-Embedded Nanofibrous Membranes Help Promote Healing of Tendon Rupture</p>

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