Achilles tendon rupture managed operatively decreases rerupture but increases complication .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):104 Int Orthop. 2012 Apr;36(4):765-73. Epub 2011 Dec 9.10 randomised control trials were identified from the literature that compared the use of operative and nonoperative treatment for acute ruptures of the Achilles tendon. 894 patients were identified from these studies. Meta-analysis revealed that patients who underwent operative treatment were less likely to have a re-rupture (RR 0.44, p=0.002); however, these patients were more likely to suffer other complications. Functional analysis was not conducted, due to the heterogeneity of functional outcome reporting.
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Acute Achilles tendon ruptures are a common injury which can have debilitating effects on functional performance and mobility. Operative and conservative management options are currently used for this type of injury. It is generally accepted that operative treatment is recommended for young and physically active patients; however, a controversy still remains over the best treatment option. The aim of this meta-analysis is to elucidate the advantages and disadvantages of both operative and nonoperative treatments using the highest quality of evidence available.
¿Cuál era la pregunta principal de la investigación?
Does operative treatment provide better clinical result for Achilles tendon rupture when compared with non operative treatment?
- 10 studies were used to conduct the meta-analysis for re-ruptures. Re-rupture occurred in 4.31% of the 441 patients treated operatively and 9.71% of the patients treated non-operatively-, this was a significant difference between the groups [RR 0.44, 95% CI (0.26-0.74), (p=0.002)]
- 9 studies evaluating complication rate (852 patients) indicated that there was a greater number of complications in the operative group compared to the conservative group, 26.6% of 421 vs 7.91% of 431 [RR 4.07, 95% CI (1.56-10.67) (p=0.004)]
- 2 studies evaluating sick leave found that the mean time for sick leave was shorter in the operative group compared to the nonoperative [MD -23.75, 95% CI (-41.61 to -5.89), p=0.009]
- There were no differences in the number of patients who resumed pre-injury sports and activity levels based on the outcomes of 5 studies (455 patients) (p=0.30)
- Subgroup analysis of complications indicated that the operative group had a significantly higher complication rate in terms of scar adhesion (RR11.76, 95% CI (4.64-29.80), p<0.00001) (6 studies), superficial infection (RR 4.43, 95 % CI (0.97-20.23), p=0.05) (4 studies), and sensibility disturbance (RR07.53, 95% CI (2.55-22.18), p=0.0003)
- A meta-analysis of functional outcomes could not be carried out due to the wide variety of measures taken
¿Qué es lo que más debo recordar?
Operative treatment of acute Achilles tendon ruptures results in a significantly reduced rate of re-rupture and a reduced number of sick leave days required. However, the overall complication rate is greater when compared to conservative treatment. Both treatment methods demonstrated a similar return to pre-injury sports and activity levels among patients.
¿Cómo afectará esto al cuidado de mis pacientes?
Operative treatment is able to reduce the risk of re-rupture in patients who have an acute Achilles tendon rupture, but this procedure is associated with a higher risk of other complications when compared to conservative treatment. Future assessments should consider economic analyses and functional assessments to further compare operative and non-operative treatment options.
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