Achilles tendon rupture: Surgery with accelerated rehab similar to non-surgical treatment .
Este estudo foi identificado como tendo um impacto potencialmente elevado.
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Desenvolvido com recurso ao mais avançado processamento de linguagem natural, o modelo High Impact da OE prevê com maior precisão o desempenho futuro de um estudo em termos de citações do que o fator de impacto da revista por si só.
Isto permite o reconhecimento precoce de investigação clinicamente significativa e ajuda os leitores a concentrarem-se nos artigos com maior probabilidade de moldar a prática futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(4):10 Am J Sports Med. 2013 Dec;41(12):2867-76. doi: 10.1177/0363546513503282. Epub 2013 Sep 6.101 patients with an acute Achilles tendon rupture were randomized to one of two groups: a surgical group, wherein surgical repair was performed and early weight-bearing was encouraged, or a non-surgical group, wherein patients were treated conservatively and early weight-bearing was also encouraged. The purpose of this study was to evaluate these two treatment methods with respect to functional outcomes. Results indicated that patients in the surgical group were not significantly different than the non-surgical group with respect to function, physical activity levels post-injury, quality of life, and the incidence of re-ruptures.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
3/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Currently, evidence regarding the optimal form of treatment for acute Achilles tendon ruptures is conflicting. In particular, topics such as surgical versus conservative treatment, early versus delayed loading, and mobilization of the tendon following surgery contribute to this ongoing debate. Adding even more complexity to the issue, outcomes that are traditionally reported include the incidence of re-ruptures; however, recent evidence suggests more emphasis should be placed on functional recovery, rather than the occurrence of these complications. Therefore, this study was needed to compare whether surgical repair with early tendon loading and range of motion was more beneficial in terms of functional and patient-reported outcomes than traditional conservative treatment for acute Achilles tendon rupture.
Qual era a principal questão de investigação?
Over a period of 1 year, did surgical repair with early tendon loading and range of motion yield better functional and patient-reported outcomes in patients with acute Achilles tendon ruptures when compared to traditional non-surgical treatment methods?
- Median ATRS scores significantly improved over time in both groups at the 3, 6 and 12 month follow-up time periods (p<0.001), however there was no significant difference in ATRS scores between the surgical and non-surgical groups at any time point (p>0.05).
- Physical activity levels at 12 months post-operation, measured using the PAS questionnaire, were not significantly different from baseline in both the surgical group (p=0.78) and the non-surgical group (p=0.23).
- The activities of daily living (ADL) and sport and recreation subscores of the FAOS significantly improved over time between all time frames (p<0.05), except for the ADL subscore between 6 and 12 months in the surgical group (p=0.10). There were no significant between-group differences in median FAOS ADL and sport and recreation subscores at 3 months (p=0.42 and p=0.24, respectively).
- The quality of life (QOL) subscore of the FAOS significantly improved over time in both groups between all time frames (p<0.001). There were no significant between-group differences in median FAOS QOL subscores at 3 months (p=0.10).
- Compared to baseline, quality of life measured by the EQ-5D was significantly decreased at 12 months in both the surgical and non-surgical groups (both p=0.03), however there was no significant difference between groups at this time point (p=0.30).
- Except for concentric and eccentric power at 6 months, limb symmetry index (LSI) values were higher in the surgical group compared to the non-surgical group at all time points. However all of these differences, except for hopping and the drop counter-movement jump test at 12 months (p<0.05), were not considered statistically significant (p>0.05).
- 0 patients in the surgical group and 5 patients in the non-surgical group (10%) suffered a re-rupture (between 5 and 12 weeks post-injury) (p=0.06), although 1 patient in the surgical group suffered a partial re-rupture. Following subsequent surgery on those with re-ruptures, there was no significant difference in all functional test scores between those who suffered from a re-rupture and those who did not at 6 and 12 months (p>0.05), except for the heel-rise height at 6 months (p=0.011).
- 1 patient (2%) in the surgical group and 2 patients (4%) in the non-surgical group suffered a deep vein thrombosis. A superficial wound infection occurred in 12% of the patients in the surgical group (6 patients) and a persistent partial sural nerve disturbance occurred in 1 patient from the surgical group.
De que é que me devo lembrar mais?
Surgical repair of an acute Achilles tendon rupture with early full weight-bearing, range of motion and strength training was not found to be statistically superior to non-surgical treatment with immediate weight-bearing, with respect to function, physical activity levels post-injury, quality of life, and the incidence of re-ruptures. It was also found that for those who suffered a re-rupture and underwent subsequent surgical repair, most functional scores measured at 6 and 12 months were not significantly different than those of patients who did not suffer a re-rupture.
Como é que isto afectará o tratamento dos meus doentes?
The results from this study suggest that surgical repair for acute Achilles tendon ruptures with immediate full weight-bearing and range of motion is well tolerated, but is not superior to non-surgical treatment with early weight-bearing. This lack of significance, however, may be attributable to type II error. Therefore, optimal treatment should be specific to the individual and their specific goals. Future research could assess this correlation more accurately by quantitatively measuring the amount of time patients actually spent bearing their weight post-injury, instead of simply encouraging the patients to immediately bear their full weight post-injury.
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