FOOT & ANKLE
Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation
Este estudio ha sido identificado como potencialmente de alto impacto.
La métrica de alto impacto de OE, impulsada por la IA, estima la influencia que probablemente tendrá un artículo integrando señales tanto de la revista en la que se publica como del contenido científico del propio artículo.
Desarrollado mediante el procesamiento del lenguaje natural más avanzado, el modelo de Alto Impacto de OE predice con mayor precisión el futuro rendimiento de las citas de un estudio que el factor de impacto de la revista por sí solo.
Esto permite reconocer antes las investigaciones clínicamente significativas y ayuda a los lectores a centrarse en los artículos con más probabilidades de configurar la práctica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):73 J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. Epub 2010 Oct 29.144 patients with primary complete Achilles tendon rupture were randomized to be treated with either a surgical repair and accelerated functional rehabilitation or with only the accelerated functional rehabilitation. Over the course of a two year follow up, it was observed that Achilles tendon rupture led to clinically similar results between the two treatment groups.
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)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
التوزيع العشوائي
3/4
قياسات النتائج
4/4
الشمول / الاستبعاد
4/4
وصف العلاج
5/5
الإحصاء
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?
Achilles tendon rupture is a common sporting injury in adults with an increasing incidence due to continued sporting activity with growing age. So far evidence had favored surgical repair to be better in preventing re-rupture rates. However, the treatment of choice still remains controversial. Early weight-bearing with protected range of motion demonstrates better range of motion, strength, and return to activity, while minimizing re-ruptures or possibility of healing in a lengthened position. This study aimed to compare outcome of patients with acute Achilles tendon ruptures, who had been treated with operative repair and accelerated functional rehabilitation, with outcomes of similar patients who had been treated with accelerated functional rehabilitation alone.
¿Cuál era la pregunta principal de la investigación?
Are there any long-term differences in the results between patients receiving operative repair and accelerated functional rehabilitation versus those patients receiving accelerated functional rehabilitation alone, in the two-year post-operative period?
¿Cuáles fueron los hallazgos importantes?
- At the 2-year follow-up, re-rupture occurred in two patients in the operative group at one and three months after injury and in three patients in the nonoperative group at one, two, and three months after injury.
- There was significant difference in the plantar flexion strength ratio (affected to unaffected limb) at 240 degrees at two years (mean difference, 14.15%; 95% CI, 1.12% to 27.19%; p = 0.03) in favor of the operative group.
- The mean range of dorsiflexion was 20.3 degrees +/- 12 degrees in the operative group and 17.9 degrees +/- 6.0 degrees in the nonoperative group. The mean range of plantar flexion was 44.5 degrees +/- 8.4 degrees in the operative group and 46.8 degrees +/- 8.5 degrees in the nonoperative group.
- The side-to-side difference in plantar flexion range of motion was greater in the nonoperative group than in the operative group (mean difference between groups, 2.21 degrees; 95% CI, 3.9 degrees to 0.5 degrees; p = 0.01)
- The mean side-to-side difference in calf circumference was 1.7 +/- 2.0 cm in the operative group and 1.5 +/- 5.6 cm in the nonoperative group. This difference was not significant (mean difference between groups, 0.2 cm; 95% CI, 1.8 to 1.3 cm; p = 0.75).
- The mean Leppilahti score was 82.6 +/- 11.1 points in the operative group and 82.2 +/- 12.3 points in the nonoperative group. These values were not significant (mean difference: 0.4 point; 95% CI, 5.4 to 5.0 points; p = 0.89).
- Study pitfalls, however, included no specification of intent to treat analysis, a largely male population, and an under-powered sample size.
¿Qué es lo que más debo recordar?
The results of this study supported the use of accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes were clinically similar to those experienced for operative treatment. However, this study was under-powered.
¿Cómo afectará esto al cuidado de mis pacientes?
In patients with Achilles tendon rupture, accelerated functional rehabilitation appears to be effective when used after surgical and nonsurgical treatments. Further methodologically sound studies with sufficient power are necessary to confirm these findings.
DESCARGO DE RESPONSABILIDAD
El contenido de esta página tiene únicamente fines informativos y no pretende sustituir el consejo, diagnóstico o tratamiento médico profesional. Si necesita tratamiento médico, busque siempre el consejo de su médico o acuda al servicio de urgencias más cercano. Las opiniones, creencias y puntos de vista expresados por las personas sobre el contenido que se encuentra en esta página no reflejan las opiniones, creencias y puntos de vista de OrthoEvidence.
0 de 4 artículos mensuales GRATIS desbloqueados
