Non-operative management of Achilles tendon rupture equivalent to the surgical repair .
Cette étude a été identifiée comme étant potentiellement à fort impact.
L'indicateur High Impact de l'ENP, basé sur l'IA, estime l'influence qu'un article est susceptible d'avoir en intégrant des signaux provenant à la fois de la revue dans laquelle il est publié et du contenu scientifique de l'article lui-même.
Développé à l'aide d'un traitement du langage naturel de pointe, le modèle High Impact de l'ENP prédit avec plus de précision les futures citations d'une étude que le seul facteur d'impact de la revue.
Cela permet d'identifier plus tôt les recherches cliniquement significatives et aide les lecteurs à se concentrer sur les articles les plus susceptibles d'influencer les pratiques futures.
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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
5/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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?
- 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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
