SLR - September 2020 - Joelaki J. Cartman

Prospective Randomized Clinical Trial of Open Operative, Minimally Invasive and Conservative Treatments of Acute Achilles Tendon Tear

Reference: Fischer S, Colcuc C, Gramlich Y, Stein T, Abdulazim A, von Welck S, Hoffoman R. Prospective Randomized Clinical Trial of Open Operative, Minimally Invasive and Conservative Treatments of Acute Achilles Tendon Tear. Archives of Orthopedic and Trauma Surgery. 2020 May 4

Scientific Literature Review

Reviewed By: Joelaki J. Cartman, DPM
Residency Program: East Liverpool City Hospital – East Liverpool, OH

Podiatric Relevance: Podiatric surgeons frequently treat patients with Achilles tendon ruptures. These tendon ruptures represent the most common tendon rupture of the lower extremity. The frequency of these injuries is only going to increase as the popularity of high-risk sports and increased activity in older individuals continues to rise. The goal of treatment for these injuries is restoring structural integrity to the tendon and returning the patient to their original level of activity. Many recent studies have shown that when an early functional rehab is performed, both surgical and conservative treatment options produce equivalent treatment results. Unfortunately, many of these results have lacked objectivity due to the subjective nature of patient responses in their follow up questionnaires. The aim of this study was to evaluate the results of patients with acute Achilles tendon ruptures treated conservatively and surgical using a dynamometer as well as evaluation of the tendon with ultrasound.

Methods: The study was conducted as a prospective, randomized, and monocentric study from 2012 to 2015. Ninety patients with acute Achilles tendon ruptures were split evenly into three groups (30 patients in each group). Patient received either conventional open suture repair, minimally invasive suture repair, or conventional treatment. Regardless of treatment, all groups followed the same early functional rehabilitation program. Follow-up was the same for all three groups. Patients received follow up physical exams at six, 12 and 24 months. Plantarflexion strength was assessed via The Biodex isokinetic dynamometer with further evaluation including physical test and ultrasound of the tendon. Additional data was collected using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS-AH) and the SF-36 questionnaire which patients received prior to each examination.

Results: Sixty-nine patients made it to the 24-month follow-up mark. There was a total of four re-ruptures (1: open, 1: minimal and 2: conservative). A positive correlation was found between the dynamometer measurement and the AOFAS-AH score for all groups. There was no significant difference between the three groups after two years. Ultrasound showed structural loosening and thickened cross-sectional area when compared to the un-injured side. There was no correlation between dynamometer measurements and ultrasound results between treatment groups.

Conclusions: After 24-months, the results showed no difference could be found in patients with acute Achilles tendon ruptures treated either surgically or conservative. The study also shows that use of the dynamometer showed a positive correlation between AOFAS-AH and force of plantarflexion. There are limitations in this study including not allowing for blinding, no validation in AOFAS-AH score for German speaking countries and no uniform definition for complications. These results show that use of the dynamometer is valuable as a measurement tool in post treatment outcome after Achilles tendon injury. The results also suggest that conservative or surgical option for this tendon rupture are equally effective.

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