Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University, Campus Innenstadt, Nussbaumstr. 20, 80336, Munich, Germany.
Princess Royal Hospital, Shrewsbury and Telford NHS Trust and the Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. Epub 2015 Sep 26.
Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair.
A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included.
One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment.
Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician.
II.
与非手术治疗相比，急性跟腱断裂后的手术修复可降低再断裂率。开放性修复后，早期功能康复可改善预后，但存在感染和伤口愈合不良的风险。微创外科可降低这些风险；然而，其稳定性令人担忧。因此，医生可能对采用功能康复持保留态度。微创修复后的术后治疗仍无共识。本研究旨在确定微创修复后最有效和安全的术后康复方案。
在 Embase、MEDLINE 和 Cochrane 图书馆中进行了系统的文献检索，以查找报告微创修复后早期功能康复的前瞻性试验。纳入了 7 项研究。
确定了 1 项随机对照试验、1 项前瞻性对照研究和 5 项前瞻性非对照研究。4 项研究采用完全负重，所有研究均显示出良好的功能结果、早期重返工作/运动和高满意度。1 项研究允许早期活动，导致了出色的主观和客观结果。唯一的随机对照试验实施了最加速的方案，在立即完全负重结合自由踝关节活动的情况下，显示出更好的功能结果和更少的并发症。非对照研究报告了在联合治疗后，患者满意度高、功能结果良好且能早期重返工作/运动。
在功能支具中立即负重，结合早期活动，是安全的，微创修复跟腱断裂后可获得更好的结果。我们推荐的治疗方案为患者提供了质量保证，为主治医生提供了可靠性。
II 级。
