Lantto Iikka, Heikkinen Juuso, Flinkkila Tapio, Ohtonen Pasi, Siira Pertti, Laine Vesa, Leppilahti Juhana
Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
Am J Sports Med. 2016 Sep;44(9):2406-14. doi: 10.1177/0363546516651060. Epub 2016 Jun 15.
The optimal treatment of acute Achilles tendon ruptures for active patients is under debate.
To compare clinical outcomes and calf muscle strength recovery after the nonsurgical treatment and open surgical repair of acute Achilles tendon ruptures with identical accelerated rehabilitation programs.
Randomized controlled trial; Level of evidence, 1.
From 2009 to 2013, a total of 60 patients with an acute Achilles tendon rupture were randomized to surgery or nonsurgical treatment. Nonsurgical treatment included first a week of cast immobilization, followed by a functional orthosis for 6 weeks, allowing full weightbearing after week 1 and active plantar flexion after week 5. Surgery was simple end-to-end open repair, and postoperative treatment was identical to nonsurgical treatment. Outcome measures included the Leppilahti Achilles tendon performance score, isokinetic calf muscle strength, and RAND 36-Item Health Survey at 18-month follow-up.
At 18-month follow-up, the mean Leppilahti score was 79.5 and 75.7 for the surgically and nonsurgically treated groups, respectively (mean difference, 3.8; 95% CI, -1.9 to 9.5; P = .19). Angle-specific peak torque results of affected legs showed that surgery resulted in faster and better recovery of calf muscle strength over the entire range of motion of the ankle joint: at 6 months, the difference varied from 16% to 24% (P = .016), favoring the surgically treated group, whereas at 18 months, surgically treated patients had 10% to 18% greater strength results (P = .037). At 18 months, a 14% difference in the peak torque of the affected leg favored the surgical group versus the nonsurgical group (mean peak torque, 110.3 vs 96.5 N·m, respectively; mean difference, 13.6 N·m; 95% CI, 2.0-25.1 N·m; P = .022). The RAND 36-Item Health Survey indicated better results in the domains of physical functioning (P = .006) and bodily pain (P = .037) for surgically treated patients.
Surgical and nonsurgical treatments of acute Achilles tendon ruptures have similar results in terms of the Achilles tendon performance score, but surgery restores calf muscle strength earlier over the entire range of motion of the ankle joint, with a 10% to 18% strength difference favoring surgery at 18 months. Surgery may also result in better health-related quality of life in the domains of physical functioning and bodily pain compared with nonsurgical treatment.
NCT02012803 (ClinicalTrials.gov).
对于活跃患者的急性跟腱断裂的最佳治疗方法仍存在争议。
比较采用相同加速康复方案的急性跟腱断裂非手术治疗与切开手术修复后的临床疗效及小腿肌肉力量恢复情况。
随机对照试验；证据等级，1级。
2009年至2013年，共有60例急性跟腱断裂患者被随机分为手术组或非手术组。非手术治疗首先包括1周的石膏固定，随后使用功能性矫形器6周，第1周后允许完全负重，第5周后进行主动跖屈。手术采用简单的端端切开修复，术后治疗与非手术治疗相同。结局指标包括18个月随访时的莱皮拉hti跟腱功能评分、等速小腿肌肉力量以及兰德36项健康调查。
在18个月随访时，手术治疗组和非手术治疗组的平均莱皮拉hti评分分别为79.5和75.7（平均差异为3.8；95%可信区间为-1.9至9.5；P = 0.19）。患侧腿特定角度的峰值扭矩结果显示，手术治疗在踝关节整个活动范围内能使小腿肌肉力量恢复得更快且更好：在6个月时，差异在16%至24%之间（P = 0.016），手术治疗组更优，而在18个月时，手术治疗患者的力量结果高出10%至18%（P = 0.037）。在18个月时，患侧腿峰值扭矩相差14%，手术组优于非手术组（平均峰值扭矩分别为110.3和96.5 N·m；平均差异为13.6 N·m；95%可信区间为2.0 - 25.1 N·m；P = 0.022）。兰德36项健康调查表明，手术治疗患者在身体功能（P = 0.006）和身体疼痛（P = 0.037）方面的结果更好。
急性跟腱断裂的手术治疗和非手术治疗在跟腱功能评分方面结果相似，但手术能在踝关节整个活动范围内更早恢复小腿肌肉力量，在18个月时力量差异为10%至18%，手术更具优势。与非手术治疗相比，手术在身体功能和身体疼痛方面可能也会带来更好的健康相关生活质量。
NCT02012803（ClinicalTrials.gov）
