Westin Olof, Svedman Simon, Senorski Eric Hamrin, Svantesson Eleonor, Nilsson-Helander Katarina, Karlsson Jón, Ackerman Paul, Samuelsson Kristian
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Orthop J Sports Med. 2018 Dec 26;6(12):2325967118813904. doi: 10.1177/2325967118813904. eCollection 2018 Dec.
There is limited evidence regarding the patient-related factors that influence treatment outcomes after an acute Achilles tendon rupture.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the predictors of functional and patient-reported outcomes 1 year after an acute Achilles tendon rupture using a multicenter cohort and to determine patient characteristics for reporting within the top and bottom 10% of the Achilles tendon Total Rupture Score (ATRS) and heel-rise height outcomes. The hypothesis was that older age, greater body mass index (BMI), and female sex would lead to inferior outcomes.
Cohort study; Level of evidence, 2.
Patients were selected by combining 5 randomized controlled trials from 2 different centers in Sweden. Functional outcomes were assessed using validated heel-rise tests (height, number of repetitions, total work, and concentric power) for muscular endurance and strength, and the relationship between injured and uninjured legs was calculated as the limb symmetry index (LSI). Patient-reported outcomes were measured using the ATRS. All outcomes were collected at the 1-year follow-up. Independent predictors included were patient sex, smoking, BMI, age, and surgical versus nonsurgical treatment.
Of the 391 included patients, 307 (79%) were treated surgically. The LSI of heel-rise height at the 1-year follow-up decreased by approximately 4% for every 10-year increment in age (beta, -3.94 [95% CI, -6.19 to -1.69]; = .0006). In addition, every 10-year increment in age resulted in a 1.79-fold increase in the odds of being in the lowest 10% of the LSI of heel-rise height. Moreover, a nonsignificant superior LSI of heel-rise height was found in patients treated surgically compared with nonsurgical treatment (beta, -4.49 [95% CI, -9.14 to 0.16]; = .058). No significant predictor was related to the ATRS. Smoking, patient sex, and BMI did not significantly affect the 1-year results for the LSI of the heel-rise tests.
Older age at the time of injury negatively affected heel-rise height 1 year after an Achilles tendon rupture. Irrespective of age, a nonsignificant relationship toward the superior recovery of heel-rise height was seen in patients treated surgically. None of the factors studied affected patient-reported outcomes.
关于影响急性跟腱断裂后治疗效果的患者相关因素，证据有限。
目的/假设：本研究的目的是使用多中心队列确定急性跟腱断裂1年后功能和患者报告结局的预测因素，并确定在跟腱总断裂评分（ATRS）和提踵高度结局处于前10%和后10%范围内报告的患者特征。假设是年龄较大、体重指数（BMI）较高和女性性别会导致较差的结局。
队列研究；证据等级，2级。
通过合并来自瑞典2个不同中心的5项随机对照试验来选择患者。使用经过验证的提踵测试（高度、重复次数、总功和向心功率）评估肌肉耐力和力量的功能结局，并计算受伤腿和未受伤腿之间的关系作为肢体对称指数（LSI）。使用ATRS测量患者报告的结局。所有结局均在1年随访时收集。纳入的独立预测因素包括患者性别、吸烟、BMI、年龄以及手术与非手术治疗。
在纳入的391例患者中，307例（79%）接受了手术治疗。在1年随访时，年龄每增加10岁，提踵高度的LSI下降约4%（β，-3.94[95%CI，-6.19至-1.69]；P = 0.0006）。此外，年龄每增加10岁，提踵高度LSI处于最低10%的几率增加1.79倍。此外，与非手术治疗相比，手术治疗的患者提踵高度的LSI有不显著的优势（β，-4.49[95%CI，-9.14至0.16]；P = 0.058）。没有显著的预测因素与ATRS相关。吸烟、患者性别和BMI对提踵测试LSI的1年结果没有显著影响。
受伤时年龄较大对跟腱断裂1年后的提踵高度有负面影响。无论年龄如何，手术治疗的患者在提踵高度的较好恢复方面存在不显著的关系。所研究的因素均未影响患者报告的结局。
