Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital and University of Bern, Bern, Switzerland.
Foot Ankle Int. 2020 Jul;41(7):784-792. doi: 10.1177/1071100720919029. Epub 2020 Jun 16.
There is controversy whether nonoperative or operative treatment for Achilles tendon rupture is superior. It is unknown if patients with acute Achilles tendon rupture return to previous sports activity. The purpose of this study was to assess 5-year return to sport and subjective satisfaction, minimum 1-year functional outcomes, and complications in patients following nonoperative treatment of Achilles tendon rupture with early weightbearing rehabilitation.
An institutional review board-approved, retrospective observational study involving 89 patients was performed. Out of 114 consecutive patients, 89 (78%) responded to questionnaires for sports activity. Nonoperative treatment consisted of an equinus cast and rehabilitation boot that enabled early weightbearing. Sports activity at 1-year and 5-year follow-up was compared to the prerupture status. Based on the prerupture Tegner Activity Scale (TAS), patients were divided into low-level (<6) and high-level (≥6) activity groups. Clinical assessment at minimum 1-year follow-up was performed with the Thermann score. Mean clinical follow-up was 34 ± 23 months.
Overall, >70% of the patients returned to their previous sports activity level after a nonoperative early weightbearing treatment. Return-to-sport rate was significantly ( = .029) higher for patients in the low-level activity group (91%) compared to patients (67%) in the high-level activity group at 5-year follow-up. Subjective satisfaction with treatment was good in both groups (93% and 96%, respectively). The mean Thermann score did not differ between the 2 groups at 1-year follow-up. There were 11 reruptures, 5 deep venous thromboses, and 1 case of complex regional pain syndrome.
Nonoperative treatment for Achilles tendon rupture yielded good functional outcome and high patient satisfaction. For patients with a high preinjury activity level, return to previous sporting level (assessed by TAS) was possible in 67% of the patients compared to >90% of patients with low preinjury activity level.
Level III, retrospective comparative series.
对于跟腱断裂，非手术治疗还是手术治疗更优存在争议。对于急性跟腱断裂患者，其是否能重返先前的运动活动状态尚不清楚。本研究的目的是评估接受早期负重康复的非手术治疗的跟腱断裂患者在 5 年时的运动重返情况和主观满意度、至少 1 年的功能结果以及并发症。
进行了一项机构审查委员会批准的回顾性观察性研究，共纳入 89 例患者。在 114 例连续患者中，有 89 例（78%）对运动活动问卷调查做出了回应。非手术治疗包括使用矫形马蹄足石膏和康复靴，从而实现早期负重。在 1 年和 5 年随访时比较患者的运动重返情况与损伤前状态。根据损伤前的 Tegner 活动量表（TAS），患者被分为低水平（<6）和高水平（≥6）活动组。在至少 1 年的随访时进行 Thermann 评分的临床评估。平均临床随访时间为 34±23 个月。
总体而言，在接受非手术早期负重治疗后，超过 70%的患者恢复到了损伤前的运动水平。在 5 年随访时，低水平活动组（91%）患者的运动重返率明显高于高水平活动组（67%）（ =.029）。两组患者对治疗的主观满意度均良好（分别为 93%和 96%）。在 1 年随访时，两组间 Thermann 评分无差异。有 11 例再断裂、5 例深静脉血栓形成和 1 例复杂性区域疼痛综合征。
非手术治疗跟腱断裂可获得良好的功能结果和患者满意度。对于损伤前活动水平较高的患者，有 67%的患者可恢复到损伤前的运动水平（通过 TAS 评估），而损伤前活动水平较低的患者中，有>90%的患者可恢复到相同水平。
III 级，回顾性比较系列研究。
