Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China.
BMC Musculoskelet Disord. 2023 Mar 4;24(1):163. doi: 10.1186/s12891-023-06260-w.
To explore and compare the clinical outcomes in patients undergoing primary repair versus augmented repair with a gastrocnemius turn-down flap for acute Achilles tendon rupture.
From 2012 to 2018, the clinical data of 113 patients with acute Achilles tendon rupture who were treated with primary repair or augmented repair with a gastrocnemius turn-down flap by the same surgeon were retrospectively reviewed. The patients' preoperative and postoperative scores on the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society Ankle⁃Hindfoot (AOFAS) score, the Victorian Institute of Sport Assessment⁃Achilles (VISA-A), the Achilles tendon total rupture score (ATRS), and the Tegner Activity Scale were examined and compared. The postoperative calf circumference was measured. A Biodex isokinetic dynamometer was used to evaluate the plantarflexion strength on both sides. The time to return to life and exercise as well as the strength deficits in both groups were recorded. Finally, the correlation analyses between patient characteristics and treatment details with clinical outcomes were conducted.
In total, 68 patients were included and completed the follow-up. The 42 and 26 patients who were treated with primary repair and augmented repair were assigned to group A and B, respectively. No serious postoperative complications were reported. No significant between-group differences in any outcomes were observed. It was found that female sex was correlated with poorer VISA-A score (P = 0.009), complete seal of paratenon was correlated with higher AOFAS score (P = 0.031), and short leg cast was correlated with higher ATRS score (P = 0.006).
Augmented repair with a gastrocnemius turn-down flap provided no advantage over primary repair for the treatment of acute Achilles tendon rupture. After surgical treatment, females tended to had poorer outcomes, while complete seal of paratenon and short leg cast contributed to better results.
Cohort study; Level of evidence, 3.
探讨和比较初次修复与腓肠肌翻转瓣增强修复治疗急性跟腱断裂的临床效果。
回顾性分析 2012 年至 2018 年间，由同一位医生采用初次修复或腓肠肌翻转瓣增强修复治疗的 113 例急性跟腱断裂患者的临床资料。比较患者术前、术后视觉模拟评分（VAS）、美国矫形足踝协会踝后足（AOFAS）评分、维多利亚运动评估-跟腱（VISA-A）评分、跟腱总断裂评分（ATRS）和提踵活动量表的评分，测量术后小腿周径，采用 Biodex 等速测力计测量双侧跖屈肌力，记录两组患者的重返生活和运动时间以及肌力缺失情况。最后，对患者特征和治疗细节与临床结果之间的相关性进行分析。
共纳入 68 例患者并完成随访，初次修复和增强修复的患者分别为 42 例和 26 例，分为 A 组和 B 组。两组患者均未出现严重的术后并发症。两组患者在各评估指标上的差异均无统计学意义。研究发现，女性与较差的 VISA-A 评分相关（P=0.009），腱周膜完整封闭与较高的 AOFAS 评分相关（P=0.031），短腿石膏固定与较高的 ATRS 评分相关（P=0.006）。
腓肠肌翻转瓣增强修复治疗急性跟腱断裂的效果并不优于初次修复。女性患者术后的结果往往较差，而腱周膜完整封闭和短腿石膏固定有助于获得更好的效果。
队列研究；证据等级，3 级。
