Ge Laurence, Saunders Noah, Betts Dakota, Holmes James R, Walton David M, Talusan Paul G
Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA.
The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Foot Ankle Orthop. 2023 Sep 26;8(3):24730114231198849. doi: 10.1177/24730114231198849. eCollection 2023 Jul.
There continues to be controversy regarding treatment options for Achilles tendon ruptures (ATR). The aim of our study is to compare outcomes between operatively and nonoperatively managed Achilles ruptures in young adults (age 18-30 years), which has not been previously evaluated.
At a single institution, all patients aged 18-30 years at time of injury who underwent treatment for an acute ATR from 2014 to 2021 were evaluated. Medical records were reviewed to collect demographics, dates of injury and treatment, smoking status, body mass index (BMI), Charlson Comorbidity Index (CCI), rate of deep venous thrombosis (DVT) after treatment, and rate of rerupture. Patients then completed Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) questionnaires. Mann-Whitney nonparametric testing was used to evaluate for any statistical differences in PROMIS scores.
Sixty-six operative patients qualified and 28 (42%) participated. Thirty-seven nonoperative patients qualified and 14 (38%) participated. All patients had a CCI of 0. One patient in the operative cohort and 2 in the nonoperative reported active smoking. In the operative and nonoperative cohorts, respectively, the average age was 24.4 and 27.8 years; average BMI 26.5 (SD = 4.8) and 27.3 (SD = 4.3, = .52); DVT rates 4 (6.1%) and 2 (5.4%); and rerupture rates 2 (3.0%) and 1 (2.7%), respectively. PROMIS scores did not differ in the operative and nonoperative groups: PROMIS PF mean of 60.4 (SD = 9.8) and 62.9 (SD = 9.1), respectively ( = .33); as well as PROMIS PI mean of 44.6 (SD = 5.9) and 43.9 (SD = 6.5), respectively ( = .59).
This study should be interpreted with the understanding that we had a considerable loss to follow-up rate. In the study cohort, we found that young adults with ATR may be considered for either operative or nonoperative management. Rates of DVT, rates of rerupture, and PROMIS scores were not dissimilar between the 2 cohorts.
Level III, retrospective cohort study.
跟腱断裂（ATR）的治疗方案一直存在争议。我们研究的目的是比较年轻成年人（18 - 30岁）中手术治疗和非手术治疗跟腱断裂的疗效，此前尚未对此进行过评估。
在单一机构中，对2014年至2021年期间因急性跟腱断裂接受治疗的所有受伤时年龄在18 - 30岁的患者进行评估。查阅病历以收集人口统计学资料、受伤和治疗日期、吸烟状况、体重指数（BMI）、Charlson合并症指数（CCI）、治疗后深静脉血栓形成（DVT）率和再断裂率。然后患者完成患者报告结局测量信息系统（PROMIS）的身体功能（PF）和疼痛干扰（PI）问卷。采用Mann - Whitney非参数检验来评估PROMIS评分的任何统计学差异。
66例手术患者符合条件，28例（42%）参与。37例非手术患者符合条件，14例（38%）参与。所有患者的CCI均为0。手术组有1例患者和非手术组有2例患者报告有主动吸烟。手术组和非手术组的平均年龄分别为24.4岁和27.8岁；平均BMI分别为26.5（标准差 = 4.8）和27.3（标准差 = 4.3，P = 0.52）；DVT发生率分别为4例（6.1%）和2例（5.4%）；再断裂率分别为2例（3.0%）和1例（2.7%）。手术组和非手术组的PROMIS评分无差异：PROMIS PF平均值分别为60.4（标准差 = 9.8）和62.9（标准差 = 9.1）（P = 0.33）；PROMIS PI平均值分别为44.6（标准差 = 5.9）和43.9（标准差 = 6.5）（P = 0.59）。
本研究应在理解我们有相当高的失访率的情况下进行解读。在研究队列中，我们发现年轻的跟腱断裂患者可考虑手术或非手术治疗。两组之间的DVT发生率、再断裂率和PROMIS评分并无差异。
III级，回顾性队列研究。
