School of Physical Education, Southwest Medical University.
Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China.
Int J Surg. 2024 Jun 1;110(6):3888-3899. doi: 10.1097/JS9.0000000000001305.
BACKGROUND: Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture. MATERIALS AND METHODS: Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85 , Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87 . RESULTS: A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26-4.17; I2 =44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76-7.27; I2 =51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91-9.99; I2 =0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96-5.43; I2 =20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00-7.73; I2 =64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11-3.59; I2 =21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12-3.90; I2 =0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76-6.89; I2 =33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25-4.03; I2 =22.09%). CONCLUSIONS: This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.
背景：跟腱断裂（ATR）是一种严重的损伤，可能需要手术治疗，即使治疗成功，也有再次断裂的风险。因此，为了最大限度地降低这种风险，重要的是要充分了解康复方案以及不同康复方法对预防再断裂的影响。
材料和方法：两名独立的团队成员在几个数据库（PubMed、EMBASE、Web of Science、Cochrane 图书馆和 CINAHL）中搜索了关于 ATR 手术治疗的随机对照试验（RCT）。我们纳入了涵盖 ATR 开放性或微创性手术的文章，这些文章都有详细的康复方案和再断裂报告。研究方案已在 PROSPERO 注册，并按照 PRISMA 指南进行了报告，补充数字内容 1，http://links.lww.com/JS9/C85，补充数字内容 2，http://links.lww.com/JS9/C86，并使用 AMSTAR 工具进行了评估，补充数字内容 3，http://links.lww.com/JS9/C87。
结果：共有 43 项 RCT 符合荟萃分析的条件，共有 2553 例患者纳入了联合队列。总体而言，ATR 患者术后再断裂的发生率为 3.15%（95%CI：2.26-4.17；I2=44.48%）。早期固定组 ATR 患者术后再断裂的发生率为 4.07%（95%CI：1.76-7.27；I2=51.20%）；早期固定+主动活动范围（AROM）组的发生率为 5.95%（95%CI：2.91-9.99；I2=0.00%）；早期固定+负重组的发生率为 3.49%（95%CI：1.96-5.43；I2=20.06%）；早期负重+AROM 组的发生率为 3.61%（95%CI：1.00-7.73；I2=64.60%）；加速康复（固定）组的发生率为 2.18%（95%CI：1.11-3.59；I2=21.56%）；加速康复（非固定）组的发生率为 1.36%（95%CI：0.12-3.90；I2=0.00%）。此外，立即 AROM 组患者术后再断裂的发生率为 3.92%（95%CI：1.76-6.89；I2=33.24%）；非立即 AROM 组的发生率为 2.45%（95%CI：1.25-4.03；I2=22.09%）。
结论：这项荟萃分析表明，在跟腱术后早期康复中采用加速康复干预是有益的。然而，对于早期踝关节活动，建议在固定后一到两周后进行。
Cochrane Database Syst Rev. 2024-9-23
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