Brodeur Peter G, Salameh Motasem, Boulos Alexandre, Blankenhorn Brad D, Hsu Raymond Y
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Foot Ankle Orthop. 2024 Jul 30;9(3):24730114241266190. doi: 10.1177/24730114241266190. eCollection 2024 Jul.
In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume.
The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends.
The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied.
This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period.
Level III, retrospective cohort study.
随着关于跟腱断裂（ATR）非手术治疗的证据越来越多，欧洲和加拿大的研究显示手术治疗的发生率在下降，而美国尚未出现这种情况。本研究的主要目的是评估美国ATR修复手术量的趋势。
使用美国骨科医师协会（ABOS）第二部分口试病例清单数据库。要求提供2006年至2020年期间所有使用原发性ATR修复代码的病例。分析了提交的跟腱修复手术总量、提交跟腱修复病例的考生数量以及每个考试年份提交的病例总数。采用泊松回归和线性回归来确定具有统计学意义的趋势。
2006年至2011年期间，提交给ABOS第二部分口试的跟腱修复病例总数显著增加，然后下降至2020年。以跟腱修复病例占提交的骨科病例总数的比例来看，呈现相同趋势。提交跟腱修复病例的考生数量从2006年至2009年增加，然后下降至2020年。在研究期间，接受足踝专科培训的考生每人提交的ATR修复病例数量有所增加。
这是第一项证明美国ATR修复手术量下降的研究。ABOS第二部分病例清单中ATR修复手术量的下降与之前公布的美国外科医生的实践模式不相符，但不一定能推广到该时期之外。尽管ABOS第二部分病例清单中总体ATR修复手术量在下降，但我们发现接受足踝专科培训的外科医生在收集病例期间进行的ATR手术数量在增加。
三级，回顾性队列研究。
