Abduljawad Salim M, Almonla Yaser, Bin Sahl Abdullah, Balvinder Rana, Pillai Anand
College of Medicine, Alfaisal University, Riyadh, SAU.
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR.
Cureus. 2024 Nov 24;16(11):e74338. doi: 10.7759/cureus.74338. eCollection 2024 Nov.
Achilles tendon rupture is the most commonly ruptured tendon in humans. Recent evidence suggests no significant differences in long-term functional outcomes between conservative and surgical management. Conservative treatment carries a higher risk of re-rupture, while surgical management presents risks such as wound infections and sural nerve damage. This retrospective cohort study aims to compare functional outcomes and patient-specific factors in conservative versus surgical management of Achilles tendon ruptures using the Achilles Tendon Total Rupture Score (ATRS).
Hospital electronic records from a major acute teaching hospital were reviewed to gather data on patients treated for Achilles tendon rupture. Patients were categorised into surgical or conservative treatment groups, and ATRSs were recorded at least one year post-injury. Statistical analysis, including the Wilcoxon rank sum and Welch t-tests, was used to compare ATRS outcomes between the groups. Outcomes were also stratified by age, sex, side of rupture, and tendon gap did not yield significant differences in outcomes. Notably, all female patients in this study were treated conservatively, precluding direct gender comparisons within the surgical treatment group. In addition, no consistent trends emerged regarding the side or specific location of the rupture.
The final sample comprised 25 patients, excluding those with missing data and patients over 75 years old. No significant difference was observed in the overall ATRS between the surgical (mean 89.9) and conservative (mean 89.2) management (p = 0.662). However, older males (aged 51-75) demonstrated better outcomes with surgical management (mean ATRS 95.4) compared to conservative management (mean 86.2, p = 0.027). Younger males (aged 18-50) showed a trend toward better outcomes with conservative treatment (mean 91.9) compared to surgery (mean 80.7), although this was not statistically significant. Patients with larger tendon gaps (≥20 mm) had higher ATRSs regardless of treatment modality, but these findings did not reach statistical significance.
This study found no significant difference in long-term functional outcomes between conservative and surgical management of Achilles tendon ruptures. However, older males benefited more from surgery, while younger males showed a trend toward better outcomes with conservative treatment, but the decision to offer surgery should not be based on age alone. Better functional outcomes were found irrespective of the tendon gap in both groups. Further research with larger sample sizes is needed to validate these findings and guide patient-specific treatment decisions.
跟腱断裂是人类最常发生断裂的肌腱。最近的证据表明，保守治疗和手术治疗在长期功能结果方面没有显著差异。保守治疗再次断裂的风险较高，而手术治疗存在伤口感染和腓肠神经损伤等风险。这项回顾性队列研究旨在使用跟腱完全断裂评分（ATRS）比较跟腱断裂保守治疗与手术治疗的功能结果及患者特定因素。
回顾一家大型急性教学医院的医院电子记录，以收集接受跟腱断裂治疗患者的数据。患者被分为手术治疗组或保守治疗组，并在受伤至少一年后记录ATRS评分。采用包括Wilcoxon秩和检验和Welch t检验在内的统计分析方法比较两组的ATRS结果。结果还按年龄、性别、断裂侧别和肌腱间隙进行分层，结果未产生显著差异。值得注意的是，本研究中的所有女性患者均接受保守治疗，排除了在手术治疗组内进行直接性别比较的可能性。此外，关于断裂的侧别或具体位置未出现一致趋势。
最终样本包括25名患者，排除了数据缺失的患者和75岁以上的患者。手术治疗组（平均89.9）和保守治疗组（平均89.2）的总体ATRS评分未观察到显著差异（p = 0.662）。然而，年龄较大的男性（51 - 75岁）手术治疗的结果（平均ATRS 95.4）优于保守治疗（平均86.2，p = 0.027）。年龄较小的男性（18 - 50岁）与手术治疗（平均80.7）相比，保守治疗有更好结果的趋势（平均91.9），尽管这在统计学上不显著。肌腱间隙较大（≥20 mm）的患者无论治疗方式如何，ATRS评分都较高，但这些结果未达到统计学意义。
本研究发现跟腱断裂保守治疗与手术治疗在长期功能结果方面没有显著差异。然而，年龄较大的男性从手术中获益更多，而年龄较小的男性保守治疗有更好结果的趋势，但手术决策不应仅基于年龄。两组无论肌腱间隙如何都有较好的功能结果。需要更大样本量的进一步研究来验证这些发现并指导针对患者的治疗决策。
