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Treatment of acute Achilles tendon rupture - a multicentre, non-inferiority analysis

Artikel i vetenskaplig tidskrift
Författare Olof Westin
Tony Sjögren
S. Svedman
Alexandra Horvath
E. H. Senorski
Kristian Samuelsson
P. Ackermann
Publicerad i BMC Musculoskeletal Disorders
Volym 21
Nummer/häfte 1
ISSN 1471-2474
Publiceringsår 2020
Publicerad vid Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Institutionen för kliniska vetenskaper, Avdelningen för ortopedi
Språk en
Länkar dx.doi.org/10.1186/s12891-020-03320...
Ämnesord ATRS, Achilles tendon, Rupture, Treatment, Non-surgical, Surgical, treatment, Heel-rise test, Rehabilitation, deep-vein thrombosis, prospective randomized-trial, heel-rise height, nonoperative treatment, weight-bearing, accelerated rehabilitation, nonsurgical treatments, operative treatment, surgical repair, metaanalysis, Orthopedics, Rheumatology
Ämneskategorier Ortopedi

Sammanfattning

Background While numerous clinical studies have compared the surgical and non-surgical treatment of acute Achilles tendon rupture (ATR), there are no studies that have performed a non-inferiority analysis between treatments. Methods Data from patients who were included in five randomised controlled trials from two different centres in Sweden were used. Outcomes at 1 year after ATR consisted of the patient-reported Achilles tendon Total Rupture Score (ATRS) and the functional heel-rise tests reported as the limb symmetry index (LSI). The non-inferiority statistical 10% margin was calculated as a reflection of a clinically acceptable disadvantage in ATRS and heel-rise outcome when comparing treatments. Results A total of 422 patients (350 males and 72 females) aged between 18 and 71 years, with a mean age of 40.6 (standard deviation 8.6), were included. A total of 363 (86%) patients were treated surgically. The ATRS (difference (Delta) = - 0.253 [95% confidence interval (CI); - 5.673;5.785]p = 0.36) and LSI of heel-rise height (difference = 1.43 [95% CI; - 2.43;5.59]p = 0.81), total work (difference = 0.686 [95% CI; - 4.520;6.253]p = 0.67), concentric power (difference = 2.93 [95% CI; - 6.38;11.90]p = 0.063) and repetitions (difference = - 1.30 [95% CI; - 6.32;4.13]p = 0.24) resulted in non-inferiority within a Delta - 10% margin for patients treated non-surgically. Conclusion The non-surgical treatment of Achilles tendon ruptures is not inferior compared with that of surgery in terms of 1-year patient-reported and functional outcomes.

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