Current evidence for nonoperative treatment specific for insertional Achilles tendinopathy favors ESWT or the combined treatment of ESWT plus eccentric exercises. In addition, each included studies' surgical techniques were extracted for better interpretation of baseline characteristics, and end-to-end Bunnell type was the most adopted technique for ATR repair. doi: 10.1136/bmj.d5928. One group was diagnosed with IAT with a Haglunds deformity. https://doi.org/10.1177/0363546505281810. After 28.6 months, the VAS decreased from 7.0 to 1.8 [17]. The mean age of enrolled patients was around 40 years old, ranging from 18 to 63 years old, which conformed to the regular ATR population. Holm C, Kjaer M, Eliasson P: Achilles tendon rupturetreatment and complications: a systematic review. All procedures involved in this meta-analysis were performed under Revman (Version 5.3). The mean value increased from 50.6 to 64. DOI: 10.1177/1938640020916954 Abstract Aim: To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. developing a treatment algorithm; general disorders; podiatric assessment in sports; practice management; sports injuries; sports medicine and podiatry; sports podiatry; trauma. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, et al. The search items were as follows: (insertional OR insertion) AND (tendinopathy OR tendinitis OR tendinosis OR enthesitis or enthesopathy) AND Achilles. Magnussen RA, Dunn WR, Thomson AB. Clin Orthop Relat Res. There is a paradigm shift toward early mobilization and weightbearing. Introduction: This biomechanical study aims to assess the function of patients who were treated non-operatively for delayed diagnosis Achilles tendon rupture. Visualization of bias assessment. Thromb Haemost. Journal of Orthopaedic Surgery and Research (2015) 25:e110. Last but not least, different follow-up periods could be a significant factor affecting the results so that it was recorded. Epub 2014 Jul 7. J Clin Epidemiol. BMJ. Pavone V, Cannav L. Low-energy extracorporeal shock-wave therapy in the treatment of chronic insertional Achilles tendinopathy: a case series. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Am J Sports Med. Moher D, Liberati A, Tetzlaff J, Altman DG. Moher D, Liberati A, Tetzlaff J, Altman DG. Ohberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain-results of a pilot study. doi: 10.3928/01477447-20130724-23. Proc Biol Sci. Google Scholar. Visual analog scale (VAS), Victorian Institute of Sport Assessment-Achilles questionnaire, AOFAS, satisfaction rate, and other scales were used to assess the clinical outcome. The pooled result showed that neither surgical treatment nor conservative management had a shorter period of absence from work (three studies, 330 participants, Z = 0.10, P = 0.92, I2 = 77%, RR: 0.22, 95% CI: 4.32 to 3.89). have taken re-rupture rate, deep vein thrombosis, return to sport, ankle range of motion, and related score into consideration, while adhesion, sural nerve injury, period of absence from work, and infection are added in our study. Operative treatment versus nonoperative treatment of Achilles tendon The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). government site. 1 and Table 1. (29) while 21 days was the longest period reported by Nistor et al. therapy. Mller M, Movin T, Granhed H, Lind K, Faxn E, Karlsson J. Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses. Because of the limited and conflicting evidence, eccentric exercise was given a Grade I recommendation according to the Grades of Recommendation [2]. Federal government websites often end in .gov or .mil. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. (2017) 137:33340. Foot (Edinburgh, Scotland). The detailed information of baseline characteristics of each RCTs is shown in Table 2. However, another RCT indicated that low-energy ESWT had no significant benefit for IAT at the 24 weeks follow-up, especially in the elderly [31]. PDF Achilles Tendon Repair Post-Op Rehabilitation Protocol (2016) 24:140920. and transmitted securely. Article doi: 10.1007/s00228-007-0265-9, 6. Biometrics. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Unauthorized use of these marks is strictly prohibited. Sports Health. FOIA Maffulli G, Padulo J, Iuliano E, Furia J, Rompe J, Maffulli N. Extracorporeal shock wave therapy in the management of insertional Achilles tendinopathy the ASSERT database; 2018. BackgroundExcellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture.PurposeTo describe a new nonoperative treatment protocol for Achilles tendon ruptu. doi: 10.1302/0301-620X.97B5.34581, 44. No use, distribution or reproduction is permitted which does not comply with these terms. Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. Costantino C, Pogliacomi F, Vaienti E. Cryoultrasound therapy and tendonitis in athletes: a comparative evaluation versus laser CO2 and t.e.ca.R. (2016) 75:539. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also crucial in decision making. PDF ACHILLES REPAIR REHABILITATION PROTOCOL - Mountain Ortho therapy) in athletes affected by insertional tendonitis and found that cryoultrasound showed significant advantages over the other two, but there was no significant difference between laser therapy CO2 and t.e.ca.r. Acta Bio-Medica Atenei Parmensis. In a prospective case series study, 22 tendons were injected with 25% dextrose-lidocaine. doi: 10.1016/j.jclinepi.2009.06.005, 14. When it comes to blinding of participants and personnel in performance bias, unclear risk occurred in Nistor et al. Bethesda, MD 20894, Web Policies We aim to provide a clear summary of the best available evidence for nonoperative treatment specific to insertional Achilles tendinopathy. Copyright 2021 She, Teng, Li, Zheng, Chen and Hou. Ames PR, Longo UG, Denaro V, Maffulli N: Achilles tendon problems: not just an orthopaedic issue. One and two years were the widely accepted follow-up period among the included RCTs. Bone Joint J. Knee Surg Sports Traumatol Arthrosc. We aim to provide a clear summary of the best available evidence for nonoperative treatment specific to insertional Achilles tendinopathy. The search of PubMed, Embase, Web of Science database, and additional search finally yielded 470 records after duplicates were removed. EPIDEMIOLOGY. https://doi.org/10.1177/1941738116631498. Conservative treatment for insertional Achilles tendinopathy: platelet-rich plasma and focused shock waves. Furia et al. Secondary outcomes consisted of complication rate (defined as complication occurred after treatment except for re-rupture), deep vein thrombosis, adhesion of scar to the underlying tendon, sural nerve injury, superficial infection, deep infection, period of absence from work, functional scores of Achilles Tendon Rupture Score (ATRS) (16), and mean of dorsiflexion and plantarflexion. The Achilles tendon total rupture score (ATRS): development and validation. 2022 Oct;50(12):3286-3298. doi: 10.1177/03635465221117780. Furthermore, different periods of follow-up, surgical techniques and conservative management strategy may lead to different outcomes. An official website of the United States government. 2020 Dec 17;5(4):95. doi: 10.3390/jfmk5040095. The .gov means its official. The overall results revealed that surgical treatment had a lower re-rupture rate, while no significant difference was found in the subgroup of accelerated functional rehabilitation with early range of motion, which might indicate that early involvement of rehabilitation was not beneficial to functional recovery. The weighted mean of decreased VAS in 9 of 12 groups was 4.49 points (larger than that of eccentric exercises) at the final follow-up. Brief Summary: To compare the end-results of three different methods of treatment of acute achilles tendon ruptures, it is necessary to establish identical rehabilitation protocols. After combining the results, the weighted mean of declined value of the pain scale was 2.83. (2020). (2020). Achilles tendon rupture accounts for 20% of all large tendon ruptures. (2000) 283:200812. https://doi.org/10.1007/s001670000189. Shijun Wei or Feng Xu. (27) and Keating et al. Accelerated Rehabilitation in Non-operative Management of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis. Treatment of Acute Achilles Tendon Rupture - PMC - National Center for compared three therapies (cryoultrasound therapy, laser therapy CO2, and t.e.ca.r. Regarding the summary of our results, a novel inspiration about adopting conservative management as the major treatment plan with lesser complication and similar outcome has been generated. A systematic review of literature and meta-analysis. ATRS functional score, with high reliability, validity, and sensitivity for quantifying functional outcome of patient receiving ATR treatment, is an indispensable index to determine the better treatment (16). CAS Stehno-Bittel L, Reddy GK, Gum S, Enwemeka CS. found that eccentric training resulted in only 32% satisfaction in patients with IAT, while the rate (89%) was much higher in patients with mid-portion Achilles tendinopathy [6]. (2017) 10:7280. Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V, et al. Outcomes of interest were Achilles tendon rupture score (ATRS) (standardized patient-reported instrument related to symptoms and physical activity after treatment of an acute Achilles tendon rupture), rerupture rate, strength, range of motion, return to work, and sports. The training protocol also varied between studies: 5 groups required full-range eccentric exercises (heel lower than forefoot), the other 2 groups performed floor-level eccentric training. doi: 10.1177/036354659302100606, 27. Sode J, Obel N, Hallas J, Lassen A: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Lin L, Chu H. Quantifying publication bias in meta-analysis. Am J Sports Med. doi: 10.1007/s00402-020-03461-z, 37. Combined results were pooled in studies that reported open as well as minimally invasive surgery. Knee Surg Sports Traumatol Arthrosc. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment . doi: 10.1055/s-0038-1667034, 47. Each outcome measure was assessed individually and visualization of results is shown in Supplementary Figures 2AL. Published by Elsevier Inc. All rights reserved. *Correspondence: Lin Chen, chenlinllu@163.com; Huige Hou, drhouhuige@126.com, These authors have contributed equally to this work, https://doi.org/10.3389/fsurg.2021.607743, https://www.frontiersin.org/articles/10.3389/fsurg.2021.607743/full#supplementary-material, Creative Commons Attribution License (CC BY). Mosser P, Kelm J, Anagnostakos K. Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture. https://doi.org/10.11138/mltj/2017.7.1.098. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. Cochrane Handbook for Systematic Reviews of Interventions version 6.0. Orthop J Sports Med. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gtzsche PC, Ioannidis JP, et al. (2011) 93:10718. demonstrated that ESWT with additional dietary supplement containing arginine, Vinitrox, collagen, methyl-sulfonyl-methane, vitamin C, and bromelain significantly improved the therapeutic response when compared to ESWT with placebo [20]. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. In comparison with the former meta-analysis of this topic performed by Deng et al. 627, Wuluo Road, Wuhan, 430030, Hubei Province, P. R. China, Xiaosong Zhi,Jing Han,Shijun Wei&Feng Xu, Department of Emergency, Taikang Tongji (Wuhan) Hospital, Wuhan, Hubei Province, P. R. China, Graduate School of Wuhan University of Science and Technology, Wuhan, Hubei Province, P. R. China, The First Clinical Medical School Of Southern Medical University, Guangzhou, Guangdong Province, P. R. China, You can also search for this author in IAT is considered to be more refractory than mid-portion AT, so more trials focus on a combination treatment. AOFAS was recorded in 2 groups, and the mean value increased from 68.2 to 84.5. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also important in decision making. 8600 Rockville Pike Article Figure 5. Treatment Results After Acute Rupture of the Achilles Tendon. Saku I, Kanda S, Saito T, Fukushima T, Akiyama T. Wound management with negative pressure wound therapy in postoperative infection after open reconstruction of chronic Achilles tendon rupture. The change in the range of VAS in sub-groups showed as 5.10 (high energy) vs. 4.40 (low energy) and 4.15 (failure in previous therapy) vs. 5.12 (no previous therapy). https://doi.org/10.1046/j.1445-2197.2003.02748.x. 2019;58(4):61722. Keywords: doi: 10.1249/00005768-199806000-00002, 41. Barnes GD. (1993) 21:7919. Delayed treatment for more than 4 weeks was excluded and the same for treatment of re-rupture of ATR.