We ultimately found 7 articles that fit our inclusion criteria for analysis. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. Wu Z, Yao W, Chen S, Li Y. Higgins JP, White IR, Anzures-Cabrera J. Meta-analysis of skewed data: combining results reported on log-transformed or raw scales. doi: 10.1053/j.jfas.2014.09.040, 49. and transmitted securely. (2020). (2005) 5:13. doi: 10.1186/1471-2288-5-13, 24. 2017;38(10):11609. There is a paradigm shift toward early mobilization and weightbearing. BMJ. IAT is considered to be more refractory than mid-portion AT, so more trials focus on a combination treatment. (2006) 445:21621. https://doi.org/10.1177/107110079201300810. The other items of the included RCTs were classed as low risk or unclear.. Egger AC, Berkowitz MJ: Achilles tendon injuries. AJR Am J Roentgenol. rupture rate with non-operative management. doi: 10.1001/jama.283.15.2008, 13. The MantelHaenszel model was used to analyze the pooled outcomes with the presentation of the risk ratio (RR) and 95% confidence interval (CI). Consequently, thromboprophylaxis is necessary after ATR treatment and intermittent pneumatic compression has been reported to be highly effective in reducing deep vein thrombosis in ATR patients (43). Moreover, maximum load, speed of contraction, and frequency of sessions should also be studied and optimized. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Your US state privacy rights, (2014) 14:135. doi: 10.1186/1471-2288-14-135, 22. To the best of our knowledge, treatment on ATR should be focused on optimal functional recovery accompanied by the least complication. This trial shed light on what considerations might inform treatment decisions when patients choose to proceed with surgery or not, since functional outcomes appear to be similar. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also important in decision making. Giai Via A, Oliva F, Padulo J, Oliva G, Maffulli N. Insertional calcific tendinopathy of the Achilles tendon and dysmetabolic diseases: an epidemiological survey. 2013 Aug;36(8):e1053-9. Epub 2010 Oct 29. Comparing Surgical and Conservative Treatment on Achilles Tendon However, it is widely considered that IAT is a distinct clinical entity [5], and non-surgical interventions in IAT have not shown expectative clinical outcomes as good as the same treatment in mid-portion Achilles tendinopathy [6]. Domeij-Arverud E, Labruto F, Latifi A, Nilsson G, Edman G, Ackermann PW. One group was treated with ESWT and additional arginine supplement. PubMed Besides, no difference was found at 24 weeks between the standard nonoperative treatment combined with low-energy ESWT and low-energy ESWT alone for chronic insertional Achilles tendinopathy, especially in elderly patients [31]. Epub 2017 Mar 31. (2015) 25:e110. Statistical significance was set at P < .05. doi: 10.1007/s12178-017-9386-7, 4. https://doi.org/10.1177/03635465980260030301. The eligibility criteria were patients with ATR, surgical treatment (open or minimally invasive surgery) vs. conservative treatment (cast immobilization or functional bracing), age >16 years old, treatment initiated within 4 weeks of injury, reporting of re-rupture, complications, functional outcomes, and patients' satisfaction on corresponding treatment and outcomes. Any disagreement on study inclusion was resolved by consensus or routine meeting of all authors listed in this meta-analysis. Foot Ankle Int. Biometrics. In a pilot study in 2003, the injections of sclerosing agent polidocanol against the local neovessels relieved the pain in 8 out of 11 patients with IAT at the 8-month follow-up [11]. Detailed information about deep infection is shown in Figure 3F. doi: 10.1177/0363546507307503, 30. Am J Sports Med. There were 11 comparative studies (5 retrospective cohort studies, 6 RCTs) with regard to different interventions (Table 8). Figure 3. Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Secondly, the terminology of Achilles tendon pathology varies among studies, so some studies may be excluded during the process of literature screening according to our strict inclusion criteria. https://doi.org/10.2106/00004623-200301000-00001. 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. Orhan Z, Ozturan K, Guven A, Cam K. The effect of extracorporeal shock waves on a rat model of injury to tendo Achillis. Patients in 5 studies were diagnosed only by clinical examination (CE); in 6 studies by CE and ultrasound (US); in 3 studies by CE and X-ray; in 2 studies by CE, US, and X-ray; in 2 studies by CE, MRI, and X-ray; in 1 study by CE, US, and MRI; and in 3 studies by CE, US, MRI, and X-ray. Biomed Res Int. Achilles Tendon Repair Post-Op Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. J Bone Joint Surg Am Vol. 2022 Oct;50(12):3286-3298. doi: 10.1177/03635465221117780. But the sample size (16/15) was small, and the younger patients were not fully evaluated. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Furia JP. HHS Vulnerability Disclosure, Help Collectively, the overall result showed that surgical treatment was associated with significant reduction in re-rupture rate (13 studies, 1139 participants, Z = 3.97, P < 0.0001, I2 = 0%, RR: 0.38, 95% CI: 0.24 to 0.41). Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM. For the stratified analysis, a test for subgroup differences was used to determine the significant level. (2020). 2014;9(4):48897. Chapter 8: Assessing Risk of Bias in Included Studies. PubMed Central Epub 2012 Jul 16. (high-energy laser therapy and eccentric exercises) [21], McCormack et al. PMC All included 13 studies reported the result of re-rupture rate, and we divided it into re-rupture in accelerated functional rehabilitation and re-rupture not in accelerated functional rehabilitation as subgroup analysis. LC and HH: supervision, conceptualization, professional suggestion, and revision. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [7, 8] during the stages of design, analysis, and reporting. Achilles Tendon Rupture Treatment: Operative Versus Nonoperative Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. doi: 10.1016/j.ijscr.2017.06.027, 51. PubMedGoogle Scholar. SW and FX resolved disagreements during the review process. In our study, superficial (5.8%) and deep infection (2.2%) were reported in the surgical treatment group, which was deleterious and intractable with poor outcome (48). Jonsson P, Alfredson H, Sunding K, Fahlstrm M, Cook J. 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). One big problem of ESWT is the high amount of pain during the treatment process. 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. Guorong She QT, Jieruo Li, Xiaofei Zheng, Lin Chen, Huige Hou. Before Orthop J Sports Med. Deng et al. 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. therapy [12]. El-Akkawi AI, Joanroy R, Barfod KW, Kallemose T, Kristensen SS, Viberg B. J Foot Ankle Surg. Collectively, fully restored function to the former level and self-satisfaction from patients should be taken into consideration as an additional assessment. Surgical repair, with a lower re-rupture rate, is favorable in most cases, while complications (20.4 vs. 7.0%) other than re-rupture are troublesome such as deep vein thrombosis, wound infection, and sensation disturbance (sural nerve injury). The overall results showed that a significantly increased incidence of sural nerve injury occurred in patients with surgical treatment than conservative management in ATR (six studies, 603 participants, Z = 3.71, P = 0.0002, I2 = 0%, RR:6.77, 95% CI: 2.47 to 18.56). Each item was categorized as high, low, or unclear. The methodological quality of non-randomized studies was assessed by methodological index for non-randomized studies (MINORS) covering 12 items with a total score of 24 for comparative studies, in which the first 8 items with a total score of 16 for non-comparative studies [10]. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. FOIA The https:// ensures that you are connecting to the Literatures were searched in PubMed, Embase, and Web of Science databases from inception to October 2020. Costantino et al. https://doi.org/10.1053/j.jfas.2011.01.003. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Because of the limited and conflicting evidence, eccentric exercise was given a Grade I recommendation according to the Grades of Recommendation [2]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). (1981) 63:3949. There was no weight bearing or functional rehabilitation protocol restriction. (2012) 470:2704. https://doi.org/10.1007/s00167-010-1374-z. Table 2. These results were similar to those of cases that received single ESWT (73.7%), but much higher than those of eccentric exercises alone (45.6%). Bone Joint J. doi: 10.1177/0363546506294856, 17. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Dichotomous variables were presented as events and the total number of events. Nilsson-Helander K, Thome R, Silbernagel KG, Thome P, Faxn E, Eriksson BI, et al. Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, et al. Predictors of functional outcome in non-operatively managed Achilles tendon ruptures. Wright JG, Swiontkowski MF, Heckman JD. Hoboken, NJ: John Wiley & Sons, Ltd. (2008). Recent research reports that the mean age of Achilles rupture has increased by 0.721 years every five years, since 1953. Supplementary Figure 1. (2001) 83:8438. doi: 10.1007/s00167-015-3976-y, 48. According to pooled results, there was no significant difference between surgical and conservative treatment regarding ATRS assessment (three studies, 207 participants, Z = 1.86, P = 0.06, I2 = 0%, RR: 4.27, 95% CI: 0.24 to 8.77). Adv Ther. official website and that any information you provide is encrypted ANZ J Surg. Aim: doi: 10.1177/0363546508319312, 31. Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation: a prospective randomised trial of acute ruptures of the Achilles tendon. Acta Bio-Medica Atenei Parmensis. and Fischer et al. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gtzsche PC, Ioannidis JP, et al. doi: 10.21203/rs.3.rs-62388/v1, Keywords: Achilles tendon rupture, surgery, conservative, meta-analysis, clinical outcome, Citation: She G, Teng Q, Li J, Zheng X, Chen L and Hou H (2021) Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs. Patients complain of pain, stiffness, and sometimes (a solid) swelling. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment strategy is still debated. Although a total of 13 RCTs are included in this meta-analysis, the recorded categories of complications are still limited, which results in disturbance of comprehensive assessment of each treatment strategy. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Among the total 11 groups, patients from 6 groups, who were enrolled in these studies to receive ESWT, had unsatisfactory results from other nonoperative treatments before. (B) Forest plot of deep vein thrombosis. Disclaimer. https://doi.org/10.1097/JSM.0000000000000881. Delayed treatment for more than 4 weeks was excluded and the same for treatment of re-rupture of ATR. Non-operative Treatment: Non-operative management with functional rehabilitation protocols typically includes a brief, two-week period of When it comes to blinding of participants and personnel in performance bias, unclear risk occurred in Nistor et al. Detailed information about dorsiflexion is shown in Figure 5A. 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. Foot Ankle. There were 7 groups, a total of 128 patients (144 tendons), receiving eccentric training treatment (Table 4). VISA-A was assessed in 3 groups, and the mean value increased from 47.9 to 69.4. Patients in 12 groups were treated with either exclusively extracorporeal shockwave therapy (ESWT) or ESWT combined with other nonoperative therapy (without eccentric training) (Table 5). Received: 18 September 2020; Accepted: 11 January 2021; Published: 18 February 2021. therapy) in athletes affected by insertional tendonitis and found that every patient benefited from all the treatments [12]. Acute Achilles tendon ruptures: efficacy of conservative and surgical (percutaneous, open) treatment-a randomized, controlled, clinical trial. Dorsally based closing wedge osteotomy of the calcaneus for insertional Achilles tendinopathy. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Google Scholar. Copyright 2021 the American College of Foot and Ankle Surgeons. Wheeler PC. 12) The estimated incidence ranges from 11 to 37 per 100,000 population. Traditionally, early mobilization has been reserved for patients treated surgically and this may have unintentionally skewed treatment results. Epub 2017 Sep 30. https://doi.org/10.1007/s001670000189. The studies were screened by reviewing abstracts and full-texts according to the inclusion and exclusion criteria, and 23 studies [6, 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] (containing 35 groups) were eligible for the final review, including 11 comparative studies (6 RCTs, 5 non-randomized comparative studies) and 12 non-comparative studies. Manent A, Lpez L, Corominas H, Santamara A, Domnguez A, Llorens N, et al. Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? Five groups received a combined treatment of both ESWT and eccentric training (Table 6). (2016) 24:140920. Nonoperative dynamic treatment of acute achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. Overall, studies regarding various injection therapy for IAT are rare and more evidence are required (Grade I recommendation). J Bone Joint Surg Br Vol. Erroi et al. Delayed Achilles tendon rupture presentation: Non-operative - PubMed Conservative treatment was found to be capable of having similar functional outcomes with surgical treatment. P values are extracted from the original studies or calculated from the reported data. J Orthop Surg Res 16, 233 (2021). Tylenol) 500mg every 6 hours alternating with ibuprofen 600mg every 6 hours or meloxicam 15mg once daily. Six studies were RCTs, and the risk of bias was evaluated by the Cochrane bias tool. Ohberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain-results of a pilot study. (2017) 284:20161850. doi: 10.1098/rspb.2016.1850, 16. Corticosteroid injections have largely fallen out of clinical practice for tendinopathy treatment for the risk of tendon degeneration and tear, and no studies were found applying corticosteroid injection for IAT [41]. Therapeutic response of extracorporeal shock wave therapy for insertional Achilles tendinopathy between sports-active and nonsports-active patients with 5-year follow-up. Mansur NSB, Baumfeld T. Shockwave therapy associated with eccentric strengthening for Achilles insertional tendinopathy: a prospective study. No use, distribution or reproduction is permitted which does not comply with these terms. We aim to provide a clear summary of the best available evidence for nonoperative treatment specific to insertional Achilles tendinopathy. Activity; 0-2 weeks. The VAS scale was evaluated in all 5 patient groups, and the weighted mean of declined value was 4.42 points. The overall result indicated that the complication rate after treatment in the conservative treatment group was significantly lower than that in surgical treatment group (12 studies, 1,107 participants, Z = 2.56, P = 0.01, I2 = 69%, RR: 2.62, 95% CI: 1.25 to 5.46). Brumann M, Baumbach SF, Mutschler W, Polzer H. Injury. One group received combined eccentric training and conventional physical therapy including gastrocnemius, soleus, hamstring stretches, and ice massage on the Achilles tendon twice a day. https://doi.org/10.1097/JSM.0b013e31818ef090. 18. BMJ. 2008;42(9):7469. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. So, whether eccentric exercises are suitable for IAT is still open for debate. All patients had follow-ups at least 3 months after specific treatments. This manuscript has been released as a pre-print at Research Square (53). Nonoperative treatment of insertional Achilles tendinopathy: a systematic review, Journal of Orthopaedic Surgery and Research, https://doi.org/10.1186/s13018-021-02370-0, https://doi.org/10.1007/s00167-010-1374-z, https://doi.org/10.1097/JSM.0000000000000881, https://doi.org/10.1177/107110079201300810, https://doi.org/10.1007/s00167-003-0418-z, https://doi.org/10.2106/00004623-200301000-00001, https://doi.org/10.1046/j.1445-2197.2003.02748.x, https://doi.org/10.1007/s00167-003-0402-7, https://doi.org/10.1053/j.jfas.2011.01.003, https://doi.org/10.1007/s12325-012-0046-4, https://doi.org/10.1007/s10103-013-1510-3, https://doi.org/10.11138/mltj/2017.7.1.098, https://doi.org/10.1053/j.jfas.2018.11.005, https://doi.org/10.1177/03635465980260030301, https://doi.org/10.1097/JSM.0b013e31818ef090, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Please enable it to take advantage of the complete set of features! Objectives To compare re-rupture rate, complication rate, and functional outcome after operative versus nonoperative treatment of Achilles tendon ruptures; to compare re-rupture rate after early and late full weight bearing; to evaluate re-rupture rate after functional rehabilitation with early range of motion; and to compare effect estimates fr. Only RCTs that reported on the comparison of surgical vs. conservative treatment of ATR were included in this meta-analysis. 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. doi: 10.1302/0301-620X.97B5.34581, 44. An official website of the United States government. The incidence of IAT increases with age and is significantly higher in patients with metabolic diseases (e.g., diabetes mellitus, hypercholesterolemia, and hypothyroidism) [4]. Low number of complications (too small to analyze). 01:55 An acute Achilles' tendon rupture is one of the most common musculoskeletal injuries, with an annual incidence of 5 to 50 events per 100,000 persons, and may result in severe disability.. The original contributions generated in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding authors. The risk of bias of randomized controlled trials (RCTs) was evaluated using the Cochrane bias tool (https://handbook-5-1.cochrane.org/), which covered six domains: random sequence generation and allocation concealment (selection bias), blinding of participants (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other bias. Careers. The detailed information of quality assessment is shown in Table 2 and Table 3. (2011) 343:d5928. (2010) 38:218693. AOFAS was assessed in 3 groups, and it changed from 68.3 at baseline to 83.4 at the final follow-up. Continuous variables were presented as mean with standard deviation and other forms of data presentation would be converted using the instruction described in the Cochrane Handbook for Systematic Reviews of Interventions and several methods reported in previous studies (2024). Deng Z, Li Z, Shen C, Sun X, Wang T, Nie M, Tang K. Arch Orthop Trauma Surg. (2013) 52:5847. Keating JF, Will EM. All authors have read and approved the manuscript. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. XZ, XL, YX, and JH drafted the manuscript. J Bone Joint Surg Am Vol. A meta-analysis of randomized, controlled trials. (2012) 94:213643. (2009) 37:14005. https://doi.org/10.1177/0363546505281810. Adhesion of scar to the underlying tendon was reported in three of the included studies, and it might lead to secondary surgery. GS and QT: conceptualization, literature researching, methodology, data analysis, and manuscript writing. Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture This is a study protocol for a prospective randomized controlled trial comparing clinical effects of mini-incision and open repair in treating acute Achilles tendon rupture. During full text screening, a total of 97 citations not compliant with the criteria were excluded and 13 citations of studies were included in this meta-analysis eventually (11, 2536). volume16, Articlenumber:233 (2021) Keywords: The Achilles' heals with or without surgery doi: 10.1007/s00402-020-03461-z, 37. therapy. Insertional Achilles tendinopathy is located at the insertion of the Achilles tendon onto the calcaneus, possibly with the formation of bone spurs and calcifications in the tendon proper at the insertion site. van der Vlist AC, Winters M. Which treatment is most effective for patients with Achilles tendinopathy? For Other bias assessment, 4 studies were classed as high risk (3 studies pooled both unilateral and bilateral cases, 1 study lacked of randomization on the baseline). This is the most comprehensive meta-analysis of RCTs comparing outcomes after receiving surgical treatment vs. conservative treatment of ATR. (2019) 364:k5120. 1. Of those, 6 groups performed a 12-week daily eccentric training regimen, and 1 group was treated with a 6-week eccentric stretching regimen. Foot Ankle Surg. doi: 10.1002/14651858.CD003674.pub4, 53. Clin Orthop Relat Res. Rendek Z, Bon Beckman L, Schepull T, Dnmark I, Aspenberg P, Schilcher J, Eliasson P. Am J Sports Med. ACHILLES TENDONOPATHY NONOPERATIVE PROTOCOL Achilles tendon problems are often overuse injuries.1 They can be subdivided into non-insertional, or insertional tendinopathies. Xiaosong Zhi and Xinyuan Liu contributed equally to this work and should be considered co-first authors. government site. Foot Ankle Int. Five of them were comparative studies, and the scores ranged from 15 to 22. sharing sensitive information, make sure youre on a federal 8600 Rockville Pike Further RCTs with a large sample size are needed to verify the effectiveness more accurately. The mean value increased from 50.6 to 64. Collectively, a novel recommendation of more than just considering re-rupture and conservative treatment with similar functional recovery as well as a lesser complication on ATR might be considered if patients' status were suitable. doi: 10.1249/00005768-199806000-00002, 41. 2012;29(9):799814. Nonoperative treatment of insertional Achilles tendinopathy: a systematic review. . https://doi.org/10.1046/j.1445-2197.2003.02748.x. Clipboard, Search History, and several other advanced features are temporarily unavailable. Range of motion is a reflection of joint motor ability, and dorsiflexion and plantarflexion are suitable indexes to the assessment. Regarding raised concerns about recent studies (911), different from the previous meta-analysis, return to sport (the same level as pre-treatment) and re-rupture rate were adopted as primary outcomes. VAS scale was evaluated in 9 of the 12 groups at the final follow-up. PubMed 2020;8(1):2325967119898118. 2019;12(6):5405. PubMed Google Scholar. The https:// ensures that you are connecting to the (2007) 35:4216. Cochrane Database Syst Rev. The ESWT in 3 of them applied low-energy shockwave treatments, and the other 2 groups used high-energy shockwave treatments. https://doi.org/10.1007/s12325-012-0046-4. However, patients' expectations are also essential that the athletic population may prefer surgical treatment to expedite recovery and prolong their professional careers (52). (2000) 283:200812. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gtzsche PC, Ioannidis JP, et al. Nistor L. Surgical and non-surgical treatment of Achilles tendon rupture. MeSH Effect of Early Versus Late Weightbearing in Conservatively Treated Acute Achilles Tendon Rupture: A Meta-Analysis. Similarly, no significant difference could be observed regarding the pooled result of mean plantarflexion (four studies, 349 participants, Z = 1.08, P = 0.28, I2 = 92%, RR: 2.43, 95% CI: 1.97 to 6.83). STATA version 12.0 (StataCorp LP, College Station, TX, USA) was used for the whole analysis. 2011;50(3):3159. 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/10.2214/AJR.09.3255. A significant difference was observed in re-rupture, complication rate, adhesion to the underlying tendon, sural nerve injury, and superficial infection. PDF Physical Therapy Guideline for Achilles Rupture Repair Before 2010;194(4):104753. Foot Ankle Surg. 2003;73(9):7126. Cetti et al. (E) Forest plot of superficial infection. 2018 Mar-Apr;57(2):346-352. doi: 10.1053/j.jfas.2017.06.006. doi: 10.1053/j.jfas.2017.05.036, 38. 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. Sode J, Obel N, Hallas J, Lassen A: Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. VISA-A was assessed in 7 of the 12 groups, and the mean value increased from 47.5 to 76.2 in combined results. PMC Would you like email updates of new search results? 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. Time Frame. Detailed information about deep vein thrombosis is displayed in Figure 3B. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, . Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion achilles tendinosis. (B) Forest plot of functional score (ATRS). The Achilles tendon total rupture score (ATRS): development and validation. Effects of rigid plaster casts and functional casts. The available data of numbers of patients (tendons) extracted from the included studies are shown in Table 1. Regarding selection bias about random sequence generation, Moller et al. (2017) 56:123643. Zhang et al. Knee Surg Sports Traumatol Arthrosc. (26). A systematic review of literature and meta-analysis. Br J Sports Med. Forest plot of secondary outcome measure indicating flexion. 2019 Jan 7;364:k5120. A prospective randomised study of comparison between surgical and non-surgical treatment. Achilles' tendon rupture is common and can be managed with non-operative and operative treatment approaches. J Bone Joint Surg Am Vol. This study followed the PRISMA 2009 checklist as provided in Additional file 1. Additional potential literatures were obtained by searching the reference list of the identified full-text articles.
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