Abstract
Category:
Trauma
Introduction/Purpose:
Achilles tendon rupture (ATR) is a common trauma among active people. Recent high-quality randomized studies, have shown that using a standardized treatment protocol with early weight-bearing and controlled early range-of-motion exercises provides similar clinical outcome than operative treatment without surgery-related complications. The purpose of this study was to find out whether the clinical results and complication rates of standardized treatment protocol in normal clinical setting with non-selected population correspond to those achieved in RCT studies.
Methods:
A treatment protocol modified from RCT studies of acute ATR was implemented in standard clinical care of Tampere University Hospital in 2008. Both conservative protocol and postoperative care protocol were based on early weight bearing and early range-of motion exercises. All patients treated due to acute ATR in our hospital during 2008 – 2014 (n=514) were included in the study. The patient records were retrospectively evaluated.
Results:
514 acute ATRs were treated. 407 (79.2%) of the patients were men and 107 (20,8%) women. The mean age of all patients was 47.2 years. In female patients the mean age was 47.0 years, in males 47.9 years. 239 (46%) of the ATRs were treated operatively and 275 (54%) non-operatively. The proportion of operatively treated patients declined from 70% (2008) to 21% (2014). The mean age of patients in the operative group was 39.7 years and 53.7 years in the non-operative group. The rerupture rate was 4.6% in operative and 5.8% in the non-operative group. 10,4% of patients in operative group had wound problems. Unsatisfactory clinical outcome was reported in 5,0% of the patients in the operative group and in 6,9% of the non-operative group.
Conclusion:
Our results show that the treatment of acute ATR in our clinic has changed remarkably during the years 2008 to 2014. In 2008 70% of acute ATRs were treated operatively whereas in 2014 only 21%. Our study shows that it is possible to implement a similar treatment protocol than used in the controlled study setting as a part of the daily clincal care. The most important finding, however, is that the clinical outcome of the patients seems to be fully comparable to the clinical results achieved in RCT-study settings despite the heterogenity of the treated patients and medical staff.