Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm
Category: Sports; Other Introduction/Purpose: The Achilles tendon is the most commonly ruptured tendon in the lower limb, and when left untreated for at least 4 weeks, these are classified as chronic or 'neglected' Achilles tendon ruptures (CATR). There is discordance on the optimal surgic...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-11-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011421S00982 |
| _version_ | 1811216915793707008 |
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| author | Hugo A. Ubillus MD Mohammad T. Azam BS Matthew B. Weiss BS Noah Kirschner Nathaniel P. Mercer MS James J. Butler John G. Kennedy MD, FRCS(Orth) |
| author_facet | Hugo A. Ubillus MD Mohammad T. Azam BS Matthew B. Weiss BS Noah Kirschner Nathaniel P. Mercer MS James J. Butler John G. Kennedy MD, FRCS(Orth) |
| author_sort | Hugo A. Ubillus MD |
| collection | DOAJ |
| description | Category: Sports; Other Introduction/Purpose: The Achilles tendon is the most commonly ruptured tendon in the lower limb, and when left untreated for at least 4 weeks, these are classified as chronic or 'neglected' Achilles tendon ruptures (CATR). There is discordance on the optimal surgical treatment to treat CATR. Given the prevalence of this injury, there is a need to determine the best treatment modality. In this study, we performed a systematic review of the literature to compare the different treatment options for CATR, analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies, and recommend a literature-based algorithmic approach to the treatment of CATR. Methods: In July 2019, MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed by 2 independent reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Full-length peer-reviewed studies in English with a sample size of 10 participants that reported functional outcome scores with a minimum follow-up of 24 months were included. We excluded systematic reviews, meta-analyses, review articles, cadaveric and animal studies, and case reports. The LOE and QOE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. Patient demographic data, surgical procedure type, subjective outcomes, postoperative strength, range of motion, postoperative imaging, return to sports and work data, complications, failures, and reoperations were evaluated. Continuous variables were reported as weighted mean and estimated standard deviation, whereas categorical variables were reported as frequencies with percentages. Results: Thirty-one studies with 653 CATRs were included. Three studies were LOE III and 28 studies were LOE IV. A large variety of repair techniques were described and analyzed, and semitendinosus tendon grafting was the most frequently utilized technique (6 of 31 studies). The most commonly reported clinical outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) score (58.6%). Most studies reported good postoperative subjective outcomes, strength outcomes, and return to sports data at mid-term follow-up. In total, 14.6% of patients experienced postoperative complications, where the most common was surgical wound complications (10.8%). Conclusion: Surgical management of CATR produces good clinical outcomes at mid-term follow-up, but a high complication rate (14.6%) was noted. This systematic review found that no evidence-based treatment guidelines exist for CATR. Future studies of higher QOE and LOE which focus on specific risk factors are warranted to determine in which case one particular technique would be suitable for CATR repair. Our proposed treatment algorithm (Figure 1) may assist in shared decision-making for this complex problem. |
| first_indexed | 2024-04-12T06:46:34Z |
| format | Article |
| id | doaj.art-0fb34559c072456388f985da2cecb6e6 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-12T06:46:34Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-0fb34559c072456388f985da2cecb6e62022-12-22T03:43:32ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142022-11-01710.1177/2473011421S00982Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment AlgorithmHugo A. Ubillus MDMohammad T. Azam BSMatthew B. Weiss BSNoah KirschnerNathaniel P. Mercer MSJames J. ButlerJohn G. Kennedy MD, FRCS(Orth)Category: Sports; Other Introduction/Purpose: The Achilles tendon is the most commonly ruptured tendon in the lower limb, and when left untreated for at least 4 weeks, these are classified as chronic or 'neglected' Achilles tendon ruptures (CATR). There is discordance on the optimal surgical treatment to treat CATR. Given the prevalence of this injury, there is a need to determine the best treatment modality. In this study, we performed a systematic review of the literature to compare the different treatment options for CATR, analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies, and recommend a literature-based algorithmic approach to the treatment of CATR. Methods: In July 2019, MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed by 2 independent reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Full-length peer-reviewed studies in English with a sample size of 10 participants that reported functional outcome scores with a minimum follow-up of 24 months were included. We excluded systematic reviews, meta-analyses, review articles, cadaveric and animal studies, and case reports. The LOE and QOE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. Patient demographic data, surgical procedure type, subjective outcomes, postoperative strength, range of motion, postoperative imaging, return to sports and work data, complications, failures, and reoperations were evaluated. Continuous variables were reported as weighted mean and estimated standard deviation, whereas categorical variables were reported as frequencies with percentages. Results: Thirty-one studies with 653 CATRs were included. Three studies were LOE III and 28 studies were LOE IV. A large variety of repair techniques were described and analyzed, and semitendinosus tendon grafting was the most frequently utilized technique (6 of 31 studies). The most commonly reported clinical outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) score (58.6%). Most studies reported good postoperative subjective outcomes, strength outcomes, and return to sports data at mid-term follow-up. In total, 14.6% of patients experienced postoperative complications, where the most common was surgical wound complications (10.8%). Conclusion: Surgical management of CATR produces good clinical outcomes at mid-term follow-up, but a high complication rate (14.6%) was noted. This systematic review found that no evidence-based treatment guidelines exist for CATR. Future studies of higher QOE and LOE which focus on specific risk factors are warranted to determine in which case one particular technique would be suitable for CATR repair. Our proposed treatment algorithm (Figure 1) may assist in shared decision-making for this complex problem.https://doi.org/10.1177/2473011421S00982 |
| spellingShingle | Hugo A. Ubillus MD Mohammad T. Azam BS Matthew B. Weiss BS Noah Kirschner Nathaniel P. Mercer MS James J. Butler John G. Kennedy MD, FRCS(Orth) Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm Foot & Ankle Orthopaedics |
| title | Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm |
| title_full | Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm |
| title_fullStr | Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm |
| title_full_unstemmed | Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm |
| title_short | Surgical Management of Chronic Achilles Tendon Rupture: A Systematic Review and Proposed Treatment Algorithm |
| title_sort | surgical management of chronic achilles tendon rupture a systematic review and proposed treatment algorithm |
| url | https://doi.org/10.1177/2473011421S00982 |
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