Onderstaande meta analyse en recente RCT laten zien dat het nog steeds onvoldoende bewezen is dat opereren het verschil maakt voor een patient. Opereren of niet opereren blijft dus nog steeds de vraag.
Int Orthop. 2012;36(4):765-73.
Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence.
Jiang N, Wang B, Chen A, Dong F, Yu B.
Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
The aim of this study was to evaluate, in a meta-analysis, the clinical effectiveness of operative treatment for acute Achilles tendon rupture (AATR) compared with nonoperative treatment.
We systematically searched six electronic databases (Medline, Embase, Clinical Ovid, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomised controlled trials (RCTs) in which operative treatment was compared with nonoperative treatment for AATR from 1980 to 2011. Trial quality was assessed using the modified Jadad scale. The data was using fixed-effects and random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively.
Ten RCTs with a total of 894 patients were screened. The results showed that operative was superior to nonoperative treatment regarding lower risk of re-rupture (P = 0.002) and shorter time for sick leave (P = 0.009) but inferior to nonoperative treatment regarding complication risks (P = 0.004). No significant difference was identified between the two methods regarding the number of patients who successfully returned to pre-injury sports (P = 0.30). Subgroup analyses revealed significant differences in relation to scar adhesion (P < 0.00001),>
Compared with conservative treatment, operative treatment can effectively reduce the risk of re-rupture but increase the probability of complications. The increased complication risk may be associated with open repair surgery. However, no sufficient evidence is available from current studies to support the belief that operation may lead to better functional recovery.
PMID: 22159659
J Bone Joint Surg Br. 2011;93(8):1071-8.
Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome.
Keating JF, Will EM.
Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, UK. john.keating@ed.ac.uk
A total of 80 patients with an acute rupture of tendo Achillis were randomised to operative repair using an open technique (39 patients) or non-operative treatment in a cast (41 patients). Patients were followed up for one year. Outcome measures included clinical complications, range of movement of the ankle, the Short Musculoskeletal Function Assessment (SMFA), and muscle function dynamometry evaluating dorsiflexion and plantar flexion of the ankle. The primary outcome measure was muscle dynamometry. Re-rupture occurred in two of 37 patients (5%) in the operative group and four of 39 (10%) in the non-operative group, which was not statistically significant (p = 0.68). There was a slightly greater range of plantar flexion and dorsiflexion of the ankle in the operative group at three months which was not statistically significant, but at four and six months the range of dorsiflexion was better in the non-operative group, although this did not reach statistically significance either. After 12 weeks the peak torque difference of plantar flexion compared with the normal side was less in the operative than the non-operative group (47% vs 61%, respectively, p < 0.005). The difference declined to 26% and 30% at 26 weeks and 20% and 25% at 52 weeks, respectively. The difference in dorsiflexion peak torque from the normal side was less than 10% by 26 weeks in both groups, with no significant differences. The mean SMFA scores were significantly better in the operative group than the non-operative group at three months (15 vs 20, respectively, p < 0.03). No significant differences were observed after this, and at one year the scores were similar in both groups. We were unable to show a convincing functional benefit from surgery for patients with an acute rupture of the tendo Achillis compared with conservative treatment in plaster. PMID: 21768631
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