Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play.
Ontology highlight
ABSTRACT: Aim
This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP.Design
A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination.Data sources
PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles.Eligibility criteria for selecting studies
Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included.Results
108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001).Conclusions
80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
SUBMITTER: Zellers JA
PROVIDER: S-EPMC5136353 | biostudies-literature | 2016 Nov
REPOSITORIES: biostudies-literature
Publications
Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play.
Zellers Jennifer A JA Carmont Michael R MR Grävare Silbernagel Karin K
British journal of sports medicine 20160603 21
<h4>Aim</h4>This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP.<h4>Design</h4>A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination.<h4>Data sources</h4>PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles.<h4> ...[more]
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Project description:ObjectiveProfessional Basketball players are at high risk of Achilles tendon rupture. Despite this, there remains limited research into the factors affecting rehabilitation and the long term outcomes of these players. Our aim is to quantify the effect of a player's Achilles tendon rupture on their post-injury performance, and also to explore for correlations between their recovery timeline and pre-injury characteristics. Creation of an injury timeline of past incidents will allow injured players to better track their progress and also inform them about the probable impact on their careers.HypothesisPlayers with Achilles tendon rupture injury will exhibit decreased performance compared to their pre-injury self and their non-injured peers after recovery.MethodsProfessional basketball players who sustained a unilateral Achilles tendon rupture from 1992 to 2016 were collected. 12 players met our inclusion criteria and their Player Efficiency Ratings (PER) were obtained as primary outcome measures; matched controls were chosen based on the PER, Age and playing position. The players' index season PER was compared against the PER during the 10 games immediately following the players' return and the PER of their post-injury peak performing season. The same data analysis was performed against their control group. To investigate the factors affecting the recovery and long-term consequences of their injury, we correlated the variables of Age, BMI, Time of Injury and pre-injury PER with the player's time to return to play and their post-injury PER.Results2 out of 12 players failed to return to playing in the elite professional league following an Achilles Tendon Rupture, others returned after a mean recovery time of 10 months. When compared to players' index PER, the mean PER reduction during the 10 games immediately following the players' return was 7.15 (P < .000). Players on average took 1.8 seasons to reach their post-injury peak performance, with only 1 player returning to his pre-injury performance. Others suffered a mean PER reduction of 3.5 (P = .004) when compared to their index PER and 5.4 (P = .045) against their matched controls.ConclusionAchilles tendon rupture can be a career-ending injury for professional basketball players. They are expected to miss 10 months for rehabilitation and reach their post-injury peak performance level at the 2nd season back. The post-injury peak performance is significantly worse than the pre-injury level, but is similar to matched non-injured players.
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Project description:To date, there is no consensus concerning the treatment of acute Achilles tendon ruptures. Although surgical treatment decreases the risk of a recurrent rupture, it is not without complications. In particular, percutaneous sutures may cause a lesion of the sural nerve. The purpose of this Technical Note is to describe a reliable and reproducible surgical procedure for treating these lesions. The first operative phase consists of an ultrasound detection that makes it possible to identify the tendon extremities and the sural nerve, which is necessary to secure the posterolateral arthroscopic tract as well as to perform the percutaneous suture. The entry point is thus centered on the lesion and placed at a distance from any surrounding nerve risk. The second arthroscopic phase makes it possible to release the tendon lesion, control the transtendon passage of the surgical threads, and evaluate the dynamic contact of the tendon edges. At the end of the intervention, the complete disappearance from the transillumination via the rupture also makes it possible to ensure the disappearance of the tendon gap. Achilles tendon percutaneous sutures after the ultrasound detection and under arthroscopic control thus makes it possible to control the contact of the tendon edges, while at the same time decreasing the risk of a lesion of the sural nerve, with minimal scarring.
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| S-EPMC11781266 | biostudies-literature
Project description:BackgroundAlthough non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture.MethodsA retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up.ResultsWe bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant (p < 0.05).ConclusionThe procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon.
| S-EPMC11780790 | biostudies-literature
Project description:PurposePatient-reported outcome measures (PROMs) have become a cornerstone for the evaluation of the effectiveness of treatment. The Achilles tendon Total Rupture Score (ATRS) is a PROM for outcome and assessment of an Achilles tendon rupture. The aim of this study was to translate the ATRS to Dutch and evaluate its reliability and validity in the Dutch population.MethodsA forward-backward translation procedure was performed according to the guidelines of cross-cultural adaptation process. The Dutch ATRS was evaluated for reliability and validity in patients treated for a total Achilles tendon rupture from 1 January 2012 to 31 December 2014 in one teaching hospital and one academic hospital. Reliability was assessed by the intraclass correlation coefficients (ICC), Cronbach's alpha and minimal detectable change (MDC). We assessed construct validity by calculation of Spearman's rho correlation coefficient with domains of the Foot and Ankle Outcome Score (FAOS), Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) and Numeric Rating Scale (NRS) for pain in rest and during running.ResultsThe Dutch ATRS had a good test-retest reliability (ICC = 0.852) and a high internal consistency (Cronbach's alpha = 0.96). MDC was 30.2 at individual level and 3.5 at group level. Construct validity was supported by 75 % of the hypothesized correlations. The Dutch ATRS had a strong correlation with NRS for pain during running (r = -0.746) and all the five subscales of the Dutch FAOS (r = 0.724-0.867). There was a moderate correlation with the VISA-A-NL (r = 0.691) and NRS for pain in rest (r = -0.580).ConclusionThe Dutch ATRS shows an adequate reliability and validity and can be used in the Dutch population for measuring the outcome of treatment of a total Achilles tendon rupture and for research purposes.Level of evidenceDiagnostic study, Level I.
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