3
|
Myhrvold SB, Brouwer EF, Andresen TKM, Rydevik K, Amundsen M, Grün W, Butt F, Valberg M, Ulstein S, Hoelsbrekken SE. Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture. N Engl J Med 2022; 386:1409-1420. [PMID: 35417636 DOI: 10.1056/nejmoa2108447] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Whether surgical repair of an acute Achilles' tendon rupture by an open-repair or minimally invasive approach is associated with better outcomes than nonsurgical treatment is not clear. METHODS We performed a multicenter, randomized, controlled trial that compared nonoperative treatment, open repair, and minimally invasive surgery in adults with acute Achilles' tendon rupture who presented to four trial centers. The primary outcome was the change from baseline in the Achilles' tendon Total Rupture Score (scores range from 0 to 100, with higher scores indicating better health status) at 12 months. Secondary outcomes included the incidence of tendon rerupture. RESULTS A total of 554 patients underwent randomization, and 526 patients were included in the final analysis. The mean changes in the Achilles' tendon Total Rupture Score were -17.0 points in the nonoperative group, -16.0 points in the open-repair group, and -14.7 points in the minimally invasive surgery group (P = 0.57). Pairwise comparisons provided no evidence of differences between the groups. The changes from baseline in physical performance and patient-reported physical function were similar in the three groups. The number of tendon reruptures was higher in the nonoperative group (6.2%) than in the open-repair or minimally invasive surgery group (0.6% in each). There were 9 nerve injuries in the minimally invasive surgery group (in 5.2% of the patients) as compared with 5 in the open-repair group (in 2.8%) and 1 in the nonoperative group (in 0.6%). CONCLUSIONS In patients with Achilles' tendon rupture, surgery (open repair or minimally invasive surgery) was not associated with better outcomes than nonoperative treatment at 12 months. (Funded by the South-Eastern Norway Regional Health Authority and Akershus University Hospital; ClinicalTrials.gov number, NCT01785264.).
Collapse
Affiliation(s)
- Ståle B Myhrvold
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Espen F Brouwer
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Tor K M Andresen
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Karin Rydevik
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Madeleine Amundsen
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Wolfram Grün
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Faisal Butt
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Morten Valberg
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Svend Ulstein
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| | - Sigurd E Hoelsbrekken
- From the Institute of Clinical Medicine, University of Oslo (S.B.M) and the Department of Orthopedic Surgery, Akershus University Hospital (S.B.M., E.F.B., T.K.M.A., S.U.), Lørenskog, Volvat Medical Center and the Norwegian Sports Medicine Clinic (K.R., S.E.H.), the Division of Orthopedic Surgery (M.A.) and the Oslo Center for Biostatistics and Epidemiology (M.V.), Oslo University Hospital, Oslo, the Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes (W.G.), and the Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen (F.B.) - all in Norway
| |
Collapse
|
4
|
Westin O, Sjögren T, Svedman S, Horvath A, Hamrin Senorski E, Samuelsson K, Ackermann P. Correction to: Treatment of acute Achilles tendon rupture - a multicentre, non-inferiority analysis. BMC Musculoskelet Disord 2021; 22:193. [PMID: 33593312 PMCID: PMC7887827 DOI: 10.1186/s12891-021-04045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
Collapse
Affiliation(s)
- Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Tony Sjögren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Svedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Integrative Orthopedic Laboratory, Stockholm, Sweden
| | - Alexandra Horvath
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Paul Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Integrative Orthopedic Laboratory, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
6
|
Nilsson N, Nilsson Helander K, Hamrin Senorski E, Holm A, Karlsson J, Svensson M, Westin O. The economic cost and patient-reported outcomes of chronic Achilles tendon ruptures. J Exp Orthop 2020; 7:60. [PMID: 32748273 PMCID: PMC7399724 DOI: 10.1186/s40634-020-00277-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose While most Achilles tendon ruptures are dramatic and diagnosed quickly, some are missed, with a risk of becoming chronic. A chronic Achilles tendon rupture is defined as a rupture that has been left untreated for more than 4 weeks. By mapping the health economic cost of chronic Achilles tendon ruptures the health-care system might be able to better distribute resources to detect these ruptures at an earlier time. Method All patients with a chronic Achilles tendon rupture who were treated surgically at Sahlgrenska University Hospital or Kungsbacka Hospital between 2013 and 2018 were invited to participate in the study. The patients were evaluated postoperatively using the validated Achilles tendon Total Rupture Score (ATRS). The health-care costs were assessed using clinical records. The production-loss costs were extracted from the Swedish Social Insurance Agency. The cost of chronic Achilles tendon ruptures was then compared with the cost of acute ruptures in a previous study by Westin et.al. Results Forty patients with a median (range) age of 66 (28–86) were included in the study. The mean total cost (± SD) for the patients with a chronic Achilles tendon rupture was 6494 EUR ± 6508, which is 1276 EUR higher than the mean total cost of acute ruptures. Patients with chronic Achilles tendon ruptures reported a mean (min-max) postoperative ATRS of 73 (14–100). Conclusion Missing an Achilles tendon rupture will entail higher health-care costs compared with acute ruptures. Health-care resources can be saved if Achilles tendon ruptures are detected at an early stage.
Collapse
Affiliation(s)
- Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Holm
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mikael Svensson
- Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|