Open in a separate window Validity, reliability and responsiveness are the clinimetric properties that define the clinical relevance of each outcome measure 8. In this regard, it is worth remembering that the process of establishing the usefulness of an outcome instrument is never complete, but rather an ongoing process whereby evidence is collected to support the use of the instrument under various conditions 9. Objective measures After an ATR patients have been reported to show a lengthening of the healed tendon along with impairments of joint ROM and calf muscle strength, endurance and trophism. Therefore, when evaluating the final outcome of treatment, it is important to include these clinician-generated measurements Each of these parameters is usually compared between the injured and the healthy side, in order to establish the limb symmetry index expressed as a percentage
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Roderik Metz: moc. E ; Geert J van der Heijden: ln. This article has been cited by other articles in PMC. Abstract Background We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures.
The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction.
Patient follow-up will be 12 month. Discussion By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial. Post operative splintage can be divided into cast immobilisation and functional bracing. Traditionally open surgical repair of a ruptured Achilles tendon has been the first choice of treatment due to low re-rupture rates and the possibility for functional post-operative splintage [ 1 - 4 ].
In general, the outcome after treatment of a re-rupture is poor, but results following treatment of a deep infection are devastating [ 6 ]. Therefore an effort should be made to prevent infectious complications. But to date, only two 2 randomized trials have been reported [ 4 , 15 ]. Data on complications using limited incision techniques are even more scant. As minimally invasive techniques differ it is hard to compare other techniques with these numbers.
An advantage of most minimally invasive techniques is smaller scars and less damage to the delicate blood supply of the AT. Importantly, in most patients minimally invasive surgery does allow functional rehabilitation [ 7 ]. Patients treated by functional rehabilitation after operation rather than cast immobilisation are reported to have a shorter in-patient stay, less time off work and a quicker return to sporting activities.
In addition, lower complication rates, including re-ruptures, are reported [ 1 - 5 ]. The main advantage of conservative, i. But, conservative treatment with cast immobilisation has shown to increase the re-rupture rate [ 1 , 5 ] and cast immobilisation induces delayed recovery due to calf muscle weakness as a result of long immobilisation of the ankle joint. In contrast, conservative treatment by functional bracing does allow immediate weight bearing, preventing calf muscle weakness and enabling fast recovery.
In three studies conservative treatment of AT rupture with functional bracing did not result in increased re-rupture rates [ 16 - 18 ]. But since only one of these is a randomized trial [ 17 ], more high quality data from randomized prospective studies is needed.
Four hospitals in the Netherlands will participate in the study, one of them being a university medical centre. The Medical Research Ethics Committee of all the participating hospitals approved the study protocol.
Patient selection and informed consent All patients who report to the emergency department of one of the participating hospitals with an acute Achilles tendon rupture will be considered for entering the study protocol. All eligible patients are asked to provide written informed consent. Table 1.
Outcome evaluation after Achilles tendon ruptures. A review of the literature
In this cohort we did find a significant plantarflexion strength deficit. Outcome evaluation after Achilles tendon ruptures. A review of the literature A systematic review of the literature. Calf muscle circumference — The maximal calf circumference is measured relative to fixed identifiable bony landmarks, e. No difficulty on any surface. Support Center Support Center.