TY - JOUR

T1 - Effect of Early Versus Late Weightbearing in Conservatively Treated Acute Achilles Tendon Rupture

T2 - A Meta-Analysis

AU - El-Akkawi, Ali Imad

AU - Joanroy, Rajzan

AU - Barfod, Kristoffer Weisskirchner

AU - Kallemose, Thomas

AU - Kristensen, Søren Skydt

AU - Viberg, Bjarke

N1 - Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

PY - 2018

Y1 - 2018

N2 - Achilles tendon ruptures can be either surgically or conservatively treated with either early functional mobilization or cast immobilization. The purpose of the present study was to conduct a meta-analysis comparing the effect of early versus late weightbearing in conservatively treated adult patients, including only randomized controlled trials (RCTs). The primary endpoint was rerupture, and the secondary endpoints were strength, quality of life during treatment, range of motion, deep venous thrombosis, return to sports, and return to work. The search for studies was conducted using PubMed, EMBASE, and the Cochrane Central Register of Controlled trials. A search was performed, and 2 reviewers independently screened the studies by title, abstract, and, finally, by reading the full text. Four studies met the inclusion criteria. The reference lists of the included studies were scanned and 1 additional RCT study was included. The critical appraisal skills program checklist was applied for study appraisal. A statistician performed the data management and analysis. No statistically significant differences were found between the 2 treatment groups concerning rerupture (p = .796), return to sports (p = .455), or return to work (p = .888). One RCT found 1 case of deep venous thrombosis in the late weightbearing group. One RCT reported significant improvement in quality of life and one reported a significantly improved range of dorsiflexion in the early weightbearing group. No statistically significant difference was found between early and late weightbearing with conservative treatment regarding the rerupture rate. The results of the other outcomes were limited by the low number of studies included in the present meta-analysis. Larger randomized studies are needed to investigate these outcomes. From the results in the present study, we would recommend early weightbearing when an Achilles tendon rupture is treated conservatively.

AB - Achilles tendon ruptures can be either surgically or conservatively treated with either early functional mobilization or cast immobilization. The purpose of the present study was to conduct a meta-analysis comparing the effect of early versus late weightbearing in conservatively treated adult patients, including only randomized controlled trials (RCTs). The primary endpoint was rerupture, and the secondary endpoints were strength, quality of life during treatment, range of motion, deep venous thrombosis, return to sports, and return to work. The search for studies was conducted using PubMed, EMBASE, and the Cochrane Central Register of Controlled trials. A search was performed, and 2 reviewers independently screened the studies by title, abstract, and, finally, by reading the full text. Four studies met the inclusion criteria. The reference lists of the included studies were scanned and 1 additional RCT study was included. The critical appraisal skills program checklist was applied for study appraisal. A statistician performed the data management and analysis. No statistically significant differences were found between the 2 treatment groups concerning rerupture (p = .796), return to sports (p = .455), or return to work (p = .888). One RCT found 1 case of deep venous thrombosis in the late weightbearing group. One RCT reported significant improvement in quality of life and one reported a significantly improved range of dorsiflexion in the early weightbearing group. No statistically significant difference was found between early and late weightbearing with conservative treatment regarding the rerupture rate. The results of the other outcomes were limited by the low number of studies included in the present meta-analysis. Larger randomized studies are needed to investigate these outcomes. From the results in the present study, we would recommend early weightbearing when an Achilles tendon rupture is treated conservatively.

KW - Achilles Tendon/injuries

KW - Acute Disease

KW - Adult

KW - Conservative Treatment/methods

KW - Denmark

KW - Female

KW - Humans

KW - Injury Severity Score

KW - Male

KW - Prognosis

KW - Randomized Controlled Trials as Topic

KW - Return to Sport

KW - Return to Work

KW - Rupture/therapy

KW - Tendon Injuries/diagnosis

KW - Time Factors

KW - Treatment Outcome

KW - Weight-Bearing

U2 - 10.1053/j.jfas.2017.06.006

DO - 10.1053/j.jfas.2017.06.006

M3 - Review

C2 - 28974345

VL - 57

SP - 346

EP - 352

JO - Journal of Foot & Ankle Surgery

JF - Journal of Foot & Ankle Surgery

SN - 1067-2516

IS - 2

ER -