PubMed https://doi.org/10.1007/s12325-012-0046-4. Coopmans L, Amaya Aliaga J, Metsemakers WJ, Sermon A, Misselyn D, Nijs S, Hoekstra H. J Foot Ankle Surg. 2001;9(4):2338. However, there were no RCTs to compare the eccentric training with sham control to make a firm conclusion. Nonoperative dynamic treatment of acute achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. In a RCT, conventional physical therapy with or without eccentric training exerted equal effects for IAT [22]. 2011;32(9):8439. Three groups had failed in a previous treatment. Foot Ankle Int. Achilles tendon (AT), a combination of the tendinous portion of gastrocnemius and soleus muscles to form the strongest tendon in the human body, is frequently injured mainly in the young to middle age active population of society, with the average age ranging from 37 to 44 years (1, 2). doi: 10.1177/0363546508319312, 31. rupture rate with non-operative management. In a retrospective case series report, dextrose injections reduced pain from either the insertion or mid-portion Achilles tendinopathy at the 28.6 months follow-up [17]. Forest plot of secondary outcome measure indicating flexion. Clin J Sport Med. Federal government websites often end in .gov or .mil. (F) Forest plot of deep infection. doi: 10.1007/s00228-007-0265-9, 6. Regarding raised concerns about recent studies (911), different from the previous meta-analysis, return to sport (the same level as pre-treatment) and re-rupture rate were adopted as primary outcomes. All literature screening processes were performed with Endnote X8. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. In a retrospective comparative study, high-energy ESWT was more effective than traditional nonoperative methods after the 12-month follow-up [13]. Provided by the Springer Nature SharedIt content-sharing initiative. This protocol is time based (dependent on tissue healing) as well as criterion based. https://doi.org/10.1046/j.1445-2197.2003.02748.x. In May 2023, Frontiers adopted a new reporting platform to be Counter 5 compliant, in line with industry standards. Am J Sports Med. Google Scholar. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, et al. (2016) 75:539. Ohberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain-results of a pilot study. Proc Biol Sci. PubMedGoogle Scholar. doi: 10.2106/00004623-200510000-00008, 11. Furia JP. The effects of conventional physical therapy and eccentric strengthening for insertional achilles tendinopathy. To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. MeSH AJR Am J Roentgenol. J Bone Joint Sur Am Vol. Knee Surg Sports Traumatol Arthrosc. All studies were assessed with the level of evidence [9]. official website and that any information you provide is encrypted Because of the limited and conflicting evidence, eccentric exercise was given a Grade I recommendation according to the Grades of Recommendation [2]. Secondly, the terminology of Achilles tendon pathology varies among studies, so some studies may be excluded during the process of literature screening according to our strict inclusion criteria. 2011;19(5):83541. Erroi et al. Overall, ESWT is widely used and supported now and has a Grade B recommendation. Moreover, maximum load, speed of contraction, and frequency of sessions should also be studied and optimized. doi: 10.1053/j.jfas.2017.05.036, 38. Am J Sports Med. doi: 10.2106/JBJS.K.00917, 9. These results were similar to those of cases that received single ESWT (73.7%), but much higher than those of eccentric exercises alone (45.6%). A histological and biomechanical study. 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. https://doi.org/10.2106/00004623-200301000-00001. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. All of them had rerupture rates, and 4 had ATRS scores and functional protocols with mention of formal physical therapy programs. 627, Wuluo Road, Wuhan, 430030, Hubei Province, P. R. China, Xiaosong Zhi,Jing Han,Shijun Wei&Feng Xu, Department of Emergency, Taikang Tongji (Wuhan) Hospital, Wuhan, Hubei Province, P. R. China, Graduate School of Wuhan University of Science and Technology, Wuhan, Hubei Province, P. R. China, The First Clinical Medical School Of Southern Medical University, Guangzhou, Guangdong Province, P. R. China, You can also search for this author in (2017) 284:20161850. doi: 10.1098/rspb.2016.1850, 16. For mean dorsiflexion, the surgical treatment group was similar to the conservative treatment group (two studies, 204 participants, Z = 0.32, P = 0.75, I2 = 51%, RR: 0.62, 95% CI: 3.23 to 4.46). . (2009) 62:100612. (2012) 94:213643. For superficial infection, compared with the surgical treatment group, conservative management showed significant evidence to prevent infection after treatment (seven studies, 659 participants, Z = 3.28, P = 0.001, I2 = 0%, RR: 7.34, 95% CI: 2.23 to 24.17). Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. and Fischer et al. Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial. We aim to provide a clear summary of the best available evidence for nonoperative treatment specific to insertional Achilles tendinopathy. Pinitkwamdee S, Laohajaroensombat S. Effectiveness of extracorporeal shockwave therapy in the treatment of chronic insertional Achilles tendinopathy. Epub 2022 Aug 25. The treatment effect of accelerated rehabilitation in nonoperatively treated patients seems to be small. Am J Sports Med. https://doi.org/10.1097/JSM.0b013e31818ef090. Deep vein thrombosis, a severe complication that usually occurred after ATR treatment owing to plaster casting immobilization (28), was reported in eight of the included studies. Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses. Detailed information about the ATRS assessment is displayed in Figure 4B. The authors declare that they have no competing interest. Nonoperative treatment of insertional Achilles tendinopathy: a systematic review. Am J Sports Med. IAT is regarded as a distinct clinical entity which is often accompanied with metabolic diseases and is difficult to manage, and the treatment and prognosis of IAT are not totally the same to those of mid-portion/non-insertional Achilles tendinopathy. 2003;85(1):13. (2010) 9:Cd003674. (2012) 470:2704. (2013) 52:5847. McCormack JR, Underwood FB, Slaven EJ, Cappaert TA. Foot Ankle Spec. The search items were as follows: (insertional OR insertion) AND (tendinopathy OR tendinitis OR tendinosis OR enthesitis or enthesopathy) AND Achilles. Wound infection, classified as superficial and deep infection, is one of the major complications in ATR patients receiving surgical repair. We retrieved all studies comparing surgical vs. conservative treatment in ATR patients for further review. Unauthorized use of these marks is strictly prohibited. In addition, each included studies' surgical techniques were extracted for better interpretation of baseline characteristics, and end-to-end Bunnell type was the most adopted technique for ATR repair. By using this website, you agree to our https://doi.org/10.1007/s00167-003-0402-7. Wound infection was a common complication of surgical treatment in ATR repair, and it could be divided into superficial and deep infection. Curr Rev Musculoskelet Med. We aim to provide a clear summary of the best available evidence for nonoperative treatment specific to insertional Achilles tendinopathy. https://doi.org/10.1177/03635465980260030301. (A) Forest plot of re-rupture rate. van der Vlist AC, Winters M. Which treatment is most effective for patients with Achilles tendinopathy? Forest plot of secondary outcome measure indicating period of absence from work and ATRS. However, studies with high-quality evidence are rare, especially for insertional form of Achilles tendinopathy. (2011) 343:d5928. Foot Ankle Int. Please enable it to take advantage of the complete set of features! Overall, male and female patients consisted of 84 and 16% of the population included in the study. An official website of the United States government. Furthermore, many patients prefer this type of rehabilitation to avoid the practical disadvantages of prolonged immobilization. . found that soft tissue treatment (Astym) plus eccentric training was more effective than eccentric exercise alone at improving function (VISA-A) during both short- and long-term follow-up periods [23]. The authors read and approved the final manuscript. PubMed Central However, the exact etiology and pathogenesis remain unclear. 2020Publish Ahead of Print. doi: 10.1111/sms.12209, 8. Knee Surg Sports Traumatol Arthrosc. In the subgroup of re-rupture that occurred in accelerated functional rehabilitation, no significant difference between surgical and conservative treatment could be observed (three studies, 289 participants, Z = 1.04, P = 0.30, I2 = 0%, RR: 0.59, 95% CI: 0.22 to 1.59). Incidence of deep vein thrombosis is reported from 0.350%, and it is a significant factor causing poor quality of life as well as the burden of social cost (4346). Ie . The ESWT in 3 of them applied low-energy shockwave treatments, and the other 2 groups used high-energy shockwave treatments. Lancet (London, England). Not surprisingly, similar results were found in pooled outcomes of mean dorsiflexion and plantarflexion. Duplicate studies were excluded, and two authors independently completed the initial title and abstract screening. Functional outcomes are similar in both groups according to our study's pooled result, but the number of studies reporting functional outcomes such as period of absence from work, ATRS score, and dorsiflexion and plantarflexion are limited. doi: 10.1002/14651858.CD003674.pub4, 53. Notarnicola A, Pesce V, Vicenti G, Tafuri S, Forcignan M, Moretti B. SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional Achilles tendinopathy. Detailed information about plantarflexion is shown in Figure 5B. In another RCT from Notarnicola et al., high-energy laser therapy gave quicker pain relief and gave the patients greater satisfaction than low-energy ESWT [21]. Br J Sports Med. One group was treated with ESWT and additional arginine supplement. Consequently, we aimed at thoroughly reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs). Ames PR, Longo UG, Denaro V, Maffulli N: Achilles tendon problems: not just an orthopaedic issue. Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V, et al. We examined the treatment effect of accelerated functional rehabilitation in nonoperative management of acute Achilles tendon ruptures. However, another RCT indicated that low-energy ESWT had no significant benefit for IAT at the 24 weeks follow-up, especially in the elderly [31]. 2019 Jan 7;364:k5120. Evidence in support of other therapies (including sclerosing therapy, dextrose injections, strengthening training, PRP, soft tissue treatment) are lacking, and more investigation with high level of evidence is needed. A prospective randomized study and review of the literature. Seventeen studies were non-randomized studies, and the methodological quality was assessed by MINORS. (A) Re-rupture rate; (B) Return-to-sport (Same level); (C) Complication rate; (D) Deep vein thrombosis; (E) Adhesion to underlying tendon; (F) Sural nerve injury; (G) Superficial infection; (H) Deep infection; (I) Period absence from work; (J) ATRS; (K) mean of dorsiflexion; (L) mean of plantarflexion. Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece. Am J Sports Med. Aim: Two authors independently assessed the risk of bias from each study under the instruction of Cochrane Risk of Bias Tool, and the same was done for protocols of included studies (18). BMJ (Clinical research ed). LC and HH: supervision, conceptualization, professional suggestion, and revision. 2016;26:239. J Bone Joint Surg. 2020;8(1):2325967119898118. 2019;12(6):5405. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current concepts review update: insertional Achilles tendinopathy. (2007) 35:4216. Five groups were evaluated with satisfactory results, and 101 out of 137 (73.7%) patients were satisfied with the outcome. official website and that any information you provide is encrypted The remaining 12 were non-comparative studies, and the scores ranged from 10 to 12. Careers. This study followed the PRISMA 2009 checklist as provided in Additional file 1. We administered overall the effect Z-test to determine the significance level for pooled effects. During full text screening, a total of 97 citations not compliant with the criteria were excluded and 13 citations of studies were included in this meta-analysis eventually (11, 2536). All procedures involved in this meta-analysis were performed under Revman (Version 5.3). Among the total 11 groups, patients from 6 groups, who were enrolled in these studies to receive ESWT, had unsatisfactory results from other nonoperative treatments before. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. (2007) 63:499503. 2023 Apr 28. doi: 10.1007/s00167-023-07411-1. (B) Forest plot indicating mean of plantarflexion. Consequently, thromboprophylaxis is necessary after ATR treatment and intermittent pneumatic compression has been reported to be highly effective in reducing deep vein thrombosis in ATR patients (43). The .gov means its official. Supplementary Figure 2. And the satisfactory rate of 2 groups (failed in previous treatments) was 30.4% vs. 63.8% in the other 3 groups. At present, surgical treatment for the repair of acute Achilles tendon rupture can be divided into 3 categories: open operations, minimally invasive techniques, and .