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State of the Art in the Treatment of Achilles Tendon Ruptures (ATR)
Background:
A comparison of the tibio talar and tibio-1st metatarsal angles in two different walking orthoses by lateral radiograph.
orthosis with wedges
vacuum orthosis (VACOped)
- Caution in the use of wedges (may not produce sufficient ankle equinus to shorten Achilles tendon during healing)
- May result in tendon elongation, and therefore,
- Reduced plantar flexion power
- Reduced function and patient outcomes
Results:
Early Protected Weightbearing for Acute Ruptures of the Achilles Tendon: Do Commonly Used Orthoses Produce the Required Equinus?
P. Ellison, A. Molloy, L. W. Mason
Aintree University Hospital
The Journal of Foot & Ankle Surgery 2017, vol. 56, issue 5, pp. 960–963. DOI: http://dx.doi.org/10.1053/j.jfas.2017.06.017.
The treatment of a rupture of the Achilles tendon
using a dedicated management programme
A. M. Hutchison, C. Topliss, D. Beard, R. M. Evans, P. Williams
Morriston Hospital, ABMU University Health, Board, Swansea, United Kingdom Bone Joint J 2015; 97-B:510–15. DOI: 10.1302/0301-620X.97B4.35314.
Summary of the SMART (Swansea Morriston Achilles Rupture Treatment) programme Retrospective analysis from 2008-2014
Programme includes
conservative treatment
211
273 patients with acute rupture
62
surgical treatment
- Dedicated Achilles clinic
- Ultrasound examination
- Functional orthosis (VACOped using defined ROM)
- Early weight-bearing
- Accelerated exercise regime
- Guideline for return to work and sport
Results
- Low rerupture rate (1.1%)
- Satisfactory functional outcome
- Reduced rate of surgical intervention
- Cost savings of £91,000 per annum
Non-operative functional treatment for acute Achilles tendon ruptures: The Leicester Achilles Management Protocol (LAMP)
Randeep S. Aujla, Shakil Patel, Annette Jones, Maneesh Bhatia
Trauma & Orthopaedic Surgery, University Hospitals of Leicester, Leicester, United Kingdom Injury 2019 Apr; 50(4): 995-999. Doi: 10.1016/j.injury.2019.03.007
Equal quality of functional results (ATRS 75.5) as SMART without inital casting. Recovery in 8 weeks. Low re-rupture rate (2%), Low number of complications. Simple, reliable and cost effective regime, that can be adopted universally.
Results:
Study with 442 patients with acute Achilles tendon (AT) ruptures treated conservativly with an eight-week functional dynamic treatment protocol including the use of dROM in a VACOped boot with immediate full weight bearing mobilisation, Use of ATRS Score.
Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis
R. Naskar, L. Oliver, P. Velazquez-Ruta, B. Dhinsa, C. Southgate
East Kent Hospital, UK
Foot Ankle Surg. 2021 Jul 2; S1268-7731(21)00138-7. Doi: 10.1016/j.fas.2021.06.008
Study with 41 patients investigating the functional outcomes of early weight bearing in a functional
orthosis including the use of dROM for conservatively managed, complete AT ruptures with a gap less than 5 cm.
Results:
Equal results compared to LAMP and SMART but also without initial casting and for gaps up to 5 cm. Excellent functional results with ATRS of 82.1, low rerupture rate (1 patient), no other complications, excellent patient satisfaction.
Overview of Proven Conservative Treatment Regimes
non-weightbearing
Phase 1
Phase 2
weightbearing as tolerated
Phase 3
Full weightbearing
Open range of motion for joint mobility
Physiotherapy
Fixed at 90º
Archill-sole
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