São Paulo, 09 de Agosto de 2004
Tem havido debate considerável sobre o melhor tratamento para ruptura aguda do tendão de Aquiles. Na Irlanda do Norte, foi desenvolvido este estudo que foi recentemente publicado no The Journal of Bone and Joint Surgery (American) um programa bem documentado e estruturado de manejo não operatório de ruptura do tendão de Aquiles com o uso de imobilização e uma órtese removível.
Os resultados foram avaliados em 140 pacientes consecutivos com ruptura completa do tendão de Aquiles que haviam sido tratados com este regime não operatório entre 1992 e 1998. Os pacientes foram avaliados com base nos resultados subjetivos e clinicamente com teste psicológico.
Um total de 56% dos pacientes apresentou um resultado excelente, 30% um resultado bom, 12% regular e 2% fraco. A taxa de complicação total foi de 8%, com três re-rupturas do tendão completas e cinco parciais, duas tromboses venosas profundas e um pé caído temporário.
Os autores concluíram que, neste estudo terapêutico com nível IV de evidência, os resultados do tratamento não operatório com órteses foram melhores que os publicados de reparo operatório de ruptura aguda do tendão de Aquiles e que os pacientes ficaram totalmente satisfeitos com o tratamento.
Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon - The Journal of Bone and Joint Surgery (American); 2004; 86: 1198-1202.
The Journal of Bone and Joint Surgery (American) 86:1198-1202 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon
Richard G.H. Wallace, MCh(Orth), MD, FRCS1, Ingrid E.R. Traynor, MPhil1, W. George Kernohan, PhD2 and Michael H.A. Eames, MD, FRCS(Tr and Orth)1
1 Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, United Kingdom. E-mail address for R.G.H. Wallace: r.wallace@dnet.co.uk. E-mail address for M.H.A. Eames: meames@doctors.org.uk
2 University of Ulster, Jordanstown, County Antrim, Northern Ireland, United Kingdom
Investigation performed at Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from The Wishbone Trust, which provided the salary for I.E.R. Traynor as a research physiotherapist for six months. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: There has been considerable debate about the best treatment for acute rupture of the Achilles tendon. At our institution, a well-documented and structured program of nonoperative management of Achilles tendon rupture with use of casts and a removable orthosis was developed.
Methods: We assessed the results in 140 consecutive patients with a complete rupture of the Achilles tendon who had been treated with our nonoperative regimen at our center between 1992 and 1998. Patients were evaluated on the basis of the subjective results and clinically with physiological testing.
Results: Overall, 56% of our patients had an excellent result; 30%, good; 12%, fair; and 2%, poor. The overall complication rate was 8%, with three complete and five partial tendon reruptures, two deep vein thromboses, and one temporary dropfoot.
Conclusions: The results of our nonoperative orthotic treatment were better overall than published results of operative repair of acute Achilles tendon rupture. Our patients were quite satisfied with their treatment.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
