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Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines.


ABSTRACT:

Purpose

This study aimed to describe and analyse usual care of Achilles tendon ruptures (ATRs) by orthopaedic surgeons and trauma surgeons in the Netherlands.

Methods

A nationwide online survey of ATR management was sent to all consultant orthopaedic and trauma surgeons in the Netherlands, requesting participation of those involved in ATR management. Data on individual characteristics and the entire ATR management (from diagnosis to rehabilitation) were gathered. Consensus was defined as ??70% agreement on an answer.

Results

A total of 91 responses (70 orthopaedic surgeons and 21 trauma surgeons) were analysed. There was consensus on the importance of the physical examination in terms of diagnosis (>?90%) and a lack of consensus on diagnostic imaging (ultrasound/MRI). There was consensus that non-surgical treatment is preferred for sedentary and systemically diseased patients and surgery for patients who are younger and athletic and present with larger tendon gap sizes. There was consensus on most of the non-surgical methods used: initial immobilisation in plaster cast with the foot in equinus position (90%) and its gradual regression (82%) every 2 weeks (85%). Only length of immobilisation lacked consensus. Surgery was generally preferred, but there was a lack of consensus on the entire followed protocol. Orthopaedic and trauma surgeons differed significantly on their surgical (p?=?0.001) and suturing techniques (p?=?0.002) and methods of postoperative immobilisation (p?ConclusionThis is the first study to describe the entire ATR management. The results show a lack of consensus and wide variation in management of ATRs in the Netherlands. This study shows that especially the methods of the perioperative and rehabilitation phases were inconclusive and differed between orthopaedic and trauma surgeons. Further research into optimal ATR management regimens is recommended. In addition, to achieve uniformity in management more multidisciplinary collaboration between Dutch and international surgeons treating ATRs is needed.

Level of evidence

Cross-sectional survey, Level V.

SUBMITTER: Dams OC 

PROVIDER: S-EPMC6706364 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines.

Dams Olivier C OC   van den Akker-Scheek Inge I   Diercks Ron L RL   Wendt Klaus W KW   Zwerver Johannes J   Reininga Inge H F IHF  

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 20180703 9


<h4>Purpose</h4>This study aimed to describe and analyse usual care of Achilles tendon ruptures (ATRs) by orthopaedic surgeons and trauma surgeons in the Netherlands.<h4>Methods</h4>A nationwide online survey of ATR management was sent to all consultant orthopaedic and trauma surgeons in the Netherlands, requesting participation of those involved in ATR management. Data on individual characteristics and the entire ATR management (from diagnosis to rehabilitation) were gathered. Consensus was def  ...[more]

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