Surgical versus nonsurgical treatment of acute Achilles ruptures in the high demand patient: Using decision analysis to help clinical decisions |
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| Affiliation: | 1. Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Schwarzenbruck, Germany;2. Stockholms Fotkirurgklinik, Sophiahemmet University, Stockholm, Sweden;3. Service de Chirurgie Orthopedique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite Cedex, France;4. Laboratoire de Biomécanique et Mécanique des Chocs, Université Lyon 1, Bron cedex, France;5. Orthopedic Department at University Hospital Uppsala, Uppsala, Sweden and Department of Foot and Ankle Surgery, Capio Movement, Halmstad, Sweden;6. Charlottenlund, Denmark;7. Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy;8. Queen Mary University of London, Centre for Sports and Exercise Medicine, London, UK;9. Keele University, School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, UK; England Dentistry, London, UK;10. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK;11. Department of Orthopaedic Surgery, Hospital Sant Rafael, Barcelona, Spain;12. Centre of Orthopaedics, North Estonia Medical Centre, Tallinn, Estonia;13. Department of Orthopaedics, East-Tallinn Central Hospital, Tallinn, Estonia;1. Foot and Ankle Unit, Hospital Vall d′Hebron, Barcelona, Spain;2. Foot and Ankle Unit, Hospital de Clinicas - Universidad de la República, Montevideo, Uruguay;1. Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China;2. Department of Anaesthesia, The 925th Hospital, 67# Huanghe RD, China;3. Department of Orthopedics, Xinqiao Hospital, 400037 Chongqing, China;1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sakarya University, Sakarya, Turkey;2. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sakarya University, Sakarya, Turkey;3. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Mehmet Akif Ersoy State Hospital, Canakkale, Turkey;4. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey |
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| Abstract: | BackgroundRecent literature suggests that functional treatment of acute non-insertional Achilles tendon ruptures yields outcomes (re-rupture and function) similar to those of surgery, but does not address the unique issues in treating high performance athletes or other high demand patients.MethodsDecision analysis was used to develop an estimate of outcome utility for both types of treatment using published Costs and Quality-Adjusted Life Years (QALYs) values. The expected value for either treatment was then calculated for high, intermediate, and normal demand patients, using the specific functional needs of the patients.ResultsNonoperative treatment is the preferred management for normal demand patients, while high and intermediate demand patients are more likely to experience better expected functional outcomes from surgery.ConclusionThe combination of a decision analysis and expected value analysis provides evidence-based support for the existing intuitive recommendations that favor surgical treatment in elite athletes and other high demand patients.Level of EvidenceIII |
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| Keywords: | Achilles tendon Achilles rupture Tendon repair Decision analysis Cost-effectiveness QALY" },{" #name" :" keyword" ," $" :{" id" :" key0035" }," $$" :[{" #name" :" text" ," _" :" Quality-adjusted life-years EV" },{" #name" :" keyword" ," $" :{" id" :" key0045" }," $$" :[{" #name" :" text" ," _" :" Expected value |
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