Sie sind auf Seite 1von 6

!

CTA/RTHOPAEDICA n



i>ii>ivVii`i
ViVi>i>ii>i
>}>]>}/B}>`>} i

i>iv"i`V]`1i>]- nx`]-i`i

i`iVi\>J}>V
-Li`{VVii`xn

"ACKGROUND 4HE BEST TREATMENT FOR ACUTE !CHILLES


TENDONRUPTUREISUNKNOWN
0ATIENTS AND METHODS 7E ASSESSED THE OUTCOME OF
NONOPERATIVE TREATMENT IN  CONSECUTIVE INDIVIDUALS
WITH AN ACUTE TOTAL!CHILLES TENDON RUPTURE WHO WERE
FOLLOWEDUNTILHEALING4HEMEANDURATIONOFTREATMENT
INCASTORORTHOSISWASWEEKS!FTERYEARS AQUES
TIONNAIRE WAS SENT TO ALL PATIENTS WHO WERE STILL ALIVE
 TOSUPPLEMENTANDCONlRMTHERETROSPECTIVEDATA
4HE QUESTIONNAIRE WAS COMPLETED BY  PATIENTS
 
2ESULTS4HERE RUPTUREFREQUENCYWASN 
PATIENTSSUFFEREDOTHERCOMPLICATIONSDEEPVENOUS
THROMBOSISANDPULMONARYEMBOLISM !TFOLLOW UP
OFTHEPATIENTSREPORTEDFULLRECOVERY
)NTERPRETATION4HELOWRE RUPTURERATEAFTERNONOP
ERATIVETREATMENTCHALLENGESTHECLAIMINRECENTSTUDIES
THATACUTERUPTUREOFTHE!CHILLESTENDONSHOULDBEOPER
ATED
N

4HEOPTIMALTREATMENTFORACUTERUPTUREOFTHE!CHIL
LES TENDON IS STILL CONTROVERSIAL 4HERE HAVE BEEN
ONLY  PROSPECTIVE RANDOMIZED TRIALS COMPARING
NONOPERATIVEANDOPERATIVETREATMENT.ISTOR
#ETTIETAL 4HERMANNETAL -AJEWSKI
ETAL -OLLERETAL ALLOFTHEMREACH
INGSOMEWHATDIFFERENTCONCLUSIONS)NSYSTEMATIC
REVIEW ARTICLES AND METAANALYSES THE CONCLUSION
ISOFTENTHATSURGICALTREATMENTHASASUBSTANTIALLY
LOWERRISKOFRE RUPTURECOMPAREDTONONOPERATIVE
TREATMENT BUTTHERISKOFINFECTIONANDOTHERCOM
PLICATIONSOFSURGICALREPAIRISINCREASED7ILLSET

AL #ETTIETAL ,OETAL 0OPOVIC


AND ,EMAIRE  "HANDARI ET AL  +OCHER
ETAL 7ONGETAL +HANETAL 
"ASEDONTHEBENElTSANDRISKS SURGICALTREATMENT
IS GENERALLY RECOMMENDED ALTHOUGH WITH SOME
MISGIVINGS"HANDARIETAL +HANETAL
7ONG ET AL   (OWEVER THIS RECOMMENDA
TIONISBASEDONANAVERAGERE RUPTURERATEOFABOUT
INPATIENTSTREATEDNONOPERATIVELY COMPARED
TO ABOUT  AFTER SURGICAL TREATMENT!T OUR HOS
PITAL NONOPERATIVETREATMENTHASBEENTHEMETHOD
OFCHOICEFORDECADES)NTHISRETROSPECTIVECOHORT
STUDY WEEVALUATEDTHERATEOFRE RUPTUREANDOTHER
COMPLICATIONS IN CONSECUTIVE PATIENTS PRESENTING
WITHACUTETOTAL!CHILLESTENDONRUPTUREWHOWERE
TREATEDNONOPERATIVELY

*>i>`i`
!TTHE$EPARTMENTOF/RTHOPEDICSIN,UND5NIVER
SITY(OSPITAL 3WEDEN EVERYPATIENTVISITANDEVERY
OPERATION IS RECORDED IN A COMPUTERIZED MEDICAL
RECORD DATABASE UNDER A GIVEN DIAGNOSIS NUMBER
!CHILLESTENDONRUPTUREHASAUNIQUECODENUMBER
!COMPUTERSEARCHOFTHEMEDICALDATABASEANDTHE
OPERATION LOG FROM  THROUGH  WAS PER
FORMED AND  INDIVIDUALS WERE IDENTIlED WITH
ACUTE TOTAL !CHILLES TENDON RUPTURE 4HE MEDICAL
CHARTS OF ALL PATIENTS WERE REVIEWED 4HE FOLLOW
INGPATIENTSWEREEXCLUDED THOSEWHOONLYHAD
APARTIALRUPTUREANDWERETREATEDACCORDINGLY BUT
WEREINCORRECTLYRECORDEDASHAVINGATOTAL!CHIL
LESTENDONRUPTUREN  PATIENTSWHODIDNOT

#OPYRIGHT4AYLOR&RANCIS)33.n0RINTEDIN3WEDENnALLRIGHTSRESERVED
$/)



RECEIVETHEIRINITIALORlNALTREATMENTAT,UND5NI
VERSITY(OSPITALNANDN RESPECTIVELY
 PATIENTS WHO DID NOT RECEIVE ANY ACTIVE TREAT
MENT DUE TO THE GENERAL CONDITION OF THEIR HEALTH
N AND PATIENTSWHORECEIVEDSURGICALTREAT
MENTN 4HELATTERWEREFOLLOWEDINTHESAME
WAY AS THOSE TREATED NONOPERATIVELY SEE HEADING
BELOW 
)N THE REMAINING  PATIENTS MEDICAL CHARTS
WERE ANALYZED AND DATA EXTRACTED ACCORDING TO
A STANDARDIZED PROTOCOL ON AVERAGE  n
YEARSAFTERTHEINJURYPATIENTSWEREDECEASEDAT
FOLLOW UP DEATHBEINGRELATEDTOTHETENDONRUP
TURE4HISPATIENTCOMMITTEDSUICIDEAFTERTHEINSUR
ANCESYSTEMREFUSEDTOACCEPTHISBILATERAL!CHILLES
TENDON RUPTURE
ASA SIDE EFFECTOFQUINOLONE TREAT
MENT! QUESTIONNAIRE WAS SENT TO THE REMAINING
 PATIENTS TO CONlRM THE DATA FROM THE MEDI
CALCHARTSANDTOOBTAINASUBJECTIVEEVALUATIONOF
THEIRFUNCTIONALSTATUS4HEINDIVIDUALSWEREASKED
TOANSWERAQUESTIONNAIREREGARDINGTHEIRMEDICAL
CONDITION AT THE TIME OF INJURY WHETHER THEY HAD
HAD A RE RUPTURE DEEP VENOUS THROMBOSIS OR PUL
MONARY EMBOLISM DURING OR AFTER TREATMENT AND
WHETHER THEIR PRESENT FUNCTION HAD BEEN AFFECTED
DAILY SOMETIMESORNEVER BYTHEPREVIOUS!CHIL
LESTENDONRUPTURETRAUMAPATIENTS
ANSWEREDTHEQUESTIONNAIRE INCASESAFTERBEING
INTERVIEWEDBYTELEPHONE)NCASES WEFAILEDTO
MAKECONTACT
4HE INFORMATION COLLECTED IN THE QUESTIONNAIRE
ANDTELEPHONEINTERVIEWSCONlRMEDTHEDATAFOUND
IN THE MEDICAL CHARTS AND GENERATED SOME PREVI
OUSLYUNKNOWNDATAMOREPATIENTSHADSUFFERED
A RE RUPTURE  OF THESE INCLUDING A DEEP VENOUS
THROMBOSISDURINGIMMOBILIZATIONOTHERPATIENTS
HADHADADEEPVENOUSTHROMBOSIS!LLOTHERCOM
PLICATIONSWEREALREADYNOTEDINTHECHARTS)N
PATIENTS INFORMATIONREGARDINGCOMPLICATIONSWAS
BASEDONTHEMEDICALCHARTSONLYDECEASEDAND
NON RESPONDING 4HISSTUDYWASAPPROVEDBYTHE
LOCAL RESEARCH ETHICS COMMITTEE AT THE &ACULTY OF
-EDICINE ,UND5NIVERSITY
i>ii>i

4HESTANDARDNONOPERATIVETREATMENTATOURDEPART
MENTDURINGTHEINCLUSIONPERIODWASACASTFOR
WEEKSN $URINGTHELASTYEARSORTHOSISWAS
USED EITHERCASTFOLLOWEDBYORTHOSISN OR

!CTA/RTHOPAEDICA n

ORTHOSISALONEN 4HEANKLEWASIMMOBILIZED
INPLANTARmEXIONFORWEEKSMEANDAYS 3$
ANDINNEUTRALPOSITIONFORANOTHERWEEKSMEAN
DAYS 3$ )FANORTHOSISWASUSED PLANTARmEX
IONWASALLOWEDDURINGWEEKSn)NALLPATIENTS
WEIGHTBEARINGWASADVISEDFROMDAY
!LLPATIENTSEXCEPTONEWEREPRESCRIBEDAHEEL
RAISE OF  CM FOR  WEEKS AFTER REMOVAL OF THE
CASTORTHOSIS!PHYSIOTHERAPISTATTHEDEPARTMENT
INSTRUCTEDALLBUTPATIENTS BOTHORALLYANDINWRIT
ING HOWTOAMBULATEANDEXERCISEDURINGANDAFTER
THE IMMOBILIZATION PERIOD!LL PATIENTS WERE ALSO
REFERREDTOALOCALPHYSIOTHERAPISTFORFOLLOW UPOF
EXERCISE
"i>ii>i

4HE INDICATION FOR SURGICAL TREATMENT WAS EITHER


ALATEDIAGNOSISnDAYSN ORTHATTHE
PATIENT DEMANDED SURGERY N    0ATIENTS WHO
UNDERWENT SURGERY HAD THE SAME TREATMENTIN
CASTORORTHOSISFORWEEKSASTHOSETREATEDNON
OPERATIVELY
.ONEOFTHESURGICALLYTREATEDPATIENTSWERE
DIAGNOSEDWITHARE RUPTURE DEEPVENOUSTHROMBO
SISORPULMONARYEMBOLIPATIENTSHADAPOSTOPER
ATIVEWOUNDINFECTIONWITHDELAYEDWOUNDHEALING
ANDHADAPERMANENTSURALNERVEINJURY
.O STATISTICAL COMPARISON BETWEEN THE NON
OPERATIVE AND OPERATIVE GROUPS WAS MADE DUE TO
THESTRONGSELECTIONBIAS(OWEVER ATTHEFOLLOW
UP AFTER  n YEARS THE OPERATED GROUP
REPORTEDASIMILARSUBJECTIVERECOVERYLEVELASTHE
NONOPERATIVELYTREATEDGROUP
i}>V

4HEMEANAGEATDIAGNOSISFORTHEPATIENTSTREATED
NONOPERATIVELYWASn YEARSPATIENTS
 WEREMALE)NMOSTPATIENTS DIAGNOSISAND
STARTOFTREATMENTWASONTHESAMEDAYASINJURYN
    )N  CASES TREATMENT STARTED  DAY
AFTER INJURY IN  CASES IT STARTED BETWEEN  AND
 DAYS AFTER INJURY AND IN  PATIENTS BETWEEN 
AND  DAYS AFTER INJURY  PATIENTS HAD DIABETES
HADIMMUNOSUPPRESSIVEMEDICATIONANDHAD
ONGOINGTREATMENTWITHQUINOLONESATTHETIMEOF
THE RUPTURE4HE CAUSE OF THE RUPTURE WAS SPORTS
RELATEDIN OFTHECASESINWHICHTHE
ETIOLOGYWASKNOWNINCASESDUETOBADMINTON
INCASESDUETOSOCCER ANDINCASESDUETO

!CTA/RTHOPAEDICA n

OTHERSPORTINGACTIVITIESATTIMEOFTHERUPTURE
PATIENTSRELATEDTHETRAUMATOANACTIVITYOTHERTHAN
SPORT ANDINCASEWITHBILATERAL!CHILLESTENDON
RUPTURETHEETIOLOGYWASQUINOLONETREATMENT
->V

6ALUES ARE GIVEN AS MEAN AND RANGE $IFFERENCES


BETWEEN OR WITHIN GROUPS WERE CALCULATED USING
THE -ANN 7HITNEY TWO TAILED TEST THE CHI SQUARE
TESTOR&ISHERSEXACTTEST

,i
OFPATIENTSHADARE RUPTURE 4HEMEAN
TIMETORE RUPTUREAFTERREMOVALOFPLASTERORORTHO
SIS WAS  n DAYS  RE RUPTURES OCCURRED
WITHINDAYSOFREMOVINGTHEANKLEIMMOBILIZ
ING TREATMENT AND THE REMAINING  RE RUPTURES
WEREEVENLYSPREADUPTODAYS!LLPATIENTS
HAD STARTED THE INITIAL TREATMENT IN PLASTER AND 
SWITCHEDTOORTHOSISAFTERWEEKS4HEMEANAGE
ATRE RUPTUREWASn YEARS ANDALLPATIENTS
BUTWEREMENPATIENTSHADPREVIOUSLYRUPTURED
THECONTRALATERAL!CHILLESTENDON
.ONEOFTHEFOLLOWINGPARAMETERSCOULDBECOR
RELATEDTOANINCREASEDRISKOFRE RUPTURESEX TYPE
OFIMMOBILIZATIONCASTORORTHOSIS STARTOFTREAT
MENT   DAYS OR  DAYS FROM INJURY ETIOLOGY
OFRUPTURE ANDIMMUNOSUPPRESSIVETREATMENTOF
THE PATIENTS WITH A RE RUPTURE UNDERWENT SURGICAL
TREATMENTFOLLOWEDBYANEW WEEKPERIODINCAST
ORORTHOSIS4HEREMAININGPATIENTSRECEIVEDNON
OPERATIVETREATMENTONCEAGAIN
PATIENTSHADADIAGNOSEDDEEPVENOUSTHROMBO
SISANDOFTHEMALSOHADADIAGNOSEDPULMONARY
EMBOLISM  PATIENT HAD BOTH A RE RUPTURE AND A
DEEPVENOUSTHROMBOSIS!TFOLLOW UPAFTERn
 YEARS  OFTHOSEWHORESPONDED
REPORTEDFULLRECOVERY REPORTEDTHAT
THEY CONSIDERED THAT THE !CHILLES TENDON RUPTURE
HADRESTRAINEDTHEIRDAILYLIVESAND
CONSIDEREDTHATTHEYWERESOMETIMESRESTRAINEDBY
THERUPTURE4HEREWASNODIFFERENCEBETWEENAGE
GROUPS REGARDING SUBJECTIVE RECOVERY 4HERE WAS
A SIMILAR RECOVERY LEVEL IN PATIENTS WITH RE RUP
TURE WITHREPORTINGDAILYRESTRAINTS AND
REPORTINGRESTRAINTSSOMETIMES



V
4O OUR KNOWLEDGE THE PRESENT REPORT DESCRIBES
THE LARGEST STUDY TO DATE OF CONSECUTIVE PATIENTS
WITHACUTETOTAL!CHILLESTENDONRUPTURESTHATWERE
TREATEDNONOPERATIVELY7EBELIEVETHATINOURSTUDY
OF  CASES ALL CONSECUTIVE PATIENTS WITH ACUTE
TOTAL!CHILLESTENDONRUPTURESHAVEBEENINCLUDED
AND THAT ALL MAJOR COMPLICATIONS ASSOCIATED WITH
THE !CHILLES TENDON RUPTURE HAVE BEEN REPORTED
!LLOURPATIENTSWEREFOLLOWEDUNTILCLINICALHEAL
ING ANDOURFOLLOW UPWITHOFTHEPATIENTS
ANSWERINGTHEQUESTIONNAIREHASMINIMIZEDBIAS
BY SELECTION 4HE RE RUPTURE RATE WAS ONLY 
WHICHISLOWERTHANINPUBLISHEDREVIEWSANDMETA
ANALYSES 7ILLS ET AL  #ETTI ET AL  ,O
ETAL 0OPOVICAND,EMAIRE "HANDARI
ETAL +OCHERETAL +HANETAL 
!CCORDINGTOTHECURRENT#OCHRANEREVIEWTRIALS
 PATIENTS PATIENTS TREATED OPERATIVELY HAD A
POOLEDRE RUPTUREINCIDENCEOF WHICHCANBE
COMPAREDWITHINTHENONOPERATIVEGROUPREL
ATIVERISK22  #)n 4HERATE
OF COMPLICATIONS OTHER THAN RE RUPTURE WAS MUCH
HIGHEROPERATIVE ANDNON OPERATIVE
INCLUDING INFECTION ADHESIONS AND DISTURBED SKIN
SENSIBILITY 22   #) n 4HE AUTHORS
CONCLUDEDTHATTHEREISEVIDENCETHATOPENOPERATIVE
TREATMENTOFACUTE!CHILLESTENDONRUPTURESSIGNIl
CANTLYREDUCESTHERISKOFRE RUPTURECOMPAREDTO
NONOPERATIVE TREATMENT BUT HAS THE DRAWBACK OF
ASIGNIlCANTLYHIGHERRISKOFOTHERCOMPLICATIONS
INCLUDINGWOUNDINFECTION+HANETAL 
)FONECOMPARESTHERE RUPTURERATEINOURNON
OPERATIVELYTREATEDPATIENTSTOANEQUIVALENTGROUP
INARECENTLYPUBLISHEDRANDOMIZEDSTUDYFAVORING
SURGICALTREATMENT-OLLERETAL OURRATEIS
CONSIDERABLYLOWERASOPPOSEDTO 4HE
REASON FOR THIS LARGE VARIATION IS NOT KNOWN AND
ONE CAN ONLY SPECULATE 4HE RISK OF RE RUPTURE IN
PATIENTSWITH!CHILLESTENDONRUPTURE INOPERATED
ASWELLASNONOPERATEDPATIENTS ISPROBABLYRELATED
TO THE QUALITY OF THE REHABILITATIONBOTH DURING
ANDALSO ANDPERHAPSEVENMOREIMPORTANTLY AFTER
REMOVALOFTHEPLASTERORTHEORTHOSIS4HEQUALITY
OF THE REHABILITATION IN A NONOPERATIVELY TREATED
PATIENT MATERIAL EXPERIENCING A RE RUPTURE FRE
QUENCY OF GREATER THAN  -OLLER ET AL 
MUST BE QUESTIONED 4HE TREATMENT STRATEGY WE



USED WAS SIMILAR TO THE ONES OFTEN RECOMMENDED


INNONOPERATIVELYTREATEDCASES#ETTIETAL
-OLLER ET AL   /NE DIFFERENCE WAS THAT WE
ALLOWED IMMEDIATE WEIGHT BEARING IN THE PLASTER
ORTHOSIS 4HIS MIGHT INCREASE THE STRENGTH OF THE
HEALEDTENDON ORATLEASTLETITREGAINITSSTRENGTH
QUICKER0ALMESETAL ASTHElBROBLASTSAND
COLLAGENlBRESlLLINGTHETENDONGAPORIENTTHEM
SELVESALONGTHELONGAXISOFTHETENDONASARESULT
OFMECHANICALSTRESS)TISPOSSIBLETHATOTHERVARIA
TIONSINTHENONOPERATIVETREATMENTREGIME SUCHAS
DEGREEOFPLANTARmEXIONINTHECAST THEUSEOFHEEL
RAISE AND VARIATIONS IN INFORMATION AND INSTRUC
TIONSOFTHEPHYSIOTHERAPISTMAYEXPLAINTHEDIFFER
ENCESFOUND ATLEASTTOSOMEEXTENT)NOURSTUDY
ONE SINGLE PHYSIOTHERAPIST INSTRUCTED THE PATIENTS
REGARDING THEIR REHABILITATION AND EXERCISE DURING
THESTUDYPERIOD
0ROMISING RESULTS HAVE BEEN DEMONSTRATED IN
OTHER STUDIES WITH FUNCTIONAL BRACING IN PATIENTS
WHOWERETREATEDNONOPERATIVELY3ALEHETAL
%AMESETAL -C#OMISETAL 2OBERTS
ET AL  0ETERSEN ET AL  AN INDICATION
THAT NONOPERATIVE TREATMENT OF !CHILLES TENDON
RUPTURECANBEIMPROVEDFURTHER&UNCTIONALBRAC
ING CONSTITUTES A MORE PHYSIOLOGICAL MECHANICAL
ENVIRONMENT FOR A HEALING TENDON THAN CAST TREAT
MENT ANDITWASSTARTEDINTHELASTPATIENTSOFOUR
STUDY 0ERHAPS THE RESULTS OF NONOPERATIVE!CHIL
LESTENDONRUPTURETREATMENTCANBEIMPROVEDEVEN
MORE WHICHWOULDJUSTIFYACONSERVATIVESTRATEGY
IN THE FUTURE EVEN MORE 4HE FACT THAT ONLY 
OF PATIENTS IN OUR SERIES REPORTED FULL SUBJECTIVE
RECOVERY AT FOLLOW UP FOUR YEARS AFTER THE INJURY
INDICATES THAT A HEALED TENDON IS NOT NECESSARILY
EQUIVALENTTOPATIENTSATISFACTION&URTHERPROSPEC
TIVE STUDIES AND PREFERABLY RANDOMIZED ONES ARE
REQUIRED TO EVALUATE THE FUNCTIONAL OUTCOME TO A
GREATERDEGREE
)FNONOPERATIVETREATMENTOF!CHILLESTENDONRUP
TURESHASARE RUPTURERATEOF ASINOURSTUDY
SURGICAL INTERVENTION AS A PRIMARY TREATMENT IS
QUESTIONABLEWHENTAKINGCOSTANDSURGICALCOMPLI
CATIONSINTOCONSIDERATION7EQUESTIONWHETHERIT
ISREASONABLETOLETALLOFOURPATIENTSWHOPRES
ENTANNUALLYWITH!CHILLESTENDONRUPTUREUNDERGO
SURGERY WITH ALL ITS RISKS AND COSTS JUST IN ORDER
TO AVOID RE RUPTURE IN A FEW PATIENTS 0ERHAPS THE
SURGICAL RESOURCES COULD BE BETTER USED FOR MORE

!CTA/RTHOPAEDICA n

EFFECTIVEPROCEDURES ANDMAYBEITWOULDEVENBE
POSSIBLETOFURTHERLOWERTHERE RUPTURERATEOFNON
OPERATIONALLYTREATEDRUPTURES
.OCOMPETINGINTERESTSDECLARED

"HANDARI - 'UYATT ' ( 3IDDIQUI & -ORROW & "USSE *


,EIGHTON2+ 3PRAGUE3 3CHEMITSCH%(4REATMENTOF
ACUTE!CHILLESTENDONRUPTURESASYSTEMATICOVERVIEWAND
METAANALYSIS#LIN/RTHOP  
#ETTI2 #HRISTENSEN3% %JSTED2 *ENSEN.- *ORGENSEN
5 /PERATIVE VERSUS NONOPERATIVE TREATMENT OF !CHIL
LESTENDONRUPTURE!PROSPECTIVERANDOMIZEDSTUDYAND
REVIEWOFTHELITERATURE!M*3PORTS-ED 
 
%AMES-( %AMES.7 -C#ARTHY+2 7ALLACE2'!N
AUDIT OF THE COMBINED NON OPERATIVE AND ORTHOTIC MAN
AGEMENTOFRUPTUREDTENDO!CHILLIS)NJURY 
 
+HAN2+ &ICK$ "RAMMAR4* #RAWFORD* 0ARKER-*
)NTERVENTIONSFORTREATINGACUTE!CHILLESTENDONRUPTURES
4HE#OCHRANE$ATABASEOF3YSTEMATIC2EVIEWS 
#$PUB $/) #$
PUB
+OCHER-3 "ISHOP* -ARSHALL2 "RIGGS++ (AWKINS2
*/PERATIVEVERSUS.ONOPERATIVE-ANAGEMENTOF!CUTE
!CHILLES4ENDON2UPTURE%XPECTED 6ALUE$ECISION!NAL
YSIS!M*3PORTS-ED  
,O)+ +IRKLEY! .ONWEILER" +UMBHARE$!/PERATIVE
VERSUS NONOPERATIVE TREATMENT OF ACUTE !CHILLES TENDON
RUPTURES A QUANTITATIVE REVIEW #LIN * 3PORT -ED 
  
-AJEWSKI- 2ICKERT- 3TEINBRUCK+!CHILLESTENDONRUP
TURE!PROSPECTIVESTUDYASSESSINGVARIOUSTREATMENTPOS
SIBILITIES/RTHOPADE  
-C#OMIS'0 .AWOCZENSKI$! $E(AVEN+%&UNCTIONAL
BRACINGFORRUPTUREOFTHE!CHILLESTENDON#LINICALRESULTS
ANDANALYSISOFGROUND REACTIONFORCESANDTEMPORALDATA
*"ONE*OINT3URG!M   
-OLLER - -OVIN 4 'RANHED ( ,IND + &AXEN % +ARLS
SON * !CUTE RUPTURE OF TENDON !CHILLIS ! PROSPECTIVE
RANDOMISED STUDY OF COMPARISON BETWEEN SURGICAL AND
NON SURGICALTREATMENT*"ONE*OINT3URG"R 
  
.ISTOR , 3URGICAL AND NON SURGICAL TREATMENT OF !CHILLES
4ENDONRUPTURE!PROSPECTIVERANDOMIZEDSTUDY*"ONE
*OINT3URG!M   
0ALMES$ 3PIEGEL(5 3CHNEIDER4/ ,ANGER- 3TRATMANN
5 "UDNY4 0ROBST!!CHILLESTENDONHEALINGLONG TERM
BIOMECHANICAL EFFECTS OF POSTOPERATIVE MOBILIZATION AND
IMMOBILIZATION IN A NEW MOUSE MODEL * /RTHOP 2ES
  
0ETERSEN/& .IELSEN-" *ENSEN+( 3OLGAARD32AN
DOMIZED COMPARISON OF #!- WALKER AND LIGHT WEIGHT
PLASTERCASTINTHETREATMENTOFlRST TIME!CHILLESTENDON
RUPTURE5GESKR,AEGER  

!CTA/RTHOPAEDICA n

0OPOVIC . ,EMAIRE 2 $IAGNOSIS AND TREATMENT OF ACUTE


RUPTURESOFTHE!CHILLESTENDON#URRENTCONCEPTSREVIEW
!CTA/RTHOP"ELG  
2OBERTS#0 0ALMER3 6INCE! $ELISS,*$YNAMISEDCAST
MANAGEMENTOF!CHILLESTENDONRUPTURES)NJURY
  
3ALEH- -ARSHALL0$ 3ENIOR2 -AC&ARLANE!4HE3HEF
lELDSPLINTFORCONTROLLEDEARLYMOBILISATIONAFTERRUPTURE
OFTHECALCANEALTENDON!PROSPECTIVE RANDOMISEDCOM
PARISON WITH PLASTER TREATMENT * "ONE *OINT 3URG "R
  



4HERMANN ( :WIPP ( 4SCHERNE ( &UNCTIONAL TREATMENT


CONCEPTOFACUTERUPTUREOFTHE!CHILLESTENDONYEARS
RESULTSOFAPROSPECTIVERANDOMIZEDSTUDY5NFALLCHIRURG
  
7ILLS # ! 7ASHBURN 3 #AIOZZO 6 0RIETTO # ! !CHIL
LESTENDONRUPTURE!REVIEWOFTHELITERATURECOMPARING
SURGICALVERSUSNONSURGICALTREATMENT#LIN/RTHOP
  
7ONG* "ARRASS6 -AFFULLI.1UANTITATIVEREVIEWOFOPERA
TIVEANDNONOPERATIVEMANAGEMENTOFACHILLESTENDONRUP
TURES!M*3PORTS-ED  

Das könnte Ihnen auch gefallen