Impact of Tendon Gap on Decision-Making in Acute Achilles Tendon Rupture: A Systematic Review
Notice bibliographique
Résumé
Acute Achilles tendon rupture (AATR) is a prevalent injury that significantly impacts clinical decision-making, particularly concerning the initial gap size following the rupture. This review aims to evaluate the influence of initial gap size on treatment decisions in managing acute Achilles tendon complete ruptures. A comprehensive search was conducted across four electronic databases - PubMed, Scopus, Web of Science (WoS), and the Cochrane Library - as well as Google Scholar. Two independent reviewers assessed the methodological quality of each included study using the Newcastle-Ottawa Scale (NOS), with studies classified as poor (0-3 stars), fair (4-6 stars), or good (7-9 stars). Discrepancies between reviewers were resolved by the senior author. Initially, 531 articles were identified; after removing 183 duplicates, 348 articles remained for title and abstract screening. From these, 305 were excluded, resulting in 43 studies selected for full-text assessment. Ultimately, eight studies, encompassing a total of 679 patients, met the specified inclusion and exclusion criteria and were included in the final synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram illustrates the study selection process. Eight studies, encompassing 679 patients, were included. Gap-based treatment protocols were commonly employed, with a threshold of 5-10 mm influencing surgical decision-making. Re-rupture rates were consistently low across both operative and nonoperative groups, with no statistically significant differences reported in most studies. While several studies found no correlation between gap size and the Achilles tendon Total Rupture Score (ATRS), others demonstrated that gaps >5 mm or >10 mm were associated with significantly worse functional outcomes or plantarflexion strength deficits. One study highlighted that the location of the rupture relative to the calcaneal enthesis may better predict long-term strength and fatigue scores than gap size alone. The quality of the included studies varied, with six rated as fair quality and two as good quality; none were classified as poor quality. Larger initial gaps in AATR (especially >5-10 mm) tend to be associated with marginally poorer functional outcomes and a higher risk of re-rupture, though evidence is mixed. Many clinicians, therefore, use a conservative cut-off (<10 mm) when selecting nonoperative treatment. However, patients with large gaps may still do well with modern functional protocols. In decision-making, the tendon gap should be considered alongside patient activity level and preferences. The literature is limited by small cohorts and variable methods; future trials are needed to define optimal gap-based guidelines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,114 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,012 | 0,016 |
| Bibliométrie | 0,008 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».