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Sex Differences in Outcome After an Acute Achilles Tendon Rupture
BACKGROUND: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. PURPOSE: To evaluate whether there are any differences in outcome between the sexes by combining the...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622365/ https://www.ncbi.nlm.nih.gov/pubmed/26665094 http://dx.doi.org/10.1177/2325967115586768 |
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author | Grävare Silbernagel, Karin Brorsson, Annelie Olsson, Nicklas Eriksson, Bengt I. Karlsson, Jon Nilsson-Helander, Katarina |
author_facet | Grävare Silbernagel, Karin Brorsson, Annelie Olsson, Nicklas Eriksson, Bengt I. Karlsson, Jon Nilsson-Helander, Katarina |
author_sort | Grävare Silbernagel, Karin |
collection | PubMed |
description | BACKGROUND: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. PURPOSE: To evaluate whether there are any differences in outcome between the sexes by combining the data from 2 large randomized controlled trials that used identical outcome measures. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Included in the evaluation were patients from 2 consecutive randomized controlled trials comparing surgical and nonsurgical treatment performed at our research laboratory. Patients who had a rerupture were excluded from analysis. A total of 182 patients (152 males, 30 females), with mean ± SD age of 40 ± 11 years, were included; 94 (76 males, 18 females) were treated with surgery and 88 (76 males, 12 females) nonsurgically. Patient-reported outcome was evaluated using the Achilles tendon Total Rupture Score (ATRS), and the functional outcome was measured with a heel-rise test (measurement of muscular endurance and heel-rise height) at 6 and 12 months after injury. RESULTS: Male patients had a greater improvement in heel-rise height at 12 months (P = .004). When each treatment group was analyzed separately, it was found that female patients had significantly (P < .03) more symptoms after surgical treatment (mean ± SD ATRS, 59 ± 24) compared with males at 6 (73 ± 19) and 12 months (74 ± 27 vs 86.5 ± 17). This sex difference was not found in the nonsurgical treatment group. For the entire group, there were no significant differences between treatments on ATRS at 6 and 12 months. The surgical group had significantly better results compared with the nonsurgical group in heel-rise endurance at 6 and 12 months and in heel-rise height recovery at 6 months (P < .03 for both). CONCLUSION: Sex differences were demonstrated, and female patients had a greater degree of deficit in heel-rise height as compared with males, irrespective of treatment. Females had more symptoms after surgery both at 6 and 12 months, but this difference was not found when treated nonsurgically. CLINICAL RELEVANCE: Further research is needed to determine whether women will benefit more from nonsurgical compared with surgical treatment after an Achilles tendon rupture. |
format | Online Article Text |
id | pubmed-4622365 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-46223652015-12-10 Sex Differences in Outcome After an Acute Achilles Tendon Rupture Grävare Silbernagel, Karin Brorsson, Annelie Olsson, Nicklas Eriksson, Bengt I. Karlsson, Jon Nilsson-Helander, Katarina Orthop J Sports Med 40 BACKGROUND: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. PURPOSE: To evaluate whether there are any differences in outcome between the sexes by combining the data from 2 large randomized controlled trials that used identical outcome measures. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Included in the evaluation were patients from 2 consecutive randomized controlled trials comparing surgical and nonsurgical treatment performed at our research laboratory. Patients who had a rerupture were excluded from analysis. A total of 182 patients (152 males, 30 females), with mean ± SD age of 40 ± 11 years, were included; 94 (76 males, 18 females) were treated with surgery and 88 (76 males, 12 females) nonsurgically. Patient-reported outcome was evaluated using the Achilles tendon Total Rupture Score (ATRS), and the functional outcome was measured with a heel-rise test (measurement of muscular endurance and heel-rise height) at 6 and 12 months after injury. RESULTS: Male patients had a greater improvement in heel-rise height at 12 months (P = .004). When each treatment group was analyzed separately, it was found that female patients had significantly (P < .03) more symptoms after surgical treatment (mean ± SD ATRS, 59 ± 24) compared with males at 6 (73 ± 19) and 12 months (74 ± 27 vs 86.5 ± 17). This sex difference was not found in the nonsurgical treatment group. For the entire group, there were no significant differences between treatments on ATRS at 6 and 12 months. The surgical group had significantly better results compared with the nonsurgical group in heel-rise endurance at 6 and 12 months and in heel-rise height recovery at 6 months (P < .03 for both). CONCLUSION: Sex differences were demonstrated, and female patients had a greater degree of deficit in heel-rise height as compared with males, irrespective of treatment. Females had more symptoms after surgery both at 6 and 12 months, but this difference was not found when treated nonsurgically. CLINICAL RELEVANCE: Further research is needed to determine whether women will benefit more from nonsurgical compared with surgical treatment after an Achilles tendon rupture. SAGE Publications 2015-05-29 /pmc/articles/PMC4622365/ /pubmed/26665094 http://dx.doi.org/10.1177/2325967115586768 Text en © The Author(s) 2015 http://creativecommons.org/licenses/by-nc-nd/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm). |
spellingShingle | 40 Grävare Silbernagel, Karin Brorsson, Annelie Olsson, Nicklas Eriksson, Bengt I. Karlsson, Jon Nilsson-Helander, Katarina Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title | Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title_full | Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title_fullStr | Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title_full_unstemmed | Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title_short | Sex Differences in Outcome After an Acute Achilles Tendon Rupture |
title_sort | sex differences in outcome after an acute achilles tendon rupture |
topic | 40 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622365/ https://www.ncbi.nlm.nih.gov/pubmed/26665094 http://dx.doi.org/10.1177/2325967115586768 |
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