117.
What treatment of acute Achilles tendon rupture is offered in the
Nordic countries?
Kristoffer W. Barfod, Fredrik Nilsen, Katarina Nilsson Helander, Ville M.
Mattila, Ola Tingby, Anders Troelsen
Ortopaedics Hvidovre Hospital, Denmark; Ortopaedics, Varberg Hospital,
Sweden; Ortopaedics, Kungsbacka Hospital, Sweden; Ortopaedics, Tampere
University hospital, Finland; Ortopaedics, Notodden Hospital, Norway;
Ortopaedics, Hvidovre Hospital, Denmark
Background:
The best treatment of acute Achilles tendon rupture has been
discussed for decades, but no consensus has been reached. During the past half
decade a number of randomised controlled trials have generally favored non-
surgical treatment and dynamic rehabilitation. Uniform adherence to evidence
based treatment algorithms would be desirable, but it is our hypothesis that the
offered treatments shows great variation across departments in the Nordic
countries.
Purpose / Aim of Study:
To investigate how acute Achilles tendon rupture is
treated in the Nordic countries and identify possible regional differences.
Materials and Methods:
A questionnaire was distributed to all orthopaedic
departments treating acute traumatology in Denmark (DK), Sweden (S),
Norway (N) and Finland (F). The questionnaire was returned by 122 of 155
departments (response rate:81%). Two-way tables with Fisher’s exact test was
used.
Findings / Results:
In DK, N and S significantly more hospitals recommend
surgical treatment compared to F (P<0.0001). DK 83% (19/23), N 93%
(28/30),
S 65% (26/40) and F 30% (8/27). Dynamic rehabilitation is used
significantly less in DK and S (P=0.006). DK 27% (6/22), N 58% (15/26), S
30% (12/40)
and F 65% (17/26). There is significant difference between
countries in the educational level of performing surgeons (P<0.0001).
Hospitals where surgery is performed by a specialist: DK 22% (5/23), N 26%
(8/31),
S 73% (29/40) and F 41% (11/27).
Conclusions:
Surgical treatment seems to be the treatment of choice in
Danish, Norwegian and Swedish hospitals regardless of increasing evidence
favoring non-surgical treatment. Despite clinical evidence of superiority of
dynamic rehabilitation it is used in less than half of hospitals in DK and S. As
hypothesized treatment algorithms shows considerable variation and do not
adhere to clinical evidence.
