Search

The incidence of Achilles tendon (AT) rupture, especially nonsport‐related rupture, is increasing, while the reasons for this increase are largely unknown. The association between the AT rupture and the use of various drug treatments was studied. We collected AT rupture patients from the Finnish Hospital Discharge Register. We also acquired information about all the doctor‐prescribed drugs they had purchased within 1 year before the rupture. For comparison, we randomly selected age‐ and sex‐matched controls from the Finnish Population Register. There were 1118 AT rupture patients. Several drug groups had a statistically significant association with the AT rupture. Our study confirmed an association between fluoroquinolone antibiotics and AT rupture (OR 2.20, P = 0.005). A statistically significant association of renin‐angiotensin II receptor antagonists with tendon rupture (OR 7.59, P = 0.003) was a previously unreported finding. The increasing incidence of AT rupture, especially in middle‐aged and elderly patients, might partially be a consequence of the increased use of certain drug treatments. Some associations are probably explained by the symptomatic treatment of the painful tendon before the rupture. [ABSTRACT FROM AUTHOR]

Background: It remains controversial whether nonsurgical or surgical treatment provides better calf muscle strength recovery after an acute Achilles tendon rupture (ATR). Recent evidence has suggested that surgery might surpass nonsurgical treatment in restoring strength after an ATR. Purpose: To assess whether magnetic resonance imaging (MRI) findings could explain calf muscle strength deficits and the difference between nonsurgical and surgical treatments in restoring calf muscle strength. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From 2009 to 2013, 60 patients with acute ATRs were randomized to surgery or nonsurgical treatment with an identical rehabilitation protocol. The primary outcome measure was the volume of calf muscles assessed using MRI at 3 and 18 months. The secondary outcome measures included fatty degeneration of the calf muscles and length of the affected Achilles tendon. Additionally, isokinetic plantarflexion strength was measured in both legs. Results: At 3 months, the study groups showed no differences in muscle volumes or fatty degeneration. However, at 18 months, the mean differences between affected and healthy soleus muscle volumes were 83.2 cm3 (17.7%) after surgery and 115.5 cm3 (24.8%) after nonsurgical treatment (difference between means, 33.1 cm3; 95% CI, 1.3-65.0; P = .042). The study groups were not substantially different in the volumes or fatty degeneration of other muscles. From 3 to 18 months, compensatory hypertrophy was detected in the flexor hallucis longus (FHL) and deep flexors in both groups. In the nonsurgical treatment group, the mean difference between affected and healthy FHL muscle volumes was −9.3 cm3 (12%) and in the surgical treatment group was −8.4 cm3 (10%) (P ≤ .001). At 18 months, Achilles tendons were, on average, 19 mm longer in patients treated nonsurgically compared with patients treated surgically (P < .001). At 18 months, surgically treated patients demonstrated 10% to 18% greater strength results (P = .037). Calf muscle isokinetic strength deficits for the entire range of ankle motion correlated with soleus atrophy (ρ = 0.449-0.611; P < .001). Conclusion: Treating ATRs nonsurgically with a functional rehabilitation protocol resulted in greater soleus muscle atrophy compared with surgical treatment. The mean Achilles tendon length was 19 mm longer after nonsurgical treatment than after the surgical treatment of ATRs. These structural changes partly explained the 10% to 18% greater calf muscle strength observed in patients treated with surgery compared with those treated nonsurgically. Registration: NCT02012803 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: The optimal treatment of acute Achilles tendon ruptures for active patients is under debate. Purpose: To compare clinical outcomes and calf muscle strength recovery after the nonsurgical treatment and open surgical repair of acute Achilles tendon ruptures with identical accelerated rehabilitation programs. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From 2009 to 2013, a total of 60 patients with an acute Achilles tendon rupture were randomized to surgery or nonsurgical treatment. Nonsurgical treatment included first a week of cast immobilization, followed by a functional orthosis for 6 weeks, allowing full weightbearing after week 1 and active plantar flexion after week 5. Surgery was simple end-to-end open repair, and postoperative treatment was identical to nonsurgical treatment. Outcome measures included the Leppilahti Achilles tendon performance score, isokinetic calf muscle strength, and RAND 36-Item Health Survey at 18-month follow-up. Results: At 18-month follow-up, the mean Leppilahti score was 79.5 and 75.7 for the surgically and nonsurgically treated groups, respectively (mean difference, 3.8; 95% CI, –1.9 to 9.5; P = .19). Angle-specific peak torque results of affected legs showed that surgery resulted in faster and better recovery of calf muscle strength over the entire range of motion of the ankle joint: at 6 months, the difference varied from 16% to 24% (P = .016), favoring the surgically treated group, whereas at 18 months, surgically treated patients had 10% to 18% greater strength results (P = .037). At 18 months, a 14% difference in the peak torque of the affected leg favored the surgical group versus the nonsurgical group (mean peak torque, 110.3 vs 96.5 N·m, respectively; mean difference, 13.6 N·m; 95% CI, 2.0-25.1 N·m; P = .022). The RAND 36-Item Health Survey indicated better results in the domains of physical functioning (P = .006) and bodily pain (P = .037) for surgically treated patients. Conclusion: Surgical and nonsurgical treatments of acute Achilles tendon ruptures have similar results in terms of the Achilles tendon performance score, but surgery restores calf muscle strength earlier over the entire range of motion of the ankle joint, with a 10% to 18% strength difference favoring surgery at 18 months. Surgery may also result in better health-related quality of life in the domains of physical functioning and bodily pain compared with nonsurgical treatment. Registration: NCT02012803 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Examines the interval between last hospitalization and the suicide of psychiatric patients treated for physical illness in northern Finland. Exhibition of increased suicide risk among psychiatric patients shortly after hospitalization; Survey of information pertaining to suicides over a period of thirteen years; Survival time for psychiatric patients with history of hospitalization.