Operative versus nonoperative treatment of acute Achilles tendon ruptures: a quantitative review.

OBJECTIVE: To determine the optimal treatment of acute Achilles tendon ruptures. DATA SOURCES: A comprehensive search for all of the English articles published between 1959 and 1997. STUDY SELECTION: All of the articles were reviewed independently by at least three of the four authors to decide on eligibility based on predetermined criteria. Disagreements were discussed and then settled, if necessary, by a majority vote. DATA EXTRACTION: Eligible studies were reviewed independently, and data were extracted by using standardized coding forms. Inconsistencies in data extraction were settled by discussion and majority vote. The main outcomes extracted were strength, time to return to work, frequency of return to sports, rerupture rate, and complications. Complications were divided into major, moderate, and minor categories. DATA SYNTHESIS: The overall rerupture rate was 2.8% for operatively treated and 11.7% for nonoperatively treated patients (p < 0.001). The rate of minor and moderate complications in operatively treated patients was 20 times that of nonoperatively treated patients. The difference in rates for major complications was not statistically significant. CONCLUSIONS: Although operative treatment provides a reduced rerupture rate compared with nonoperative treatment, the minor and moderate complication rate of operative treatment is 20 times greater. Treatment should be individualized to the concerns and health of the patient. Future clinical trials are necessary to determine the optimal method of both operative and conservative treatment.

"Bedside" test of static rear stability of occupied wheelchairs.

The assessment of static stability can be helpful in wheelchair prescription and adjustment, but ordinarily requires a tipping platform. We developed a simple "bedside" test of rear wheelchair stability, using a goniometer and a plumb line. The angle of the wheelchair handle while the occupied wheelchair was on a level surface was subtracted from the angle measured while the occupied chair was balanced over the rear axle. The intraobserver and interobserver reliability and the validity in comparison with platform testing were assessed by studying 30 patient-occupied wheelchairs. There was a high correlation (r = 0.93, p less than 0.001) between the values obtained from the beside and platform tests and no significant difference between them. Intraobserver and interobserver reliabilities were 0.87 (p less than 0.001) and 0.94 (p less than 0.001). There was no significant difference between the first and second test values done by a single observer; the mean difference (+/- 1SD) between observers, 1.3 degrees (+/- 1.6 degrees), was small but statistically significant. The bedside test is simple, reliable, valid, and suitable for use as a screening test for the platform assessment of rear stability.