Randomized Controlled Trial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2024; 15(12): 1191-1199
Published online Dec 18, 2024. doi: 10.5312/wjo.v15.i12.1191
Enhanced recovery after surgery protocols for minimally invasive treatment of Achilles tendon rupture: Prospective single-center randomized study
Xiu-Jie Yan, Wei-Hong Zhang
Xiu-Jie Yan, Wei-Hong Zhang, School of Health and Nursing, Zhengzhou University, Zhengzhou 450000, Henan Province, China
Author contributions: Yan XJ wrote the manuscript; Zhang WH reviewed the manuscript; Both authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Third Medical Center, PLA General Hospital.
Clinical trial registration statement: The study did not undergo clinical trial registration as required by the regulations and journal guidelines.
Informed consent statement: Written informed consent was obtained from the patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: In accordance with the guidelines for data sharing, the data generated and analyzed during this study will be made available to interested researchers at 18638127788@163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Hong Zhang, MD, PhD, Professor, School of Health and Nursing, Zhengzhou University, No. 100 Science Avenue, Zhengzhou 450000, Henan Province, China. 18638127788@163.com
Received: August 18, 2024
Revised: September 27, 2024
Accepted: October 21, 2024
Published online: December 18, 2024
Processing time: 121 Days and 17.6 Hours
Abstract
BACKGROUND

Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation.

AIM

To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators.

METHODS

This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design.

RESULTS

All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 vs 18.88, P < 0.0001), quality of life score (53.25 vs 38.99, P < 0.0001), and Barthel index (70.44 vs 51.63, P < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% vs 10.00%, P = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% vs 11.25%, P = 0.0564). Hospital stay (5.40 days vs 7.26 days, P < 0.0001) and postoperative bed rest (3.34 days vs 5.42 days, P < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group vs 87.50% in the control group (P = 0.0031).

CONCLUSION

The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

Keywords: Achilles tendon rupture; Minimally invasive surgery; Perioperative period; Rapid rehabilitation; Orthopedic surgery

Core Tip: This study highlighted the substantial benefits of implementing a nursing-led rapid rehabilitation program for patients undergoing minimally invasive Achilles tendon repair. By integrating rapid rehabilitation strategies, patients experienced faster recovery, reduced pain, shorter hospital stays, and lower complication rates. The program not only improved functional outcomes and quality of life but also enhanced patient satisfaction and adherence to rehabilitation protocols. This approach provides valuable evidence supporting its adoption as a standard practice for optimizing postoperative care and recovery.