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Early weight-bearing in nonoperative treatment of acute Achilles tendon rupture did not influence mid-term outcome: a blinded, randomised controlled trial

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Acute Achilles tendon rupture leads to impaired outcome at short term, but little is known concerning medium-term results. The aim of the present study was to investigate the influence of early weight-bearing on clinical outcome 4.5 years after nonoperative treatment of acute Achilles tendon rupture.

Method

The study was performed as a medium-term follow-up on patients included in a randomised controlled trial. Both groups were treated with nonoperative management and controlled early motion. The intervention group was allowed full weight-bearing from day 1, and the control group was non-weight-bearing for 6 weeks. 60 patients were randomised 1:1. Of those, 56 were eligible for inclusion in the medium-term follow-up and 37 participated (18 control, 19 intervention). The outcomes were Achilles tendon Total Rupture Score (ATRS) and heel raise work performed at an average of 4.5 years after the initial injury. Statistical analysis was performed using paired t tests and linear regression.

Results

No differences were found between control and intervention groups at 4.5 years. ATRS scores consistently improved in both the intervention and the control groups from 0.5 to 1 year and from 1 to 4.5 years, ending up at 80.5 on average after 4.5 years. Heel raise height kept improving from 0.5 to 4.5 years, reaching a limb symmetry index of 82.4%. The heel raise work improvement from 0.5 to 1 year did not continue. No significant change was found from 1 to 4.5 years, ending at a limb symmetry index of 60%.

Conclusion

Early weight-bearing did not influence outcome 4.5 years after nonoperative treatment of acute Achilles tendon rupture. The calf muscle of the injured limb performs 40% less work, when compared to the healthy limb, though lifting height recovers better.

Level of evidence

II.

Clinical trials identifier

NCT02760784.

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Abbreviations

ATRS:

Achilles Tendon Total Rupture Score

ATR:

Achilles tendon rupture

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Acknowledgements

Special thanks to Thomas Kallemose statistician at the research department of Copenhagen University Hospital, Hvidovre, Denmark.

Funding

The study was funded by Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark, with no external funding, or involvement.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark

    Rasmus Kastoft, Jeannette Ø. Penny & Kristoffer Barfod

  2. Department of Orthopedic Surgery, Copenhagen University Hospital, Laboratory of Human Movement Analysis, Hvidovre, Denmark

    Jesper Bencke & Merete B. Speedtsberg

Authors
  1. Rasmus Kastoft
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  2. Jesper Bencke
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  3. Merete B. Speedtsberg
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  4. Jeannette Ø. Penny
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  5. Kristoffer Barfod
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Corresponding author

Correspondence to Rasmus Kastoft.

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Conflict of interest

Except for the following, no authors have anything to declare. Kristoffer Barfod: None related to the present study. Project support and travel support from DJO.

Ethical approval

Local ethics committee reference number: 16015461.

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Kastoft, R., Bencke, J., Speedtsberg, M.B. et al. Early weight-bearing in nonoperative treatment of acute Achilles tendon rupture did not influence mid-term outcome: a blinded, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 27, 2781–2788 (2019). https://doi.org/10.1007/s00167-018-5058-4

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  • DOI: https://doi.org/10.1007/s00167-018-5058-4

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