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Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Randomized Controlled Trial

Young, Simon W. FRACS; Patel, Alpesh FRACS; Zhu, Mark MBChB; van Dijck, Stephanie FRACS; McNair, Peter PhD, PT; Bevan, Wesley P. FRACS; Tomlinson, Matthew FRACS

Journal of Bone & Joint Surgery - American Volume: 2 July 2014 - Volume 96 - Issue 13 - p 1073–1079
doi: 10.2106/JBJS.M.00248
Scientific Articles
Supplementary Content

Background: The rate of Achilles tendon ruptures is increasing, but there is a lack of consensus on treatment of acute injuries. The purpose of this trial was to compare outcomes of weight-bearing casts with those of traditional casts in the treatment of acute Achilles tendon ruptures.

Methods: Eighty-four patients with an acute Achilles tendon rupture were recruited over a two-year period. Patients were randomized to be treated with either a weight-bearing cast with a Böhler iron or a non-weight-bearing cast for eight weeks. Patients underwent muscle dynamometry testing at six months, with additional follow-up at one and two years. The primary outcomes that were assessed were the rerupture rate and the time taken to return to work. Secondary outcomes included return to sports, ankle pain and stiffness, footwear restrictions, and patient satisfaction.

Results: There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at two years, one (3%) of the thirty-seven patients in the weight-bearing group and two (5%) of the thirty-seven in the non-weight-bearing group had sustained a rerupture (p = 0.62). The patients in the weight-bearing group experienced less subjective stiffness at one year. There were no significant differences in time taken to return to work, Leppilahti scores, patient satisfaction, pain, or return to sports between the groups.

Conclusions: Use of weight-bearing casts for the nonoperative treatment of Achilles tendon ruptures appears to offer outcomes that are at least equivalent to those of non-weight-bearing casts. The overall rerupture rate in this study was low, supporting the continued use of initial nonoperative management for the treatment of acute Achilles tendon ruptures.

Levels of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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2Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand

3University of Auckland School of Medicine, 85 Park Road, Grafton 1023, Auckland, New Zealand

4Health & Rehabilitation Research Centre, AUT University, 55 Wellesley Street East, Central Auckland 1010, Auckland, New Zealand

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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