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Nonoperative Dynamic Treatment of Acute Achilles Tendon Rupture: The Influence of Early Weight-Bearing on Clinical Outcome: A Blinded, Randomized Controlled Trial

Barfod, Kristoffer Weisskirchner PhD, MD; Bencke, Jesper MSc, PhD; Lauridsen, Hanne Bloch MSc; Ban, Ilija MD; Ebskov, Lars MD; Troelsen, Anders MD, DMSc, PhD

Journal of Bone & Joint Surgery - American Volume: 17 September 2014 - Volume 96 - Issue 18 - p 1497–1503
doi: 10.2106/JBJS.M.01273
Scientific Articles
Supplementary Content

Background: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early rehabilitation remains unclear. The purpose of this study was to compare immediate weight-bearing with non-weight-bearing in a nonoperative dynamic treatment protocol for Achilles tendon rupture.

Methods: The study was conducted as a blinded, randomized, controlled, parallel superiority trial. Patients eighteen to sixty years of age were eligible for inclusion. Both groups were treated nonoperatively with controlled early motion. The intervention group was allowed full weight-bearing from day one, and the control group was non-weight-bearing for six weeks. The primary outcome was the Achilles tendon Total Rupture Score (ATRS) after one year. Secondary outcomes included heel-rise work, health-related quality of life, and the rerupture rate. Outcome assessors were blinded to the intervention.

Results: Thirty patients were randomized to each group; twenty-nine in the weight-bearing group and twenty-seven in the control group were analyzed. The only significant difference between the groups was better health-related quality of life in the weight-bearing group at twelve months (p = 0.009). The mean ATRS at twelve months was 73 in the weight-bearing group and 74 in the control group (p = 0.81). At twelve months, the total heel-rise work performed by the injured limb relative to that by the uninjured limb was 53% in the weight-bearing group and 58% in the control group (p = 0.37). There were three reruptures in the weight-bearing group and two in the control group (p = 1.0).

Conclusions: The ATRS and heel-rise work results did not differ significantly between the groups. The rerupture rate was 9% overall, and both groups had substantial functional deficits in the injured limb compared with the uninjured limb. Immediate weight-bearing can be recommended as an option in the nonoperative treatment of Achilles tendon rupture.

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

1Gait Analysis Laboratory (J.B. and H.B.L.), Department of Orthopedics (K.W.B., I.B., L.E., and A.T.), Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark. E-mail address for K.W. Barfod:

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