Young, J Bone Joint Surg Am 2014 - Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures

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Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures

Young, Tomlinson, et al.·J Bone Joint Surg Am·2014·74 citations·RCT

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

84 patients with an acute Achilles tendon rupture were recruited over a 2-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 8 weeks.
Patients underwent muscle dynamometry testing at 6 months, with additional follow-up at one and 2 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 2 years, one (3%) of the 37 patients in the weight-bearing group and 2 (5%) of the 37 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.

Level of evidence: Therapeutic Level I. Copyright remains with the authors and publisher.

Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures

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Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures

Young, Tomlinson, et al.·J Bone Joint Surg Am·2014·74 citations·RCT

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

84 patients with an acute Achilles tendon rupture were recruited over a 2-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 8 weeks.
Patients underwent muscle dynamometry testing at 6 months, with additional follow-up at one and 2 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 2 years, one (3%) of the 37 patients in the weight-bearing group and 2 (5%) of the 37 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.

Level of evidence: Therapeutic Level I. Copyright remains with the authors and publisher.

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