Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study

Am J Sports Med. 2013 Dec;41(12):2867-76. doi: 10.1177/0363546513503282. Epub 2013 Sep 6.


Background: The optimal treatment for acute Achilles tendon ruptures is still a subject of debate. Early loading of the tendon is a factor that has been shown to be beneficial to recovery and to minimize complications. The main outcome of previous studies has been complications such as reruptures and deep infections, without focusing on the functional outcome relevant to the majority of patients who do not experience these complications.

Purpose: To evaluate whether stable surgical repair and early loading of the tendon could improve patient-reported outcome and function after an acute Achilles tendon rupture.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 100 patients (86 men, 14 women; mean age, 40 years) with an acute total Achilles tendon rupture were randomized to either surgical treatment, including an accelerated rehabilitation protocol, or nonsurgical treatment. The primary outcome was the Achilles tendon Total Rupture Score (ATRS). The patients were evaluated at 3, 6, and 12 months for symptoms, physical activity level, and function.

Results: There were no significant differences between the groups in terms of symptoms, physical activity level, or quality of life. There was a trend toward improved function in surgically treated patients; the results were significantly superior when assessed by the drop countermovement jump (95% CI, 0.03-0.15; P = .003) and hopping (95% CI, 0.01-0.33; P = .040). No reruptures occurred in the surgical group, while there were 5 in the nonsurgical group (P = .06). There were 6 superficial infections in the surgically treated group; however, these superficial infections had no bearing on the final outcome. Symptoms, reduced quality of life, and functional deficits still existed 12 months after injury on the injured side in both groups.

Conclusion: The results of the present study demonstrate that stable surgical repair with accelerated tendon loading could be performed in all (n = 49) patients without reruptures and major soft tissue-related complications. However, this treatment was not significantly superior to nonsurgical treatment in terms of functional results, physical activity, or quality of life.

Keywords: ATRS; Achilles tendon Total Rupture Score; Achilles tendon rupture; EQ-5D; FAOS; Foot and Ankle Outcome Score; functional evaluation; heel-rise test; physical activity level; rerupture.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achilles Tendon / injuries*
  • Activities of Daily Living
  • Adult
  • Aged
  • Female
  • Humans
  • Incidence
  • Infections / epidemiology
  • Infections / etiology
  • Leg Injuries / rehabilitation
  • Leg Injuries / surgery
  • Leg Injuries / therapy*
  • Male
  • Middle Aged
  • Movement*
  • Quality of Life
  • Recovery of Function
  • Rupture / rehabilitation
  • Rupture / surgery
  • Rupture / therapy*
  • Self Report
  • Tendon Injuries / rehabilitation
  • Tendon Injuries / surgery
  • Tendon Injuries / therapy*
  • Treatment Outcome
  • Weight-Bearing*
  • Young Adult