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. 2019 Sep;27(9):2781-2788. doi: 10.1007/s00167-018-5058-4. Epub 2018 Jul 20.


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.

Keywords: ATRS; Achilles Tendon Total Rupture Score; Achilles tendon rupture; Conservative; Early weight-bearing; Heel raise height; Heel raise work; Nonoperative.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Achilles Tendon / injuries*
  • Acute Disease
  • Adult
  • Female
  • Follow-Up Studies
  • Heel
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / physiology
  • Recovery of Function*
  • Rupture / surgery*
  • Tendon Injuries / therapy*
  • Treatment Outcome
  • Weight-Bearing*

Associated data

  • ClinicalTrials.gov/NCT02760784