The recovery after Achilles tendon rupture: a protocol for a multicenter prospective cohort study

BMC Musculoskelet Disord. 2019 Feb 11;20(1):69. doi: 10.1186/s12891-019-2437-z.


Background: Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs. The primary aim of this study is to give a broad insight into the recovery after ATR. Secondarily this study aims to explore factors contributing to recovery and gain insight into the cost-effectiveness of ATR management.

Methods: This multicenter prospective cohort study will include all adult (≥ 18 years) patients with an ATR treated at the three main hospitals in the Northern Netherlands: University Medical Center Groningen, Martini Hospital Groningen and Medical Center Leeuwarden. All subjects will be invited for three visits at 3, 6 and 12 months post-injury. The following data will be collected: patient-reported outcome measures (PROMs), physical tests, imaging and economic questionnaires. At 3 months post-injury personal, injury, and treatment data will be collected through a baseline questionnaire and assessment of the medical file. The PROMs concern the Dutch version of the Achilles Tendon Total Rupture Score, EQ-5D-5 L, Oslo Sport Trauma Research Center Overuse Injury Questionnaire, Injury Psychological Readiness Return to Sport Scale, Tampa Scale of Kinesiophobia, Expectations, Motivation and Satisfaction questionnaire and a ranking of reasons for not returning to sport. The administered physical tests are the heel-rise test, standing dorsiflexion range of motion, resting tendon length and single leg hop for distance. Ultrasound Tissue Characterization will be used for imaging. Finally, economic data will be collected using the Productivity Cost Questionnaire and Medical Consumption Questionnaire.

Discussion: This prospective cohort study will contribute to optimal decision making in the primary treatment and rehabilitation of ATRs by providing insight into (1) ATR recovery (2) novel imaging for monitoring recovery (3) (barriers to) return to sport and (4) cost-effectiveness of management. The analysis of these data strives to give a broad insight into the recovery after ATR as well as provide data on novel imaging and costs, contributing to individualized ATR management.

Trial registration: NTR6484 . 20/06/2017. 20/07/2017.

Keywords: Achilles tendon rupture; Economic; Multicenter; PROM; Prospective cohort; Rehabilitation; Shared-decision making; Ultrasound tissue characterization.

MeSH terms

  • Achilles Tendon / diagnostic imaging
  • Achilles Tendon / injuries*
  • Achilles Tendon / physiopathology
  • Clinical Decision-Making
  • Cost-Benefit Analysis
  • Health Care Costs
  • Humans
  • Multicenter Studies as Topic
  • Netherlands
  • Patient Reported Outcome Measures
  • Patient Satisfaction
  • Physical Examination
  • Predictive Value of Tests
  • Prospective Studies
  • Recovery of Function
  • Research Design*
  • Tendon Injuries / diagnosis
  • Tendon Injuries / economics
  • Tendon Injuries / physiopathology
  • Tendon Injuries / therapy*
  • Time Factors
  • Treatment Outcome