Acute Achilles Tendon Ruptures: Efficacy of Conservative and Surgical (Percutaneous, Open) Treatment-A Randomized, Controlled, Clinical Trial

J Foot Ankle Surg. 2019 Nov;58(6):1229-1234. doi: 10.1053/j.jfas.2019.02.002.

Abstract

There is controversy regarding the best treatment for acute ruptures of the Achilles tendon. Multiple treatments present good results in the short and long term, none being superior to the other if a protocol of rehabilitation with full early weightbearing rehabilitation is followed. The objective of this study was to provide evidence on the efficacy and safety of conservative or surgical (percutaneous or open) treatment for acute Achilles tendon rupture. A randomized, controlled, parallel-groups, pilot clinical trial was performed in patients aged ≥18 years who arrived at the emergency room of our center experiencing acute Achilles tendon rupture. Patients were randomized via a computer-generated list to receive 1 of 3 treatments (conservative, percutaneous surgery, or open surgery). All patients followed the same protocol of rehabilitation with early weightbearing. A responder (i.e., successful treatment) was defined as capable of standing heelrise mono- and bipodally for 3 seconds, having a pain score ≤2 (verbal numerical rating scale) after walking, and having returned to active previous life (sport) at 1-year follow-up. From 2014 to 2017, 34 consecutive patients (median age, 41 years [range 18 to 59]; 32 male [94%]) were included: 11 conservative treatment, 11 percutaneous surgery, and 12 open surgery. At 1-year follow-up, the proportion of responders was 100% (11/11, 95% confidence interval [CI] 74% to 100%), 82% (9/11, 95% CI 52% to 95%), and 83% (10/12, 95% CI 55% to 95%), respectively. There was no case of total rerupture. Similar efficacy was found for conservative, percutaneous, and open surgery treatments for acute Achilles tendon rupture at 1-year follow-up with an early weightbearing rehabilitation program.

Keywords: acute Achilles tendon rupture; conservative treatment; early weightbearing rehabilitation program; surgical treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Achilles Tendon / diagnostic imaging
  • Achilles Tendon / surgery*
  • Adolescent
  • Adult
  • Casts, Surgical
  • Conservative Treatment
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Pain Measurement
  • Physical Therapy Modalities
  • Pilot Projects
  • Return to Sport
  • Rupture / therapy*
  • Suture Techniques
  • Sutures
  • Tendon Injuries / therapy
  • Ultrasonography
  • Young Adult