Acute Achilles tendon ruptures: Surgical versus non-surgical treatment using early functional rehabilitation: A randomized controlled study

Abstract

Patients were randomized to surgical or non-surgical treatment for acute Achilles tendon rupture. All patients in both the groups underwent functional [bracing] treatment that includes early weight bearing and early range of motion exercises. The primary outcomes included calf circumference, range of motion, calf muscle strength and functional evaluation by Achilles tendon total rupture [ATRS] score at 6 and 12 months after injury. The secondary outcome is re-rupture rates and other complications.Results: A total of 30 patients [15 patients treated operatively and 15 patients treated non-operatively] were randomized. There were 19 men and 11 women. Mean age 49.5 ± 11.5 years. Re-ruptures occurred in 1 patient [7%] in the surgical group and 2 patients [13%] in the non-surgical group [P=0.368]. The mean ATRS Score at 6 months and 12 months was 74 and 86 in the surgical group and 69 and 84 in the non-surgical group respectively. There was no statistically significant difference between 2 groups with regard to calf circumference ROM, Plantar flexion strength and ATRS Score [p=0.713, p=0.412]. More complications occurred in the operative group, mainly related to wound and soft tissues, compared to non-operative group [15 vs 8].Conclusion: The results of this study demonstrates no significant differences between operative and non-operative functional treatment with regard to re-rupture rates and functional results. Early weight bearing and early ROM exercises are beneficial whether treated by surgical or non-surgical treatment. Addition of functional [Brace] rehabilitation to non-operative treatment avoids wound complications associated with surgery and is a valid alternative to surgical treatment.