Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures.
BACKGROUND
There is no consensus regarding the optimal treatment for patients with acute Achilles tendon rupture. Few randomized controlled studies have compared outcomes after surgical or nonsurgical treatment with both groups receiving early mobilization.


OBJECTIVE
This study was undertaken to compare outcomes of patients with acute Achilles tendon rupture treated with or without surgery using early mobilization and identical rehabilitation protocols.


METHODS
Randomized, controlled trial; Level of evidence, 1.


METHODS
Ninety-seven patients (79 men, 18 women; mean age, 41 years) with acute Achilles tendon rupture were treated and followed for 1 year. The primary end point was rerupturing. Patients were evaluated using the Achilles tendon Total Rupture Score (ATRS), functional tests, and clinical examination at 6 and 12 months after injury.


RESULTS
There were 6 (12%) reruptures in the nonsurgical group and 2 (4%) in the surgical group (P = .377). The mean 6- and 12-month ATRS were 72 and 88 points in the surgical group and 71 and 86 points in the nonsurgical group, respectively. Improvements in ATRS between 6 and 12 months were significant for both groups, with no significant between-group differences. At the 6-month evaluation, the surgical group had better results compared with the nonsurgically treated group in some of the muscle function tests; however, at the 12-month evaluation there were no differences between the 2 groups except for the heel-rise work test in favor of the surgical group. At the 12-month follow-up, the level of function of the injured leg remained significantly lower than that of the uninjured leg in both groups.


CONCLUSIONS
The results of this study did not demonstrate any statistically significant difference between surgical and nonsurgical treatment. Furthermore, the study suggests that early mobilization is beneficial for patients with acute Achilles tendon rupture whether they are treated surgically or nonsurgically. The preferred treatment strategy for patients with acute Achilles tendon rupture remains a subject of debate. Although the study met the sample size dictated by the authors' a priori power calculation, the difference in the rerupture rate might be considered clinically important by some.
Nilsson-Helander
Katarina
K
Katarina Nilsson-Helander, Department of Orthopaedics, Kungsbacka Hospital, SE-434 40 Kungsbacka, Sweden. ina.nilsson@telia.com
Silbernagel
Karin Grävare
KG
Thomeé
Roland
R
Faxén
Eva
E
Olsson
Nicklas
N
Eriksson
Bengt I
BI
Karlsson
Jon
J
D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D001265:Athletic Injuries / Q000601:surgery* / Q000628:therapy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012421:Rupture / Q000601:surgery / Q000628:therapy; D013647:Task Performance and Analysis; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult