title: Major functional deficits persist 2 years after acute Achilles tendon rupture.
abstract: OBJECTIVE
  The purpose of this prospective randomized controlled study was to evaluate the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically. The focus was to evaluate whether any improvements occurred between the one and 2-year evaluation.
  
  
  METHODS
  Eighty-one patients (67 men, 14 women) with a mean (SD) age of 42 (9.1) were included in this study. Forty-two patients were treated surgically, and 39 treated non-surgically otherwise the treatment was identical for the two groups. All patients were evaluated using the Achilles tendon Total Rupture Score (ATRS), the Physical Activity Scale (PAS) and validated functional tests one and 2 years after injury.
  
  
  RESULTS
  There were significant functional deficits on the injured side compared with the contralateral side 2 years after Achilles tendon rupture, regardless of treatment. Only minor improvements, even though statistically significant, occurred between the 1- and 2-year evaluations. The physical activity level remained significantly reduced as compared with prior to injury, but the ATRS mean was relatively high in both groups (89 and 90).
  
  
  CONCLUSIONS
  This long-term follow-up indicates that the majority of patients with an Achilles tendon rupture have not fully recovered (in regards to symptoms, physical activity level and function) 2 years after injury regardless of surgical or non-surgical treatment. Furthermore, only minor improvements occur between the 1- and 2-year evaluations. This indicates that to enhance the final outcome the focus should be on improvements in treatment within the first year. The patients appear to have adjusted to their impairments since the patient-reported outcome is relatively high in spite of functional deficits and lower activity level compared with pre-injury.
  
  
  METHODS
  Prospective randomized study, Level I.
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden. nicklas.olsson@gu.se
authors.forename: Nicklas
authors.initials: N
authors.lastname: Olsson
authors.forename: Katarina
authors.initials: K
authors.lastname: Nilsson-Helander
authors.forename: Jón
authors.initials: J
authors.lastname: Karlsson
authors.forename: Bengt I
authors.initials: BI
authors.lastname: Eriksson
authors.forename: Roland
authors.initials: R
authors.lastname: Thomée
authors.forename: Eva
authors.initials: E
authors.lastname: Faxén
authors.forename: Karin Grävare
authors.initials: KG
authors.lastname: Silbernagel
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012421:Rupture / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult