title: Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Randomized Controlled Trial.
abstract: BACKGROUND
  The rate of Achilles tendon ruptures is increasing, but there is a lack of consensus on treatment of acute injuries. The purpose of this trial was to compare outcomes of weight-bearing casts with those of traditional casts in the treatment of acute Achilles tendon ruptures.
  
  
  METHODS
  Eighty-four patients with an acute Achilles tendon rupture were recruited over a two-year period. Patients were randomized to be treated with either a weight-bearing cast with a Böhler iron or a non-weight-bearing cast for eight weeks. Patients underwent muscle dynamometry testing at six months, with additional follow-up at one and two years. The primary outcomes that were assessed were the rerupture rate and the time taken to return to work. Secondary outcomes included return to sports, ankle pain and stiffness, footwear restrictions, and patient satisfaction.
  
  
  RESULTS
  There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at two years, one (3%) of the thirty-seven patients in the weight-bearing group and two (5%) of the thirty-seven in the non-weight-bearing group had sustained a rerupture (p = 0.62). The patients in the weight-bearing group experienced less subjective stiffness at one year. There were no significant differences in time taken to return to work, Leppilahti scores, patient satisfaction, pain, or return to sports between the groups.
  
  
  CONCLUSIONS
  Use of weight-bearing casts for the nonoperative treatment of Achilles tendon ruptures appears to offer outcomes that are at least equivalent to those of non-weight-bearing casts. The overall rerupture rate in this study was low, supporting the continued use of initial nonoperative management for the treatment of acute Achilles tendon ruptures.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 836 Peary Lane, Foster City, San Mateo, CA 94404. E-mail address: simonwyoung@gmail.com.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Young
authors.affiliation: Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Patel
authors.affiliation: University of Auckland School of Medicine, 85 Park Road, Grafton 1023, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand.
authors.forename: Stephanie
authors.initials: S
authors.lastname: van Dijck
authors.affiliation: Health & Rehabilitation Research Centre, AUT University, 55 Wellesley Street East, Central Auckland 1010, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: McNair
authors.affiliation: Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand.
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Bevan
authors.affiliation: Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tomlinson
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D001265:Athletic Injuries / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D017060:Patient Satisfaction; D020127:Recovery of Function; D012421:Rupture / Q000628:therapy; D013708:Tendon Injuries / Q000628:therapy*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology*