title: Prospective Use of a Standardized Nonoperative Early Weightbearing Protocol for Achilles Tendon Rupture: 17 Years of Experience.
abstract: BACKGROUND
  Acute traumatic rupture of the Achilles tendon can be treated operatively or nonoperatively. Throughout the literature, there is no consensus regarding the optimal treatment protocol.
  
  
  OBJECTIVE
  To report on 17 years of experience with treating this injury with a standardized nonoperative treatment protocol.
  
  
  METHODS
  Case Series; Level of evidence, 4.
  
  
  METHODS
  The treatment protocol was based on a combination of an equinus cast and rehabilitation boot, which promoted immediate full weightbearing and early functional rehabilitation. A total of 171 patients were consecutively treated and prospectively followed from 1996 to 2013. Assessed were subjective parameters such as pain, loss of strength, return to previous activity level, meteosensitivity, and general satisfaction with the treatment outcome. Clinical assessment included testing of plantar flexion strength and endurance, calf circumference, and tendon length. Subjective and clinical parameters were then used to calculate a modified Thermann score. The correlation between tendon lengthening and function was calculated using the Pearson correlation coefficient.
  
  
  RESULTS
  A total of 114 patients were followed for a minimum of 12 months (mean, 27 ± 20 months; range, 12-88 months). The mean Thermann score was 82 ± 13 (range, 41-100), and subjective satisfaction was rated "very good" and "good" in 90%. An inverse correlation was found between tendon length and muscle strength (R = -0.3). There were 11 reruptures (8 with and 3 without an adequate trauma). General complications were 5 deep venous thromboses, 1 complex regional pain syndrome, and minor problems such as transient heel pain (n = 3), heel numbness (n = 1), and cast-associated skin abrasions (n = 4).
  
  
  CONCLUSIONS
  Seventeen years of experience with a nonoperative treatment protocol for acute rupture of the Achilles tendon confirmed good functional outcome and patient satisfaction. Reruptures mostly occurred with new traumatic events in the vulnerable phase from 6 to 12 weeks after the initial injury. Muscle strength correlated to tendon length, making its assessment a crucial follow-up parameter. The protective equinus cast and boot can protect against excessive tendon lengthening during the healing process.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland.
authors.forename: Timo M
authors.initials: TM
authors.lastname: Ecker
authors.affiliation: Department of Orthopaedic Surgery, Siloah Hospital, Bern, Switzerland.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Bremer
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland.
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Müller
authors.affiliation: Department of Orthopaedic Surgery, Siloah Hospital, Bern, Switzerland martin.weber@siloah.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D061826:Foot Orthoses; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013708:Tendon Injuries / Q000628:therapy*; D016474:Weight-Bearing / Q000502:physiology*
keywords: Achilles tendon; biology of tendon; foot; rupture