Early weight-bearing in nonoperative treatment of acute Achilles tendon rupture did not influence mid-term outcome: a blinded, randomised controlled trial

Kastoft, Rasmus; Bencke, Jesper; Speedtsberg, Merete B; Penny, Jeannette Østergaard; Barfod, Kristoffer Weisskirchner

doi:10.1007/s00167-018-5058-4

Cited by 28 publications

(40 citation statements)

References 31 publications

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“…Acute Achilles tendon rupture poses a substantial socioeconomic burden,1 affecting work-active adults and with an incidence of 20–32 per 100 000 per year 2 3. Results of treatment are unsatisfactory, as one out of three patients end up with poor outcome after treatment4 5 and the deficits persist for many years 6…”

Section: Introductionmentioning

confidence: 99%

Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomised controlled trial

et al. 2019

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BackgroundEarly controlled motion (ECM) of the ankle is widely used in the non-operative treatment of acute Achilles tendon rupture, although its safety and efficacy have not been investigated properly in a randomised set-up.Purpose/Aim of the studyTo investigate if ECM of the ankle was superior to immobilisation in the treatment of acute Achilles tendon rupture.Materials and methodsThis was an assessor-blinded, randomised controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18–70 years were eligible for inclusion. The ECM group performed movements of the ankle five times a day from week 3 to week 8 after rupture. The control group was immobilised for 8 weeks. The primary outcome was the Achilles tendon Total Rupture Score (ATRS) evaluated at 1-year postinjury. The secondary outcomes were heel-rise work test (HRW), Achilles tendon elongation and rate of rerupture. Analysis was conducted as intention-to-treat using inverse probability weighting.Findings/Results189 patients were assessed for eligibility and 130 were included from February 2014 to December 2016. There were 64 patients in the ECM group and 58 in the immobilisation group. There were no statistically significant differences (p>0.3) between the ECM and the immobilisation groups at 1 year: mean (SD) ATRS was 74 (18) and 75 (18), respectively. HRW was 60% (21) and 60% (21) of the uninjured limb, and elongation was 18 mm (13) and 16 mm (11), respectively. Correspondingly, there were six and seven reruptures.ConclusionsECM revealed no benefit compared with immobilisation in any of the investigated outcomes.Trial registration numberNCT02015364

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Section: Introductionmentioning

confidence: 99%

Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomised controlled trial

et al. 2019

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“…From a functional standpoint, these patients are often left with an inability to perform a complete heel-rise, 10,19,30,[35][36][37][38] which results in deficient push-off during ambulation.…”

Section: Introductionmentioning

confidence: 99%

“…From a functional standpoint, these patients are often left with an inability to perform a complete heel‐rise, which results in deficient push‐off during ambulation. This deficit in heel‐rise height appears to relate to tendon length, and more recently, it has been suggested that a reduced muscle fascicle length may also be a contributing factor .…”

Section: Introductionmentioning

confidence: 99%

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

et al. 2019

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We examined muscle function, muscle architecture, and tendon length bilaterally in persons who experience a functional deficit 2 years after an Achilles tendon rupture. Eleven persons were investigated on the injured compared with the uninjured side 47 ± 7 months (mean ± SD) after a tendon rupture. Heel‐rise data, plantar flexion strength, tendon resting angle 3D MRI‐determined tendon length and muscle cross‐sectional area, ultrasound‐determined fascicle length, and pennation angle were obtained. The heel‐rise test yielded reduced max height (32%), number of repetitions (54%), and work performed (61%), P < .001. Plantar flexion strength was impaired (P < .001) with the knee in extension (20%‐42%) and flexion (29%‐39%). Muscle cross‐sectional area was reduced for both the soleus (36%) and gastrocnemius muscles (46%; P < .001). Both the soleus tendon (55%) and the gastrocnemius tendon (14%) were longer (P < .001), and the fascicle length of the medial gastrocnemius was substantially reduced (18%; P < .001). The difference in heel‐rise height correlated to that of the gastrocnemius tendon elongation, r = .66, P < .05, but not soleus tendon elongation. These data show that a functional deficit after an Achilles tendon rupture is associated with an elongated soleus and gastrocnemius tendon along with a reduced soleus and gastrocnemius muscle cross‐sectional area and gastrocnemius fascicle length.

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“…4,22 However, a randomized controlled study of nonoperatively treated ATRs did not find any difference in function after late or early weightbearing rehabilitation regimens at short-term 6 or 4.5-year follow-up. 17 A sustained deficit in the injured leg was observed in heel-rise work (limb symmetry index [LSI]) at short-term follow-up regardless of the nonoperative regimen. 17…”

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confidence: 99%

Gait Function and Postural Control 4.5 Years After Nonoperative Dynamic Treatment of Acute Achilles Tendon Ruptures

Speedtsberg

Kastoft

Barfod

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: An Achilles tendon rupture (ATR) is known to cause persistent biomechanical deficits such as decreased muscle strength in end-range plantar flexion and reduced tendon stiffness. Purpose/Hypothesis: This study aimed to examine whether sustained asymmetries were present in dynamic stiffness and kinematic and kinetic variables in gait and single-leg balance at 4.5-year follow-up in conservatively treated patients recovering from an ATR. We hypothesized that patients who had recovered from ATRs exhibit a midterm increase in peak ankle dorsiflexion, a decrease in concentric work, and decreased dynamic stiffness during the stance phase of gait, along with increased single-leg standing sway in the injured leg compared with the uninjured leg. Study Design: Case series; Level of evidence, 4. Methods: This study was a cross-sectional medium-term follow-up of conservatively treated patients recovering from ATRs. A total of 34 patients who underwent nonoperative treatment were included for testing 4.5 years after a rupture. The Achilles tendon length was measured using ultrasound. Standard instrumented 3-dimensional (3D) gait analysis and single-leg standing balance were performed using 3D motion capture. Kinematic and kinetic ankle parameters were calculated during gait, and quasi-stiffness was calculated as the moment change per the change in the degree of dorsiflexion during the second (ankle) rocker of the gait cycle. Center of pressure displacement (sway length), along with rambling and trembling, was calculated for the single-leg balance task. Results: Peak dorsiflexion in stance was 13.4% larger in the injured leg than the uninjured leg (16.9° ± 3.1° vs 14.9° ± 0.4°, respectively; P ≤ .001). Peak dorsiflexion was not associated with the normalized Achilles tendon length (B = 0.052; P = .775). Total positive work in the plantar flexors was 23.9% greater in the uninjured leg than the injured leg (4.71 ± 1.60 vs 3.80 ± 0.79 J/kg, respectively; P = .001). Quasi-stiffness was greater in the uninjured leg than the injured leg during the initial (0.053 ± 0.022 vs 0.046 ± 0.020 N·m/kg/deg, respectively; P = .009) and late (0.162 ± 0.110 vs 0.139 ± 0.041 N·m/kg/deg, respectively; P = .005) phases of eccentric loading. No difference was found in sway length during single-leg stance between the injured and uninjured legs (1.45 ± 0.4 vs 1.44 ± 0.4 m, respectively; P = .955). Conclusion: Patients treated conservatively have a small increase in peak dorsiflexion, decreased total concentric plantar flexor power, and decreased quasi-stiffness in initial and end-range dorsiflexion in the injured leg. These deviations could not be directly associated with the measured tendon elongation. Registration: NCT02760784 ( ClinicalTrials.gov ).

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Early weight-bearing in nonoperative treatment of acute Achilles tendon rupture did not influence mid-term outcome: a blinded, randomised controlled trial

Abstract: NCT02760784.

Cited by 28 publications

References 31 publications

Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomised controlled trial

Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomised controlled trial

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

Gait Function and Postural Control 4.5 Years After Nonoperative Dynamic Treatment of Acute Achilles Tendon Ruptures

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