Treatment of acute Achilles tendon rupture – a multicentre, non-inferiority analysis

Abstract

Background While numerous clinical studies have compared the surgical and non-surgical treatment of acute Achilles tendon rupture (ATR), there are no studies that have performed a non-inferiority analysis between treatments. Methods Data from patients who were included in five randomised controlled trials from two different centres in Sweden were used. Outcomes at 1 year after ATR consisted of the patient-reported Achilles tendon Total Rupture Score (ATRS) and the functional heel-rise tests reported as the limb symmetry index (LSI). The non-inferiority statistical 10% margin was calculated as a reflection of a clinically acceptable disadvantage in ATRS and heel-rise outcome when comparing treatments. Results A total of 422 patients (350 males and 72 females) aged between 18 and 71 years, with a mean age of 40.6 (standard deviation 8.6), were included. A total of 363 (86%) patients were treated surgically. The ATRS (difference (Δ) = − 0.253 [95% confidence interval (CI); − 5.673;5.785] p = 0.36) and LSI of heel-rise height (difference = 1.43 [95% CI; − 2.43;5.59] p = 0.81), total work (difference = 0.686 [95% CI; − 4.520;6.253] p = 0.67), concentric power (difference = 2.93 [95% CI; − 6.38;11.90] p = 0.063) and repetitions (difference = − 1.30 [95% CI; − 6.32;4.13] p = 0.24) resulted in non-inferiority within a Δ − 10% margin for patients treated non-surgically. Conclusion The non-surgical treatment of Achilles tendon ruptures is not inferior compared with that of surgery in terms of 1-year patient-reported and functional outcomes.

Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

“…There is conclusive evidence that outcomes after surgical and non-surgical treatment of ATR are comparable [ 51 , 52 ], and recent literature has indicated that functional rehabilitation without surgery can lead to comparable results (patient-reported outcomes and re-rupture) to surgery, without the risk of complications [ 105 ]. However, surgical intervention has been noted to provide improved strength compared with functional rehabilitation, and even if this might not be critical for most individuals, for elite athletes it could be career ending; therefore, surgical intervention was recommended for all elite athletes wishing to return to sport after ATR [ 106 ].…”

“…Because there is conclusive evidence that outcomes after surgical and non-surgical treatment of ATR are comparable and the optimal treatment is continuously debated [ 32 , 51 , 52 ], methods of rehabilitation are becoming increasingly significant [ 32 , 53 , 54 ]. Nevertheless, data on the course of the recovery after ATR are still limited, potentially resulting in suboptimal rehabilitation [ 4 ].…”

Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison

“…This lesion can be treated conservatively or surgically, requiring, in any case, long periods of rehabilitation (not less than 6 months), with a permanent strength deficit of 10% to 30% [ 19 ]. Because of conclusive evidence that outcomes after surgical and nonsurgical treatment of Achilles tendon rupture are comparable [ 20 , 21 , 22 ], methods of rehabilitation are becoming increasingly significant. Traditionally, surgical management of acute Achilles tendon rupture was followed by a prolonged period of ankle immobilization in a rigid cast, which, on the other side, posed the problem of stiffness (due to adhesion and muscle atrophy).…”

The economic cost and patient-reported outcomes of chronic Achilles tendon ruptures

“…There is no official MCID (Minimal Clinically Important Difference) for ATRS. However, earlier studies have defined the MCID as 8–10 points [ 5 , 26 ]. Both the preoperative and the postoperative ATRS were filled out retrospectively.…”