On the treatment of Achilles tendon rupture. A prospective, randomised study of the results after surgical and non-surgical treatment

Abstract

Only two prospective, randomised studies have been published on the outcome after treatment for Achilles tendon rupture. The controversy regarding the optimal treatment continues. In the present study, 112 patients with acute Achilles tendon rupture were randomised and all of them were followed up for two years. Fifty-nine patients were treated surgically with end-to-end sutures followed by two weeks of plaster treatment and six weeks of treatment in a brace with increasing range of motion. Fifty-three patients were treated non-surgically with four weeks of plaster in equinus and four weeks in a neutral position. The re-rupture rate was 20.8% in the non-surgical-treatment group and 1.7% in the surgical-treatment group (p=0.001). There were no major surgical complications. A new Achilles Tendon Rupture score including five objective and three subjective parameters did not reveal any significant difference between the treatment groups. The time of return to work and sports did not differ significantly between the treatment groups either. Calf muscle strength was evaluated both for purposes of test-retest reliability in healthy volunteers and for outcome reasons in the clinical study. Isokinetic torque production in concentric and eccentric muscle action in plantar flexion and dorsiflexion at the ankle joint was studied on the right and left sides. Calf muscle endurance was evaluated using a standardised heel-raise test, until fatigue. The reliability test showed acceptable reproducibility for the isokinetic tests and the endurance tests. After treatment for ATR, we found calf muscle hypotrophy, thickening of the Achilles tendon, decreased calf muscle strength and reduced endurance on the injured side throughout the study period. There were, however, no significant differences between the treatment groups. Magnetic resonance imaging and ultrasonography detected the same amount of pathological findings during healing in both treatment groups. The correlation between the radiological findings and the clinical parameters was weak.The non-surgical treatment of ATR, which produced treatment failure in every fifth patient, cannot be regarded as acceptable for healthy, active people under the age of 65 years. Surgical treatment followed by early functional rehabilitation is a safe method for the treatment of ATR with a low risk of complications. However, surgical and non-surgical treatments produced equally good medium-term results in the group of patients in whom no rerupture occurred.