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

Abstract

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

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation

“…The authors found no evidence of a diference in func tional outcome. One further study, published in 2019, 28 randomly allocated 130 patients to cast immo bilisation or early controlled motion at a single centre. The authors found no evidence that early controlled motion was of benefit compared with immobilisation in any of the investigated outcomes.…”

Non‐uniform displacement within ruptured Achilles tendon during isometric contraction

“…Treatment is either surgical or non‐surgical, and these modes involve different immobilization periods 4‐6 . Early mobilization seems to lead to better functional outcomes, a higher quality of life and a shorter rehabilitation period 7‐10 …”

Individualized treatment for acute Achilles tendon rupture based on the Copenhagen Achilles Rupture Treatment Algorithm (CARTA): a study protocol for a multicenter randomized controlled trial

“…Therefore, the present trial has chosen a functional outcome as the primary outcome. In contrast, several previous randomized controlled trials have used patient-reported outcome measures as primary outcomes [4,12,31]. However, their results have shown the patients to have an acceptable score within the patient reported outcome measures but markedly low scores among the tests of physical function.…”