Early Functional Treatment Versus Cast Immobilisation in Tension After Achilles Rupture Repair


Research Paper Title

Early Functional Treatment Versus Cast Immobilisation in Tension After Achilles Rupture Repair: Results of a Prospective Randomised Trial With 10 or More Years of Follow-up.

Background

There are no long-term prospective controlled trials comparing postoperative regimens after Achilles tendon rupture repair.

Purpose

To compare ≥10-year outcomes of 2 postoperative regimens after Achilles tendon rupture repair: early weight-bearing with early mobilisation versus early weight-bearing with early immobilisation in tension.

Study Design

Randomised controlled trial; Level of evidence, 1.

Methods

A total of 50 patients with acute Achilles tendon ruptures were randomised postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks (group 1) or Achilles tendon immobilisation in tension using a below-knee cast with the ankle in a neutral position for 6 weeks (group 2). Patients were assessed at 3, 6, and 14 months and 11 years postoperatively.

Results

There were 37 patients (74%) evaluated at a mean (±SD) of 11.0 ± 0.9 years. The mean Leppilahti score was 92.9 ± 5.6 in group 1 and 93.6 ± 7.2 in group 2 (P = .68). The mean isokinetic plantar flexion peak torque deficits or average work deficits in plantar flexion showed no differences between the groups with any angular velocity.

Isokinetic strength changed minimally between 1 and 11 years compared with the unaffected ankle, but a mean deficit of 5% in peak torque and mean deficit of 8% in average work were still present after 11 years. On the contrary, isometric plantar flexion strength recovered significantly, with only a 2.4% difference at 11-year follow-up.

Conclusion

After the 11-year follow-up, early mobilisation and immobilisation in tension after Achilles rupture repair resulted in similar clinical outcomes and isokinetic strengths. Regardless of patient satisfaction with the operative treatment, calf muscle strength did not recover normally even at 11-year follow-up.

Reference

Lantto, I., Heikkinen, J., Flinkkila, T., Ohtonen, P., Kangas, J., Siira, P. & Leppilahti, J. (2015) Early Functional Treatment Versus Cast Immobilization in Tension After Achilles Rupture Repair: Results of a Prospective Randomized Trial With 10 or More Years of Follow-up. The American Journal of Sports Medicine.  43(9), pp.2302-2309. Published online before print July 30, 2015, doi: 10.1177/0363546515591267.

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