SLR - December 2020 - Paul S. Hong

Efficacy of Early Controlled Motion of the Ankle Compared with Immobilization in Non-Operative Treatment of Patients with an Acute Achilles Tendon Rupture: An Assessor-Blinded, Randomized Controlled Trial

Reference: Barfod KW, Hansen MS, Holmich P, Kristensen MT, Troelsen A. Efficacy of early controlled motion of the ankle compared with immobilization in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomized controlled trial. Br J Sports Med. 2020 Jun;54(12):719-724.

Level of Evidence: Level II

Scientific Literature Review

Reviewed By: Paul S. Hong, DPM
Residency Program: Montefiore Medical Center – Bronx, NY

Podiatric Relevance: Achilles rupture is a common condition seen and treated by foot and ankle surgeons. Operative and non-operative treatment options have been investigated in the literature. When opting for non-operative treatment, functional rehabilitation is supported by some of the studies, but the studies are of low methodological quality. This study investigates the effect of early controlled motion of the ankle joint compared with immobilization of the ankle in non-operative treatment of acute Achilles tendon rupture. 

Methods: This study performed an assessor-blinded, randomized controlled trial with patients allocated in a 1:1 ratio at Copenhagen University Hospital Hvidovre from 2014 to 2016. Inclusion criteria includes age range 18-70 years, could attend rehabilitation and postoperative examinations. Excision criteria includes previous Achilles ruptures, previous surgery on the Achilles tendon, fluoroquinolone treatment within the last six months, tendinosis treated with corticosteroids within the last six months. The primary outcome measure was ATRS (Achilles tendon Total Rupture Score). The secondary outcome measures were heel-rise work test, elongation of the tendon, Achilles tendon resting angle, Achilles tendon length measure, re-rupture, perimeter of the calf, return to work and return to sport.

Results: Among eligible participants, 63 patients in the intervention group (early controlled motion) and 56 patients in the control group (immobilization) were enrolled. No statistically significant differences were found in the ATRS between early controlled motion group and the immobilization group at any of the follow-up times. In addition, there were no statistically significant differences in secondary outcomes.

Conclusions: The study hypothesis that the optimal loading of the Achilles tendon would be achieved by early controlled motion of the ankle, resulting in better functional outcome in comparison with immobilization, was rejected. The study revealed no statistical differences in primary and secondary outcomes. This study questions effectiveness of early controlled motion as the key to optimize treatment. Further studies should investigate individualization of treatment and if improvements of the treatment protocol can affect the outcome positively.

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