SLR - October 2020 - Elie Touma

Non-Operative Functional Treatment for Acute Achilles Tendon Ruptures: The Leicester Achilles Management Protocol (LAMP)

Reference: Aujla RS, Patel S, Jones A, Bhatia M. Non-Operative Functional Treatment for Acute Achilles Tendon Ruptures: The Leicester Achilles Management Protocol (LAMP). Injury. 2019;50(4):995-999. doi:10.1016/j.injury.2019.03.007

Scientific Literature Review

Reviewed By: Elie Touma, DPM 
Residency Program: Northwest Medical Center – Margate, FL

Podiatric Relevance: Acute Achilles tendon rupture (ATR) is one of the most common tendon ruptures encountered by most foot and ankle surgeons. The managements range from non-operative to operative which includes percutaneous or open techniques. There are numerous surgical techniques in the treatment of Achilles tendon ruptures. Operative repair of an ATR is commonly the favored option to non-operative repair. The goal of this study was to present a standardized treatment regimen and results of ATRs that were treated non-operatively using Liecetser Achilles management protocols (LAMP). 

Methods: This study is a prospective study of patients treated non-operatively for ATR from February 2011 to January 2014. Patients were excluded if they were less than 18 years of age; delay in presentation of greater than two weeks; open injury; concurrent lower limb injury, or patient preference being surgery. Patients were instructed to complete Achilles Tendon Rupture scores (ATRs) at six months and 12 months. Furthermore, they were required to undergo an assessment of the calf muscle girth and heel raise height test. The treatment regimen involved patients being placed in a VaCoped boot with immediate weight bearing for the first four weeks in a locked 30 degrees plantarflexion, at four to six weeks in dynamised 15-30 degrees plantarflexion, at six to eight weeks in 0-30 degrees in dynamised plantarflexion and by the eighth week the boot was removed. After the completion of LAMP, a physiotherapy treatment was initiated that consisted of isometric exercises, seated heel raises, dorsiflexion/plantarflexion ROM, and walking outdoors in a comfortable shoe. 

Results: A total of 442 patients met the inclusion criteria and were treated with LAMP. Two hundred eight patients did not return for follow up. 5.9 percent of patients (26 patients) developed symptomatic venous thromboembolism. Twenty-five patients developed deep venous thrombosis, and there were nine re-ruptures. The mean ATRs were 75.5 after 23 months after the injury, where males had a statistically higher ATR score compared to females. There was a statistical significance in calf muscle girth and heel rise height test when comparing to the unaffected limb. No differences were noted between males and females in muscle girth or heel raise height. 

The outcomes of the study can serve as a good reminder on the importance of the options foot and ankle surgeons have when they encounter an issue where surgical correction is not an option. Limitations to consider were that only 77 patients were included in the objective measures of the study and of the 442 patients only 234 patients were able to follow up for the ATRs. This non-operative treatment may be a good option for those with multiple comorbidities, or for those who do not have the choice to be treated surgically. As a podiatric surgical resident, I am eagerly enthusiastic to learn and be exposed to a multitude of surgical cases but learning non-operative treatment protocol for the management of acute Achilles tendon rupture is equally as important as learning the surgical techniques. 

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