Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 6/2021

01-12-2021 | Achilles Tendon Rupture | Original Article

Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study

Authors: Stijn Gillissen, Ilan Halperin, Vinay Balesar, Erwin Gorter, Alexander Greeven

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2021

Login to get access

Abstract

Purpose

Conservative treatment of achilles tendon rupture (ATR) might be favoured in centres with an early weight-bearing protocol, but no consensus exists on the clear definition of an early weight-bearing protocol. The aim of this study is to evaluate the introduction of an early weight-bearing conservative treatment protocol in patients with ATR compared to patients without this protocol.

Methods

A single-centre retrospective study was performed. All patients presenting with an ATR during a 10-year period were included. Between January 1st 2008 and December 31st 2015, all patients were included for either operative or conservative treatment without an early weight-bearing protocol (non-EWB). Between January 1st 2016 and 30th June 2019, patients were, primarily, treated conservatively with early weight-bearing protocol (EWB). A primary-outcome parameter was re-rupture, and secondary-outcome parameters were treatment-related complications.

Results

In the period 2008–2015, 246 patients were treated with non-EWB. In the period 2016–2019, 58 patients were treated conservatively with EWB. No significant differences were found in re-rupture rates between non-EWB (5.3%) and conservative EWB (6.9%) (p = 0.536) or conservative non-EWB (9.4%) and conservative EWB (6.9%) (p = 0.283). Pulmonary embolism (1.0%) and deep venous thrombosis (1.0%) were observed in operative non-EWB patients. In conservative EWB patients, superficial pressure ulcers (5.2%) and treatment failure (5.2%) were observed.

Conclusion

Conservative treatment of ATR with an early weight-bearing protocol showed similar re-rupture rates and complication rates compared to conservative and operative treatments without an early weight-bearing protocol.
Literature
1.
go back to reference Zhang H, Tang H, He Q, et al. Surgical versus conservative intervention for acute achilles tendon rupture: a PRISMA-compliant systematic review of overlapping meta-analyses. Medicine. 2015;94(45):1951.CrossRef Zhang H, Tang H, He Q, et al. Surgical versus conservative intervention for acute achilles tendon rupture: a PRISMA-compliant systematic review of overlapping meta-analyses. Medicine. 2015;94(45):1951.CrossRef
2.
go back to reference Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. Br Med Bull. 2014;109:45–54.CrossRef Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. Br Med Bull. 2014;109:45–54.CrossRef
4.
go back to reference Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med. 2008;36(9):1688–94.CrossRef Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med. 2008;36(9):1688–94.CrossRef
5.
go back to reference Deng S, Sun Z, Zhang C, et al. Surgical treatment versus conservative management for acute achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg. 2017;56(6):1236–43.CrossRef Deng S, Sun Z, Zhang C, et al. Surgical treatment versus conservative management for acute achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg. 2017;56(6):1236–43.CrossRef
6.
go back to reference Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop. 2012;36(4):765–73.CrossRef Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop. 2012;36(4):765–73.CrossRef
7.
go back to reference Nilsson-Helander K, Silbernagel KG, Thomee R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38(11):2186–93.CrossRef Nilsson-Helander K, Silbernagel KG, Thomee R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38(11):2186–93.CrossRef
8.
go back to reference Olsson N, Silbernagel KG, Eriksson BI, et al. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med. 2013;41(12):2867–76.CrossRef Olsson N, Silbernagel KG, Eriksson BI, et al. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med. 2013;41(12):2867–76.CrossRef
9.
go back to reference Pajala A, Kangas J, Ohtonen P, et al. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84(11):2016–21.CrossRef Pajala A, Kangas J, Ohtonen P, et al. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84(11):2016–21.CrossRef
10.
go back to reference Soroceanu A, Sidhwa F, Aarabi S, et al. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94(23):2136–43.CrossRef Soroceanu A, Sidhwa F, Aarabi S, et al. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94(23):2136–43.CrossRef
11.
go back to reference van der Eng DM, Schepers T, Goslings JC, et al. Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013;52(5):622–8.CrossRef van der Eng DM, Schepers T, Goslings JC, et al. Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis. J Foot Ankle Surg. 2013;52(5):622–8.CrossRef
12.
go back to reference Yang X, Meng H, Quan Q, et al. Management of acute Achilles tendon ruptures: a review. Bone Joint Res. 2018;7(10):561–9.CrossRef Yang X, Meng H, Quan Q, et al. Management of acute Achilles tendon ruptures: a review. Bone Joint Res. 2018;7(10):561–9.CrossRef
13.
go back to reference Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120.CrossRef Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120.CrossRef
14.
go back to reference Mark-Christensen T, Troelsen A, Kallermose T, et al. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1852–9.CrossRef Mark-Christensen T, Troelsen A, Kallermose T, et al. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1852–9.CrossRef
15.
go back to reference Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br. 2011;93(10):1362–6.CrossRef Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br. 2011;93(10):1362–6.CrossRef
16.
go back to reference Young SW, Patel A, Zhu M, et al. Weight-bearing in the nonoperative treatment of acute achilles tendon ruptures: a randomized controlled trial. J Bone Joint Surg Am. 2014;96(13):1073–9.CrossRef Young SW, Patel A, Zhu M, et al. Weight-bearing in the nonoperative treatment of acute achilles tendon ruptures: a randomized controlled trial. J Bone Joint Surg Am. 2014;96(13):1073–9.CrossRef
17.
go back to reference Lu J, Liang X, Ma Q. Early functional rehabilitation for acute achilles tendon ruptures: an update meta-analysis of randomized controlled trials. J Foot Ankle Surg. 2019;58(5):938–45.CrossRef Lu J, Liang X, Ma Q. Early functional rehabilitation for acute achilles tendon ruptures: an update meta-analysis of randomized controlled trials. J Foot Ankle Surg. 2019;58(5):938–45.CrossRef
18.
go back to reference Holm C, Kjaer M, Eliasson P. Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports. 2015;25(1):e1–10.CrossRef Holm C, Kjaer M, Eliasson P. Achilles tendon rupture–treatment and complications: a systematic review. Scand J Med Sci Sports. 2015;25(1):e1–10.CrossRef
19.
go back to reference Kotnis R, David S, Handley R, et al. Dynamic ultrasound as a selection tool for reducing achilles tendon reruptures. Am J Sports Med. 2006;34(9):1395–400.CrossRef Kotnis R, David S, Handley R, et al. Dynamic ultrasound as a selection tool for reducing achilles tendon reruptures. Am J Sports Med. 2006;34(9):1395–400.CrossRef
20.
go back to reference Glazebrook M, Rubinger D. Functional rehabilitation for nonsurgical treatment of acute achilles tendon rupture. Foot Ankle Clin. 2019;24(3):387–98.CrossRef Glazebrook M, Rubinger D. Functional rehabilitation for nonsurgical treatment of acute achilles tendon rupture. Foot Ankle Clin. 2019;24(3):387–98.CrossRef
Metadata
Title
Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study
Authors
Stijn Gillissen
Ilan Halperin
Vinay Balesar
Erwin Gorter
Alexander Greeven
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01376-3

Other articles of this Issue 6/2021

European Journal of Trauma and Emergency Surgery 6/2021 Go to the issue