Monday, January 4, 2010

Full weight-bearing rehabilitation has low re-rupture rate for Achilles tendon injuries

The early rehabilitation protocol using bracing shows positive results in surgical and nonsurgical patients.
By Gina Brockenbrough
A prospective study of 80 consecutive patients with Achilles tendon ruptures treated in a functional, early weight-bearing brace found a low re-rupture rate in both surgical and nonsurgical cohorts.
“Our case series demonstrates a low re-rupture rate with early functional weight-bearing rehabilitation in patients treated nonoperatively and surgically,” Victoria Sinclair, MBChB, MRCS, said during her presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society.

Full weight-bearing

In their study, Sinclair and colleagues collected data on patients with clinically diagnosed Achilles tendon ruptures who were treated at their unit between 2002 and 2008. After receiving evidence-based counseling, the patients selected to undergo surgical or conservative treatment.

Patients in both groups wore a below-the-knee brace (Vacoped, OPED AG, Switzerland), with the surgical group wearing it shortly after surgery. All patients started full weight-bearing as soon as it could be tolerated, Sinclair told Orthopedics Today.
Both groups underwent the same rehabilitation protocol. The investigators followed-up with the patients by telephone or postal mail and asked them to complete the VISA-A questionnaire and Achilles Total Rupture Score (ATRS) questionnaires.
The nonoperative group included 51 patients with a median age of 45 years, and the surgical group consisted of 29 patients with a median age of 36 years. Sinclair noted that 44% of the nonoperative group had sports-related injuries compared to 57% of the surgical group. In addition, 49% of the nonoperative group had active occupations prior to their injuries compared to 74% in the surgical group.
The nonoperative group wore the brace for a median of 8 weeks, and the surgical group spent 6.5 weeks in the brace.


At follow-up, the investigators discovered two wound infections and one keloid scar in the surgical group. While they found that 10.3% of the patients in the group had soft tissue injuries, they discovered no nerve injuries. They also found no soft tissue complications in the nonoperative group.
Gregory C. Berlet, MD, a moderator of the session noted that the patients received evidence-based counseling and self-selected their treatment. “What did you present to them and how did you remove the investigator bias?” he asked. “Often body language will convey your bias.”
Sinclair noted that the investigators attempted to remove some bias by directly quoting the literature to patients.
For more information:
Gregory C. Berlet, MD, is the chief of the foot and ankle service at Ohio State University Department of Orthopedics Orthopedic Foot and Ankle Center, 300 Polaris Parkway, Suite 2000, Westerville, OH 43082; 614-895-8809; e-mail:
Victoria Sinclair, MBChB, MRCS, can be reached at The East Lancashire Foot and Ankle Service at East Lancashire NHS Trust, Royal Blackburn Hospital, Haslingden Road, Blackburn UK, BB2 3HH; 01254; e-mail: Neither source has a direct financial interest in any company or product mentioned in this article.
  • Reference:
Sinclair V, Jackson G, McLoughlin C, et al. Functional early weight-bearing rehabilitation of Achilles tendon rupture: The influence on re-rupture rates and outcome scores. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.