Treatment decisions for acute Achilles tendon ruptures
Nicola Maffulli, Giuseppe M. Peretti
Abstract
Acute ruptures of the Achilles tendon are common. They result in major impairment to mobility, persisting even a decade after the tear, 1 Maffulli N Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999; 81: 1019-1036 Crossref PubMed Scopus (467) Google Scholar and a return to regular activity or sport can be compromised. 2 Olsson N Nilsson-Helander K Karlsson J et al. Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1385-1393 Crossref PubMed Scopus (177) Google Scholar Any form of clinical management should restore and maximise function, and minimise complications. Recent research efforts have mostly tried to identify optimal methods of either surgical or non-surgical treatment in randomised controlled trials, with prevention of re-ruptures as the primary outcome. In The Lancet, Matthew Costa and colleagues 3 Costa ML Achten J Marian IR et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020; 395: 441-448 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar report findings from UKSTAR, a randomised superiority trial performed in 39 hospitals in the UK. 540 physically active patients (mean age 48∙7 years, 79% men) who were being managed non-surgically for an acute (<14 days) Achilles tendon rupture were randomly assigned to receive a plaster cast (n=266) or functional bracing (n=274). The primary outcome was Achilles tendon Rupture Score (ATRS), 4 Nilsson-Helander K Thomeé R Silbernagel KG et al. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007; 35: 421-426 Crossref PubMed Scopus (334) Google Scholar a well validated patient-reported outcome score, at 9 months, and the main safety outcome was the incidence of re-rupture. 3 Costa ML Achten J Marian IR et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020; 395: 441-448 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar There was no difference between groups in terms of ATRS (plaster cast group: n=244, mean score 74∙4 [SD 19∙8]; functional brace group: n=259, mean 72∙8 [20∙4]; adjusted mean difference –1∙38 [95% CI –4∙9 to 2∙1]) or in the incidence of re-rupture of the tendon. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluationTraditional plaster casting was not found to be superior to early weight-bearing in a functional brace, as measured by ATRS, in the management of patients treated non-surgically for Achilles tendon rupture. Clinicians may consider the use of early weight-bearing in a functional brace as a safe and cost-effective alternative to plaster casting. Full-Text PDF Open Access