Operative Versus Non-Operative Treatment of Achilles Tendon Ruptures: A Randomized Controlled Trial (SS-66)

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The purpose of this randomized controlled trial was to compare outcomes of operative and non-operative management of Achilles tendon ruptures. Patients with acute complete Achilles tendon ruptures were randomized to receive open suture repair followed by graduated rehabilitation or graduated rehabilitation alone. The primary outcome measure was re-rupture rate. Assessments at 3 and 6 months, and 1 and 2 years included a modified Leppelhati score (no strength data), range of motion, calf circumference, and isokinetic strength at 1 and 2 years. We report the 2 year findings. Two centres randomized 145 patients (118 males and 27 females), mean age 40.9 ± 8.8 years (22.5 - 67.2) to operative (n=73) and non-operative (n=72) treatment. Fourteen were lost to follow-up. Re-rupture occurred in 3 patients in both groups. The mean modified Leppelhati score (out of 85) was 78.2 ± 7.7 in the operative group and 79.7 ± 7.0 in the non-operative group, which was not significant (-1.5 95%CI −6.4 to 3.5, p=0.55). Mean side-to-side difference in plantar flexion and calf-circumference in the operative group was −2.0 ± 3.2° and −1.4 ± 1.2cm, and in the non-operative group −0.9 ± 3.0°and −1.6 ± 1.8cm respectively. Mean isokinetic plantar flexion strength was 62.4 ± 24.2 for the operative and 56.7 ± 19.3 for the non-operative group, which was not significant (5.7, 95%CI −3.1 to 14.5, p=0.20). There were a greater number of serious adverse events in the operative group, including pulmonary embolus in 1 patient, deep vein thrombosis in 1 and deep infections requiring irrigation and debridement in 3. This study suggests that non-operative management of Achilles tendon ruptures utilizing an accelerated rehabilitation programme may produce comparable results with fewer adverse events.