12 Efficacy of early controlled motion of the ankle in non-operative treatment of acute achilles tendon rupture. An assessor-blinded RCT. (April 2019) - Barfod, Kristoffer Weisskirchner
Abstract : Background: Early controlled ankle motion (ECM) is widely used in the non-operative treatment of acute Achilles tendon rupture although its safety and efficacy has not been investigated properly in a randomized setup. Purpose/aim of the study: To investigate if ECM of the ankle was superior to immobilization (IM) in the treatment of acute Achilles tendon rupture. Materials and methods: The study was performed as an assessor blinded randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was immobilized (IM). The primary outcome was the Achilles tendon Total Rupture Score (ATRS) evaluated at 1 year post-injury. Secondary outcomes were: heel-rise-work test (HRW), Achilles tendon elongation and rate of re-rupture. Analysis was conducted as intention-to-treat with imputation of missing data. Findings/results: 189 patients were assessed for eligibility and 130 included from February 2014 to December 2016; 64 ECM and 58 IM. There was no statistically significant differences (p>0.3) between the ECM and the IM groups at 1 year; Mean (SD) ATRS was 74 (18) and 75 (18), respectively. HRW was 60% (21) and 60% (21) of the uninjured limb, and elongation was 18 mm (13) and 16 mm (11), respectively. Correspondingly, there were 6 and 7 re-ruptures. Conclusions: ECM revealed no benefit to IM in any of the investigated outcomes.