Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis. Issue 5 (July 2022)

• Record Type: Journal Article
• Authors: Naskar, R.; Oliver, L.; Velazquez-Ruta, P.; Dhinsa, B.; Southgate, C.
• Is Part Of: Foot and ankle surgery. Volume 28:Issue 5(2022)
• Page Start: 595
• Page End: 602
• Publication Date: 2022-07
• Subjects: Achilles tendon -- Achilles tendon rupture -- Complete tear -- Functional orthosis -- Early weight-bearing -- Rehabilitation; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2021.06.008
• Languages: English
• ISSNs: 1268-7731

Abstract

Abstract: Background: The optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures. Methodology: This study was done at East Kent Hospital University Foundation Trust in between 2019−2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score. Result: Our study population was predominantly male with an average age of 50 (range 22−79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions. Conclusion: Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome.