Functional Treatment or Cast Immobilization After Minimally Invasive Repair of an Acute Achilles Tendon Rupture: Prospective, Randomized Trial.

ABSTRACT

BACKGROUND: Operative repair of an acute Achilles tendon rupture (ATR) reduces the risk of re-rupture and has therefore gained popularity as a standard treatment for ATR, especially in the young and physically active patient. There is ongoing controversy over the best surgical technique and postoperative treatment. In this prospective, randomized trial, we compared cast immobilization and functional treatment with early mobilization and weightbearing after using a minimally invasive surgical technique in patients with ATR. METHODS: All patients with ATR were included. Exclusion criteria were systemic immunosuppressive therapy, re-ruptures, and severe comorbidity. All included patients underwent minimally invasive surgery, after which a below-knee splint with the foot in 10 degrees of plantar flexion was applied for the first week. Patients were then randomized to the cast immobilization group (IG) for 6 weeks or to the functional group (FG) for 6 weeks. Sixty patients were included. Median age was 43 years (range, 19-65), and 78% were male. Most ATRs were sports related. Data were collected preoperatively and during the outpatient checks at 1, 3, and 6 weeks; 3 and 6 months; and 1 year. Outcome parameters were return to work or sport, complications including re-rupture, Achilles rupture performance score (ARPS), loss of strength, range of motion, subjective result, and quality-of-life (QoL) scores. RESULTS: In our follow-up period, we did not see differences in strength, QoL scores, return to work or sports, or ARPS between the 2 treatment groups. The patients in the FG reported more complaints, mostly pain, in the first weeks after surgery, probably because of the exercise program starting 1 week postsurgery. The overall complication rate was low. In each group, we had 1 re-rupture; in the IG, however, 2 patients had a deep venous thrombosis, despite low-molecular-weight heparin. CONCLUSION: The minimally invasive repair of ATR was a safe and reliable technique with good results. Early mobilization seemed to be as safe as more traditional postoperative immobilization with equal patient satisfaction. Although not significantly different, we saw more major complications in the IG. LEVEL OF EVIDENCE Level I, prospective randomized trial.