A PROSPECTIVE, RANDOMISED TRIAL COMPARING EARLY WEIGHT-BEARING VERSUS NON-WEIGHT-BEARING AFTER ACHILLES TENDON RUPTURE REPAIR2

Abstract

Significant variation exists amongst surgeons regarding the post operative rehabilitation protocol after surgical repair of Achilles tendon ruptures. The objective of this study was to determine the effect of early weight bearing on the postoperative recovery after surgical repair of ruptured Achilles tendons. The hypothesis was that an early weight bearing routine does not increase the rate of re-rupture or other complications, and improves the quality of life by reducing discomfort of the rehabilitation phase and allowing an earlier return to work and sport.

A prospective, randomised controlled trial of patients with Achilles tendon ruptures undergoing surgical repair was performed over a three year period concluding in April 2006. Specific inclusion and exclusion criteria were used to include one hundred and ten patients in the study at two centers involving twelve surgeons. Patients were randomised to either weight bearing or non weight bearing at the initial postoperative visit and compliance was monitored with a pressure sensor in the fixed-hinged ankle foot orthosis. Patients were assessed at six, twelve and twenty-six weeks postoperatively for 1) re-rupture rate, 2) strength of calf musculature 3) ankle range of motion, 4) complications, 5) return to sporting activities, and 6) return to work. In addition, health–related quality of life was measured using the SF-36 and AOFAS Ankle-Hindfoot Scale.

Enrollment was completed as of May 2006 and six month data is over 90% completed. We are on course for < 10% loss to follow-up. Thus far, there have been no re-ruptures in either group. Definitive data analysis can only be performed once all one hundred and ten patients have completed their six month follow up. Once data analysis is completed, comparisons of patient satisfaction, strength, range of motion, complications, return to sport and return to work will be discussed.

Early weight bearing after Achilles tendon repair did not increase the rate of re-rupture. Final data analysis will document any significant differences in the parameters measured. We believe this study will provide a definitive answer on the safety of early weight bearing after surgical repair of Achilles tendon ruptures.