(duplicate) The functional outcome of non-operative management of Achilles tendon
Research type
Research Study
Full title
The functional outcome of non-operative management of Achilles tendon rupture.
IRAS ID
173470
Contact name
MR Carmont
Contact email
Sponsor organisation
Shrewsbury and Telford NHS Trust
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Rupture of the Achilles tendon is an increasingly common pathology in western countries. The incidence in Finland 2012 was determined to be 55 per 100000 person years [1]. Ruptures cause significant morbidity with absence from work and sports activity. It has been shown that patients have residual muscle weakness 2 years after injury causing altered gait and reduced push off [2]. Symptoms are long term present at 10 years following injury [3].
Management options are operative or non-operative treatment. Randomized controlled studies have failed to show a significant difference in functional outcome for these options [4-11]. Until recently, study outcomes were based upon the occurrence of re-rupture and complications of surgery. Meta-analyses show a difference in re-rupture rates, with patients with operative treatment having a lower re-rupture rate 4%, compared to non-operative treatment 10% [12-16].
The advantages of non-operated treatment include the absence of surgical complications such as surgical site infection, iatrogenic sural nerve injury and lower cost. The complications of non-operative treatment include the rare occurence of skin abrasions and infections [5, 17] and compression neuropraxia of the common peroneal nerve. These are principally due to the wearing of a tight brace. Tendon elongation however, is considered to be higher with non-operative treatment [18-20]. The hyper-dorsiflexion mechanism can lead to nerve neuropraxia and venous wall injury predisposing to deep venous thrombosis.
Muscle weakness of the plantar flexors may be as much as 10-20% when compared to the non-injured side [1, 2, 10]. This will [21] cause reduced push off and altered gait. Since calf muscle activity following rupture is greater on the injured side compared to the non-injured side [22] it is reasonable to assume that reduced plantar flexion strength is related to lengthening of the tendon [23, 24].
Tendons have been shown to lengthen following both repair and non-operative management [23-28]. Anecdotal evidence reports that there is greater degree of elongation in Achilles tendons managed non-operatively. In a randomized controlled trial however, there was less elongation in the non-operatively managed group (1.9mm) compared to the operated group (7.2mm) between weeks 7-19 [27]. In this group the maximal observed elongation was 13.9mm [27]. It has recently been reported that the resting angle of the Achilles tendon [29] increases with early rehabilitation until 3 months following surgical repair [30]. The resting angle of the Achilles tendon reflects the tenodesis effect of the tendon. The increased resting angle representing increased tendon length.
In patients managed non-operatively the behaviour of the ATRA and its relationship to other outcome parameters is not yet known. We would like to submit a research application to evaluate the ATRA along with other commonly used outcome measure in a group of patients treated non-operatively after an Achilles tendon rupture.
REC name
Wales REC 6
REC reference
15/WA/0058
Date of REC Opinion
10 Feb 2015
REC opinion
Further Information Favourable Opinion