Post-Operative Bracing following Repair of the Achilles Tendon V1
Research type
Research Study
Full title
Comparison of methods and duration of post-operative bracing following repair of acute Achilles tendon rupture.
IRAS ID
295136
Contact name
Michael Carmont
Contact email
Sponsor organisation
Department of Research & Innovation
Duration of Study in the UK
6 years, 0 months, 1 days
Research summary
The aim of management of patients with Achilles tendon rupture is to restore function and preserve push off strength, with the minimum of complications. Rupture of the Achilles tendon results in reduced ankle plantar flexion strength [Olsson, Brorsson, Lantto]. This weakness, in the form of reduced single heel-rise height, correlates with elongation of the Achilles tendon [Grävare Silbernagel]. Research has focused on reducing elongation of the tendon during rehabilitation, minimising weakness.
The aim of this study is to compare the outcome of patients following minimally-invasive Achilles tendon repair mobilising for 6 weeks of weight-bearing in an anterior shell with those mobilising for 8 weeks in an anterior shell and heel wedges.
This study is a non-randomized cohort comparison design, comparing the outcomes of two cohorts of patients following minimally-invasive surgery followed by immediate weight-bearing and early range-of-movement exercises following mid-substance rupture and repair of the Achilles tendon.
The study cohort of patients will be prospectively evaluated and will receive two weeks in a synthetic cast in plantar flexion, weight-bearing on the meta-tarsal heads. Subsequently the patient will receive 6 weeks with an anterior cast shell in plantar flexion and a boot with wedges, weight-bearing on the sole of the walker boot.
The comparison cohort of patients were retrospectively managed however received the same surgical technique, in terms of suture configuration and material, and post-operatively received two weeks in a synthetic cast. After two weeks this historical retrospective cohort used the synthetic anterior cast shell in plantar flexion only, with continued weight-bearing on the meta-tarsal heads.
Contemporaneous data collection was performed at routine follow up at the completion of brace use at 6 and 8-weeks, and at 3, 6, 9 and 12-months following repair. The primary outcome measure is the Heel-Rise Height Index (HRHI), comparing maximal sustained heel-rise of the injured side to the non-injured side at 12-months following repair [Grävare Silbernagel]. Secondary outcome measures include the ATRA [Carmont], a validated direct measure of tendon length [Hansen], the Achilles tendon Total Rupture Score (ATRS), a patient reported outcome measure [Nilsson-Helander], Tegner Score [Tegner], and the Patient Perception of Performance [Carmont 2017].REC name
South Central - Oxford C Research Ethics Committee
REC reference
21/SC/0097
Date of REC Opinion
6 Apr 2021
REC opinion
Further Information Favourable Opinion