A new study from the University of Oxford and the University of Warwick in the UK may be a breakthrough in the treatment of Achilles tendon rupture: Researchers found that early walking in a brace provides similar outcomes to plaster casting, with no increase in the risk of complications.
This finding is from the multicenter UK Study of Tendo Achilles Rehabilitation (UKSTAR), and it may signal a big change in the way that patients are treated. The study was published in The Lancet.
“Achilles tendon rupture keeps people away from sport for many months. For some, it stops them ever returning to their favorite recreational activities, and for professional athletes it can be a career-ending injury,” said Matthew Costa, PhD, Professor of Orthopaedic Trauma Surgery at NDORMS, University of Oxford.
“Immediate mobilization in a brace is a safe alternative to plaster casting after an Achilles rupture and patients report better early outcomes, probably because the brace allows them to walk earlier than the cast.”
Rupture of the Achilles tendon is a serious injury that is becoming more common. Non-operative treatment is increasingly preferred over surgery, with patients either being treated in a plaster cast to immobilize the foot and ankle or by the use of functional bracing that allows weight-bearing. Before the UKSTAR study, however, there was little evidence showing which intervention was more effective.
In the UKSTAR trial, 540 patients with an acute Achilles tendon rupture were randomly assigned to either the plaster cast (n=266) or a functional brace (n=274); 527 patients completed the trial. The primary outcome measure was the patient-reported Achilles Tendon Rupture Score (ATRS) at 9 months after injury, with secondary outcomes of quality of life, complications including re-rupture, and resource use. The ATRS evaluates the patient’s symptoms, level of activity, and pain.
The researchers reported no difference in the ATRS at 9 months: mean ATRS of 74.4 for the plaster cast group and a mean ATRS of 72.8 for the functional brace group (P=0.44). They also saw no difference in the rate of re-rupture of the tendon between groups, a concern with the use of a functional brace: 17 patients in the plaster cast group had a re-rupture compared with 13 patients in the functional brace group (P=0.40).
“Traditionally, patients with a rupture of the Achilles tendon are immobilized for several weeks in a plaster cast which restricts their mobility,” Professor Costa said. “However, our new research shows that immediate weight-bearing in a walking boot allows the tendon to heal just as quickly and with no increase in the risk of further rupture.”
Costa ML, Achten J, Marian IR, et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3.