A prospective study of 80 consecutive patients with
Achilles tendon ruptures treated in a functional, early
weight-bearing brace found a low re-rupture rate in both surgical and
Our case series demonstrates a low re-rupture rate with early
functional weight-bearing rehabilitation in patients treated nonoperatively and
surgically, Victoria Sinclair, MBChB, MRCS, said during her presentation
25th Annual Summer Meeting of the American Orthopaedic Foot and
In their study, Sinclair and colleagues collected data on patients with
clinically diagnosed Achilles tendon ruptures who were treated at their unit
between 2002 and 2008. After receiving evidence-based counseling, the patients
selected to undergo surgical or conservative treatment.
Patients in both groups wore a below-the-knee brace (Vacoped, OPED AG,
Switzerland), with the surgical group wearing it shortly after surgery. All
patients started full weight-bearing as soon as it could be tolerated, Sinclair
told Orthopedics Today.
Both groups underwent the same rehabilitation protocol. The
investigators followed-up with the patients by telephone or postal mail and
asked them to complete the VISA-A questionnaire and Achilles Total Rupture
Score (ATRS) questionnaires.
The nonoperative group included 51 patients with a median age of 45
years, and the surgical group consisted of 29 patients with a median age of 36
years. Sinclair noted that 44% of the nonoperative group had sports-related
injuries compared to 57% of the surgical group. In addition, 49% of the
nonoperative group had active occupations prior to their injuries compared to
74% in the surgical group.
The nonoperative group wore the brace for a median of 8 weeks, and the
surgical group spent 6.5 weeks in the brace.
At follow-up, the investigators discovered two wound infections and one
keloid scar in the surgical group. While they found that 10.3% of the patients
in the group had soft tissue injuries, they discovered no nerve injuries. They
also found no soft tissue complications in the nonoperative group.
Gregory C. Berlet, MD, a moderator of the session noted that the
patients received evidence-based counseling and self-selected their treatment.
What did you present to them and how did you remove the investigator
bias? he asked. Often body language will convey your bias.
Sinclair noted that the investigators attempted to remove some bias by
directly quoting the literature to patients.
For more information:
Gregory C. Berlet, MD, is the chief of the foot and ankle service at
Ohio State University Department of Orthopedics Orthopedic Foot and Ankle
Center, 300 Polaris Parkway, Suite 2000, Westerville, OH 43082; 614-895-8809;
Victoria Sinclair, MBChB, MRCS, can be reached at The East Lancashire
Foot and Ankle Service at East Lancashire NHS Trust, Royal Blackburn Hospital,
Haslingden Road, Blackburn UK, BB2 3HH; 01254; e-mail:
firstname.lastname@example.org. Neither source has a direct
financial interest in any company or product mentioned in this article.
Sinclair V, Jackson G, McLoughlin C, et al. Functional early
weight-bearing rehabilitation of Achilles tendon rupture: The influence on
re-rupture rates and outcome scores. Presented at the 25th Annual Summer
Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009.
Vancouver, British Columbia.