Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Science

Background:

• Surgical Achilles tendon rupture repair historically offered earlier motion and superior results.
• However, early motion itself, regardless of surgical intervention, is recognized for enhancing tendon healing and optimizing patient outcomes.

Purpose of the Study:

• To determine if controlled early motion in rehabilitation leads to equivalent outcomes for acute Achilles tendon rupture, irrespective of surgical versus nonoperative treatment.

Main Methods:

• A randomized controlled trial (Level 1 evidence) involving patients with acute Achilles tendon ruptures.
• Participants were randomized to undergo surgery or receive nonoperative treatment, with both groups adhering to a protocol of early, controlled motion and progressive weightbearing.
• Outcomes were assessed over 12 months using range of motion, calf circumference, and the Musculoskeletal Functional Assessment Instrument (MFAI), alongside monitoring for complications and reruptures.

Main Results:

• No significant differences were observed between the surgical and nonoperative groups in terms of plantar flexion, dorsiflexion, calf circumference, or MFAI scores at any follow-up point (2, 8, 12, 26, 52 weeks).
• Complication rates and rerupture rates were similarly low in both treatment groups.
• One patient in each group required surgical rerepair due to noncompliance.

Conclusions:

• Controlled early motion is a viable and effective rehabilitation strategy for both surgically and nonsurgically managed Achilles tendon ruptures.
• The study suggests that the critical factor for achieving comparable functional results and low rerupture rates is the implementation of early, controlled motion, rather than the surgical intervention itself.