Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study

Conservative treatment of achilles tendon rupture (ATR) might be favoured in centres with an early weight-bearing protocol, but no consensus exists on the clear definition of an early weight-bearing protocol. The aim of this study is to evaluate the introduction of an early weight-bearing conservative treatment protocol in patients with ATR compared to patients without this protocol.

A single-centre retrospective study was performed. All patients presenting with an ATR during a 10-year period were included. Between January 1st 2008 and December 31st 2015, all patients were included for either operative or conservative treatment without an early weight-bearing protocol (non-EWB). Between January 1st 2016 and 30th June 2019, patients were, primarily, treated conservatively with early weight-bearing protocol (EWB). A primary-outcome parameter was re-rupture, and secondary-outcome parameters were treatment-related complications.

In the period 2008-2015, 246 patients were treated with non-EWB. In the period 2016-2019, 58 patients were treated conservatively with EWB. No significant differences were found in re-rupture rates between non-EWB (5.3%) and conservative EWB (6.9%) (p = 0.536) or conservative non-EWB (9.4%) and conservative EWB (6.9%) (p = 0.283). Pulmonary embolism (1.0%) and deep venous thrombosis (1.0%) were observed in operative non-EWB patients. In conservative EWB patients, superficial pressure ulcers (5.2%) and treatment failure (5.2%) were observed.

Conservative treatment of ATR with an early weight-bearing protocol showed similar re-rupture rates and complication rates compared to conservative and operative treatments without an early weight-bearing protocol.