Suspected Achilles Tendon Ruptures and the Course of Action: Assessing Compliance With Local Protocols

Achilles tendon rupture is a significant injury that can cause prolonged disability and impact quality of life. It typically occurs during sports or activities involving sudden loading of the tendon, most often in active adults. Early recognition and appropriate management are vital to reduce complications, optimise healing, and support timely return to function. Clinical pathways provide structured guidance for consistent care, including immobilisation, prophylaxis, imaging, and specialist follow-up. Variation in adherence to such pathways may compromise outcomes. Clinical audit provides a means to evaluate current practice against pathway standards, while closed-loop audits allow assessment of targeted interventions aimed at improving compliance.

A closed-loop audit was performed at a large district general hospital to assess compliance with a locally developed Achilles tendon rupture pathway. The first cycle reviewed 138 patients between October 2022 and September 2023. Following the dissemination of results, display of posters in relevant areas, and introduction of a dedicated "Ultrasound Achilles" request form, a second cycle reviewed 44 patients between March and June 2024. Standards included venous thromboembolism (VTE) prophylaxis, weight-bearing advice, immobilisation, ultrasound imaging within 14 days, and referral to a virtual fracture clinic (VFC). Data were analysed using chi-squared tests.

In cycle 1 (n = 138), compliance was as follows: VTE prophylaxis 110/138 (80%); immobilisation in boot 110/138 (80%); ultrasound within 14 days 59/138 (43%); non-weight-bearing advice 91/138 (66%); and VFC referral 132/138 (96%). In cycle 2 (n = 44), after interventions including pathway dissemination and the introduction of a dedicated "Ultrasound Achilles" request form, compliance improved in several domains: VTE prophylaxis 35/44 (80.5%, p = 0.91); immobilisation 38/44 (86%, p = 0.04); ultrasound within 14 days 26/44 (59%, p = 0.03); non-weight-bearing advice 29/44 (66%, p = 0.99); and VFC referral 44/44 (100%, p = 0.01). No re-ruptures or venous thromboembolic events were recorded in either cycle.

Targeted interventions improved compliance with several aspects of the pathway, though VTE prophylaxis prescribing showed little progress. Ongoing education, structured pathways, and regular re-audits are essential to sustain improvement and ensure optimal outcomes.