Nonoperative treatment of Achilles tendon rupture with 6- versus 8-week protocol: a single-center cohort study from...

Although nonoperative treatment of Achilles tendon rupture (ATR) has become increasingly common, the optimal duration of immobilization and early functional rehabilitation remains uncertain. We aimed to compare outcomes of 8-week and 6-week nonoperative treatment protocols for ATR, with particular focus on re-rupture rates and treatment failure requiring surgery.

This register study included all university hospital-treated ATRs in the Northern Savo region, Finland, between 2014 and 2023. Patients were identified using ICD-10 and NOMESCO procedure codes. We compared outcomes between an 8-week nonoperative treatment protocol used in 2014-2018 and a 6-week protocol used in 2019-2023. Outcomes included patient demographics, treatment distribution, indications for surgery, and complications.

Among 479 ATRs, 429/479 (90%) were treated nonoperatively. Operative treatment was mainly done in athletes. Operative treatment was performed in 32/251 (13%) patients in the 8-week protocol group and in 18/228 (7.9%) patients in the 6-week protocol group. Re-rupture rates were similar between the 8-week and 6-week protocols (7/251 [2.8%] vs 4/228 [1.8%] absolute risk difference -1.0 percentage point, 95% confidence interval -3.7 to 1.6). Operative treatment was mainly indicated for athletes, chronic ruptures, and re-ruptures, with a postoperative complication rate of 14%.

Outcomes regarding re-rupture and treatment failure following the 6-week nonoperative protocol were comparable to those observed with the 8-week protocol However, larger comparative studies in more diverse populations are needed to confirm the generalizability of these findings.