UKSTAR

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation.

Costa ML, Achten J, Marian IR, et al. Lancet (London, England) 2020 · PMID 32035553 · doi:10.1016/s0140-6736(19)32942-3

Question

In adults having non-operative treatment for an acute Achilles tendon rupture, does early weight-bearing in a functional brace give better outcomes than a traditional plaster cast?

Design

Pragmatic multicentre RCT with economic evaluation across UK NHS hospitals.

Patients

Adults with an acute Achilles tendon rupture managed without surgery.

Intervention

Functional brace (boot with heel wedges) allowing early weight-bearing

Comparison

Plaster cast immobilisation in equinus

Primary outcome

Achilles Tendon Rupture Score (ATRS) at 9 months

Key result

There was no significant difference in ATRS at 9 months between the brace and cast groups, and re-rupture rates were similar. The brace was not shown to be clinically superior.

Limitations

Participants and clinicians could not be blinded, and the trial compared two non-operative regimens rather than surgery versus non-operative care.

Impact on practice

Supports either a functional brace or a cast for non-operative Achilles rupture care; many UK units now use early weight-bearing in a boot as it is safe and convenient for patients.