Willits Achilles RCT

Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.

Willits K, Amendola A, Bryant D, et al. The Journal of bone and joint surgery. American volume 2010 · PMID 21037028 · doi:10.2106/jbjs.i.01401

Question

When accelerated functional rehabilitation is used, does surgical repair of an acute Achilles rupture reduce re-rupture or improve function compared with non-operative treatment?

Design

Multicentre RCT in Canada with both arms receiving the same accelerated functional rehabilitation protocol.

Patients

Adults with an acute Achilles tendon rupture.

Intervention

Open operative repair followed by accelerated functional rehabilitation

Comparison

Non-operative treatment with accelerated functional rehabilitation

Primary outcome

Re-rupture rate; secondary isokinetic strength, Leppilahti score and range of movement

Key result

Re-rupture rates were low and not significantly different between groups, and there was no significant difference in strength, function or range of movement. Surgery carried more complications, mainly wound-related.

Limitations

Modest sample size limits power to detect small differences in re-rupture; single-country setting with a specific rehabilitation protocol.

Impact on practice

Shifted practice towards non-operative management with early functional rehabilitation for most acute Achilles ruptures, reserving surgery for selected patients.