Outcomes, physical performance, and complications following treatment of acute Achilles’ tendon ruptures

The Achilles´ tendon is the strongest tendon in the human body. A rupture may lead to gait abnormalities caused by tendon elongation. Treatment options are non-operative and surgical including open, minimally invasive, and percutaneous techniques. We performed the world’s largest randomized controlled trial (RCT) comparing three treatments of acute Achilles´ tendon ruptures. 554 patients from four centers were randomly assigned to receive non-operative treatment, open repair, or minimally invasive surgery. 526 patients were included in the analyses. The main outcome was patient satisfaction measured by the only available injury specific patient reported outcome measure for acute Achilles´ tendon rupture – the acute Achilles´ tendon Total Rupture Score (ATRS). The validity and reliability of the Norwegian translation of the ATRS was found acceptable. We also compared measurement methods for measuring the length of the Achilles´ tendon using ultrasound and found that the best agreement and most reliable measures were produced using measurements from the distal medial musculo-tendinous junction to the tendon´s insertion on the back of the heel using skin markings and a measuring tape. In the RCT we found that despite a higher risk of re-rupture after non-operative treatment, patient satisfaction and physical performance were similar comparing the three treatment groups after 1 year