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A Randomized Controlled Trial Comparing Traditional Plaster Cast Rehabilitation With Functional Walking Boot Rehabilitation for Acute Achilles Tendon Ruptures.
- Source :
-
American Journal of Sports Medicine . Sep2020, Vol. 48 Issue 11, p2755-2764. 10p. - Publication Year :
- 2020
-
Abstract
- Background: There has been a shift toward functional nonoperative rehabilitation in the treatment of Achilles tendon rupture (ATR) despite a shortage of studies directly comparing nonoperative functional rehabilitation with traditional nonoperative immobilization. Purpose: To compare patient-reported outcome measures and functional outcomes for nonoperatively treated ATR with traditional cast immobilization or functional rehabilitation in a walking boot. Study Design: Randomized controlled clinical trial; Level of evidence, 2. Methods: In a single-center nonblinded study, 140 patients were randomized to compare treatment for acute ATR in (1) an immobilizing cast in reducing degrees of equinus over a 10-week period with 8 weeks of nonweightbearing mobilization or (2) a walking boot for 8 weeks with reducing equinus and immediate full weightbearing. Exclusion criteria were delayed presentation >2 weeks after injury, tendon reruptures, and latex allergy. Analysis was undertaken on an intention-to-treat basis. Results: A total of 69 patients (median age, 41 years [interquartile range, 33-50.5 years]) were randomized to walking boot treatment and 71 patients (41 [32-49]) to cast treatment. At 6 months, patients treated in a walking boot reported better Short Musculoskeletal Function Assessment (SMFA) dysfunction index (6.62 [2.21-12.50] vs 10.66 [4.96-13.42]; P =.050), SMFA bother index (7.29 [2.08-14.58] vs 10.42 [5.73-19.27]; P =.04), Achilles Tendon Total Rupture Score (71.5 [53.50-84.25] vs 54.0 [37-76]; P =.01), and Foot and Ankle Questionnaire core score (91 [81.89-97.55] vs 85 [78.25-92.09]; P =.04). At 1 year, there was no difference in SMFA dysfunction index (2.21 [0.74-5.88] vs 2.94 [1.47-6.62]; P =.25), SMFA bother index (2.08 [0-9.38] vs 5.21 [0.52-11.98]; P =.25), Achilles Tendon Total Rupture Score (92 [72.50-96] vs 87.5 [66.0-94.75]; P =.21), or Foot and Ankle Questionnaire core score (97.75 [89.46-99.00] vs 95.50 [90.88-97.50]; P =.18). Rerupture occurred in 5 and 11 patients (P =.075) and venous thromboembolism in 2 and 3 patients (P =.67) in the boot and cast groups, respectively. Fifteen patients in the boot group but none in the cast group had skin problems (P <.001). Patients treated in a boot returned to driving at a median 12 weeks (vs 13 weeks for cast; P =.045), but there was no difference in time to return to work (P =.48). Conclusion: Functional rehabilitation with early weightbearing is a safe alternative to traditional immobilizing treatment for ATR, giving better early functional outcomes, albeit with a higher incidence of transient minor skin complications. Registration: NCT02598843 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]
- Subjects :
- *ANKLE physiology
*ORTHOPEDIC casts
*CHI-squared test
*COMPARATIVE studies
*CONFIDENCE intervals
*EMPLOYMENT reentry
*RANGE of motion of joints
*LONGITUDINAL method
*MEDICAL appointments
*NONPARAMETRIC statistics
*ORTHOPEDIC shoes
*HEALTH outcome assessment
*QUESTIONNAIRES
*REHABILITATION
*STATISTICAL sampling
*SHOES
*STATISTICAL hypothesis testing
*T-test (Statistics)
*TIME
*WALKING
*STATISTICAL power analysis
*PAIN measurement
*CALF muscles
*BODY movement
*RANDOMIZED controlled trials
*TREATMENT effectiveness
*ACUTE diseases
*PHYSICAL activity
*DATA analysis software
*HEEL (Anatomy)
*FUNCTIONAL assessment
*WEIGHT-bearing (Orthopedics)
*DESCRIPTIVE statistics
*MANN Whitney U Test
*ACHILLES tendon rupture
*DISEASE complications
*EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 03635465
- Volume :
- 48
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- American Journal of Sports Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 145453698
- Full Text :
- https://doi.org/10.1177/0363546520944905