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Early weight-bearing after Achilles tendon repair improved quality of life and activity
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April 2013
Early weight-bearing after Achilles tendon repair improved quality of life and activity
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
J Bone Joint Surg Am. 2008 Sep;90(9):1876-83Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
OE EXCLUSIVE
Dr. Beaupre on Early Weight-Bearing after Surgical Repair of the Achilles Tendon.
Synopsis
110 patients (ages of 17-70 years) after undergoing a surgical repair for Achilles tendon rupture were kept non-weight-bearing for the first two weeks after surgery. Subsequently, they were randomized to be kept either weight-bearing or non-weight-bearing for an additional four weeks. Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
Publication Funding Details
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Funding:
Non-Industry funded
Sponsor:
University of Alberta Hospital Foundation, the Royal Alexandra Hospital Foundation, the Edmonton Orthopaedic Research Committee, and industry funded by DJO Incorporated
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Achilles tendon rupture is a common condition, often managed with open surgical repair. The importance of post-operative rehabilitation can't be over emphasized. The study was conducted, as the the optimal rehabilitation protocol post surgical repair of an Achilles tendon rupture was not well outlined.
What was the principal research question?
Does the early weight-bearing translates into quicker postoperative recovery following repair of an acutely ruptured Achilles tendon in comparison to non-weight bearing?
Study Characteristics
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Population:
110 patients (mean age 39.4 yr) after undergoing a surgical repair for Achilles tendon rupture were kept non-weight-bearing for the first two weeks after surgery and seen in clinic at that time. They were administered a fixed-angle hinged ankle-foot orthosis set to a position of rest, patients in both groups were instructed to to gradually bring the fixed angle hinge to 0 degrees of plantar flexion over two to three weeks
Intervention:
Weight-bearing group: patients in this group were encouraged to begin weight bearing immediately discarding the crutches once they were comfortable (n=55)
Comparison:
Non-weight-bearing group: patients were non- weight bearing for an additional 4 weeks following baseline assessment using axillary crutches for this time. To monitor compliance a sensor was attached to the ankle-foot orthosis (n=55)
Outcomes:
Primary outcome mesures: Health-related quality of life assessed with use of the RAND 36-Item Health Survey (RAND-36).
Secondary outcome measures: Activity level, calf strength, ankle range of motion, return to sports and work, and complications
Methods:
Prospective, Single-center, RCT
Time:
6 weeks, 3 and 6 month assessments
What were the important findings?
- At 6 weeks, the weight-bearing group had significantly better scores in RAND-36 domains of physical functioning, social functioning, role-emotional and vitality scores, than the non-weight-bearing group (p<0.05). Also, the weight-bearing group reported fewer limitations of daily activities (p < 0.001).
- 89% (98/109) patients completed the 6-month follow-up
- At 6 months, no significant differences between the groups were seen in any of the outcome measures, although both groups had poor endurance of the calf musculature.
- No re-rupture reportedly occurred in either group at 6 month follow up.
What should I remember most?
Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
How will this affect the care of my patients?
In the light of this study's findings, this protocol of early weight bearing should be recommended for adoption, as the new standard of care for carefully selected group of patients. Further research with larger sample sizes is needed.
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