Outcome After Conservatively Treated Achilles Tendon Rupture

Patient-reported Outcomes After Non-operative Treatment of Acute Achilles Tendon Rupture: a Prospective Cohort Study.

The main purpose of the study is to investigate self-reported functional ability of patients undergoing conservatively treated achilles tendon rupture at 6, 12 and 24 months from the date of injury.

Study Overview

• Status: Enrolling by invitation
• Conditions: Achilles Tendon Rupture; Achilles Tendon Injury
• Intervention / Treatment: Other: 11 weeks of immobilization

Detailed Description

Background:

The achilles tendon is the most injured tendon in the lower extremity. An achilles tendon rupture (ATR) is treated either surgically or non-surgically. Previous studies have investigated early controlled motion and weight-bearing for non-surgically treated ATR. Early motion may cause tendon elongation, which leads to decrease in push off strength, and thus potentially a poorer functional outcome. Conversely, delayed initiation of mobilisation and weight-bearing may similarly hinder or delay optimal recovery of function and return to work and sports. The correct treatment and rehabilitation, including the timing of rehabilitation initiation, may therefore be crucial to ensure the patients' functional ability.

Most hospitals in Denmark treating patients with ATR, provide a regime of 8 weeks immobilization for conservatively treated patients with ATR. At Aarhus University Hospital (AUH), however, a more restrictive regime is provided for these patients, requiring immobilization for 11 weeks after injury. Typically, a late initiation of mobilization is defined as mobilization beginning in week 8, i.e. 3 weeks sooner than the standard regime at AUH. Furthermore, many "late" mobilization regimes allows for some non-weightbearing exercises prior to week 8, but at AUH patients are recommended to limit any movement during the first 11 weeks after injury. This is primarily to reduce the risk of a re-rupture, the rate of which is lower at AUH than on a national level (i.e. <5% versus 7-8% re-rupture rate). However, this delayed onset of mobilization and weight-bearing may have a negative effect on return to normal function, sports and work.

Since 2012, a number of Danish hospitals, treating patients with ATR, have reported re-rupture rates, and self-reported functional ability and working status, etc. is reported at 6, 12 and 24 months. This data are published in a report, enabling comparison with other populations. At present, AUH does not report these data into to the database, and the data published in the early report may therefore serve as comparison group in this quality assurance study.

Purpose: The aim of this quality assurance study is therefore to investigate to what extent the stricter regime at AUH following conservatively treated ATR affects the patients' functional ability after 6, 12 and 24 months after injury, compared to patients treated at other Danish hospitals with less strict regimes.

Materials and methods:

Study design and participants:This is a cohort study, using self-reported data collected prospectively from approximately 100 consecutive patients (18+) recruited at AUH with a non-surgically treated ATR. These data will be compared with self-reported data from the Danish Achilles tendon Database (DAB) i.e. an existing cohort of patients with ATR treated at other Danish Hospitals. The data is freely available in yearly reports at (https://www.hvidovrehospital.dk/sorc-c/projects/Pages/The-Danish-Achilles-tendon-Database-(DADB).aspx).

Standard mobilization procedure: As part of standard care at AUH, all patients treated non-surgically for ATR are immobilized in scotch cast during weeks 0-4. Next, the scotch cast is replaced by a ROM-WALKER for the next 7 weeks (week 5-11 after injury), but without weight bearing weeks 5-10. At week 11 the patients are allowed weight bearing up to 30 kg, after which there is no longer weight bearing restrictions.

Data collection: Patients will receive a digital letter with a link to an online questionnaire to be completed at 6 months, 12 months and 24 months from the date of injury.

Patients are asked to fill out the patient-reported outcome measure Achilles tendon Total Rupture Score, as well as additional questions regarding job status, return to sport, incidence of deep venous thrombosis, if they have had a re-rupture of the same achilles tendon and their satisfaction with treatment they received at the hospital.

The ATRS is a 10-item questionnaire, with a score of 0 to 10 (worst-best), which has been found valid, reliable and responsive in this population.

Statistical analysis:

The primary outcome is ATRS score at 12 months, which will be compared to the 12 month ATRS score in the 2021 report of the Danish Achilles Tendon Database (DADB), including app. 2000 patients.

The needed sample size to find a minimal clinical important difference of 10 points (SD 18) between our population and the population of DADB is 51 patients in each group, to achieve a power of 80% and alpha set at 5%.

Expected outcomes and perspectives: this study will bring knowledge about patient-reported outcomes on achilles function, physical acitivity and work status in patients with conservatively treated ATR, following an immobilization protocol of 11 weeks duration.

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Mette F Fenger, BA; Phone Number: 40321618; Email: Mette.Frank@auh.rm.dk
• Study Contact Backup: Name: Louise Mortensen, Msc; Phone Number: +45 61629524; Email: louimr@rm.dk

Study Locations

• Denmark
  • Aarhus, Denmark, 8200
    • Aarhus University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of 100 consecutive achilles tendon rupture patients, treated conservatively at Aarhus University Hospital during 2022.

Description

Inclusion Criteria:

• Patients with an acute achilles tendon rupture treated conservatively at AUH
• 18 years or older

Exclusion Criteria:

• Patients who have not followed the regime at AUH (e.g. terminated use of the ROM- walker prematurely or similar).

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported functional ability at 12 months after injury	Achilles tendon Total Rupture Score is a self-reported questionnaire with 10 items, summing up to a score of 0-100 points, with 100 points reflecting no disability. The primary outcome will be ATRS score at 12 months, but data will also be collected at 6 and 24 months to describe any changes over time.	12 months post-injury

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of participants who have returned to previous working status at 12 months	Self-reported return to previous work (if at working age)	12 months post-injury
Percentage of participants who have returned to previous sports activities at 24 months	Self-reported return to sport	24 months post-injury
Percentage of participants with re-rupture at 12 months	Self-reported re-rupture	12 months post-injury

Collaborators and Investigators

• Sponsor: Aarhus University Hospital
• Investigators: Study Director: Nanna Rolving, Ph.d., Aarhus University Hospital, Department of physiotherapy and occupational therapy; Study Director: Per Gundtoft, Ph.d., Aarhus University Hospital, Department of Orthopaedics

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2022
• Primary Completion (Estimated): February 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: November 3, 2022
• First Submitted That Met QC Criteria: November 10, 2022
• First Posted (Actual): November 14, 2022

Study Record Updates

• Last Update Posted (Actual): July 25, 2023
• Last Update Submitted That Met QC Criteria: July 22, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Functional ability; Immobilization; Achilles tendon rupture
• Additional Relevant MeSH Terms: Wounds and Injuries; Rupture; Tendon Injuries
• Other Study ID Numbers: AarhusUH-MFenger

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No