Operative vs. Non-Operative Treatment of Acute Ruptures of the Achilles Tendon

Operative vs. Non-Operative Treatment of Acute Ruptures of the Achilles Tendon: A Multi-centered Randomized Control Trial Using Standardized Objective and Subjective Outcome Measurement to Determine Rerupture Rate.

The proposed trial is a multi-centre prospective randomized controlled trial comparing outcomes of patients with acute Achilles tendon ruptures treated either non-operatively or with open operative tendon repair. All patients will undergo accelerated functional rehabilitation. The primary outcome measure is Achilles tendon re-rupture rate.

Equivalent clinical outcomes to surgical repair; reduced morbidity and disability to subjects through elimination of a surgical repair; reduction of cost to patients by eliminating need for surgery.

Inclusion Criteria:

• Complete mid-substance rupture of the Achilles tendon as diagnosed on clinical exam
• Present for initial assessment and treatment with application of a plantar-flexed cast within 48 hours of their injury.
• Referred to one of the participating orthopaedics surgeons in a timely fashion so as to allow for further treatment (operative repair or initiation of the rehabilitation protocol) within 14 days of their injury.

Exclusion Criteria:

• Open Achilles injury
• Achilles injury that is not a mid-substance tendon injury
• Any additional injury to the ipsilateral lower extremity
• Contraindication to surgery or anesthetic
• (Physical or mental) that may interfere with compliance with the rehabilitation protocol
• Any known factor for increased risk of Achilles tendon rupture (i.e. diabetes mellitus, immunosuppressive therapy including local or systemic steroids, and fluoroquinolone use).