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Researchers recommend early walking in a brace for Achilles tendon rupture

Published: 07 February 2020

An NIHR-funded study reveals a breakthrough for sportsmen and women in the treatment of Achilles tendon rupture, according to researchers.

Experts found that early walking in a brace provides similar outcomes to plaster casting with no increase in the risk of complications, which they say paves the way for a big change in the way that patients are treated.

The results from the UKSTAR trial are today published in The Lancet.

The multicentre trial was led by researchers at the University of Oxford and the University of Warwick. It was funded by the NIHR Health Technology Assessment (HTA) Programme and supported by the NIHR Clinical Research Network.

Achilles tendon rupture is a serious and increasingly common injury with over 11,000 cases annually among sporting and non-sporting people in the UK.

Some patients are treated with surgery, but non-operative treatment is increasingly preferred, with patients either treated in a plaster cast to immobilise the foot and ankle, or by the use of functional bracing allowing weight-bearing. But, before the UK STAR study there was little evidence about which was more effective.

Although traditional plaster cast treatment protected the tendon as it healed, there were problems with casts including the immediate impact on mobility, additional risks associated with prolonged immobilisation, and possible long-term issues arising from gait abnormalities and muscle weakness.

With the bracing method, there were questions around the safety profile, specifically whether the risk of re-rupture was higher, leading to the American Academy of Orthopaedic Surgeons being unable to recommend for or against functional bracing in their 2009 guidelines. However, the study found that the risk of re-rupture of the tendon in bracing was lower than reported in existing literature. 

UK STAR involved 540 participants from 39 UK hospitals making it the largest study of its kind comparing the two treatments. Patients were randomly assigned to a plaster cast or functional brace. The objective was to compare function and pain, quality of life, complications including re-rupture, and resource use in patients having non-operative treatment. The study found no difference between the patient-reported Achilles Tendon Rupture Score (ATRS) at nine months, or in the rate of re-rupture of the tendon.

"This research is particularly important for sportsmen and women of all levels and abilities,” said Matthew Costa, Professor of Orthopaedic Trauma Surgery at NDORMS, University of Oxford. “Achilles tendon rupture keeps people away from sport for many months. For some, it stops them ever returning to their favourite recreational activities, and for professional athletes it can be a career-ending injury. Immediate mobilisation in a brace is a safe alternative to plaster casting after an Achilles rupture and patients report better early outcomes, probably because the brace allows them to walk earlier than the cast."

Professor Costa added: “Our new research shows that immediate weight-bearing in a walking boot allows the tendon to heal just as quickly and with no increase in the risk of further rupture. Plus, the walking boot treatment is cheaper for the NHS."

Researchers say more research is needed exploring how best to rehabilitate patients after the walking boot is discarded.

More information about the study is available on the NIHR Funding Awards website.

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