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12 Efficacy of early controlled motion of the ankle in non-operative treatment of acute achilles tendon rupture. An assessor-blinded RCT
  1. Kristoffer Weisskirchner Barfod1,
  2. Maria Swennergren Hansen2,
  3. Per Hölmich1,
  4. Morten Tange Kristensen2,
  5. Anders Troelsen3
  1. 1Sports Orthopedic Research Center – Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  2. 2Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C),Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Hvidovre, Denmark
  3. 3Department of Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark


Background Early controlled ankle motion (ECM) is widely used in the non-operative treatment of acute Achilles tendon rupture although its safety and efficacy has not been investigated properly in a randomized setup.

Purpose/aim of the study To investigate if ECM of the ankle was superior to immobilization (IM) in the treatment of acute Achilles tendon rupture.

Materials and methods The study was performed as an assessor blinded randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was immobilized (IM). The primary outcome was the Achilles tendon Total Rupture Score (ATRS) evaluated at 1 year post-injury. Secondary outcomes were: heel-rise-work test (HRW), Achilles tendon elongation and rate of re-rupture. Analysis was conducted as intention-to-treat with imputation of missing data.

Findings/results 189 patients were assessed for eligibility and 130 included from February 2014 to December 2016; 64 ECM and 58 IM. There was no statistically significant differences (p>0.3) between the ECM and the IM groups at 1 year; Mean (SD) ATRS was 74 (18) and 75 (18), respectively. HRW was 60% (21) and 60% (21) of the uninjured limb, and elongation was 18 mm (13) and 16 mm (11), respectively. Correspondingly, there were 6 and 7 re-ruptures.

Conclusions ECM revealed no benefit to IM in any of the investigated outcomes.

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