Randomised three-armed trial investigation of the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA) for individualised treatment of acute Achilles tendon rupture.

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Study Summary

300 patients with acute Achilles tendon rupture were randomized to individualized treatment using the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA), routine non-operative treatment, or routine operative treatment. The primary outcome was the limb symmetry index on the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT performance at 6 months, heel-rise height, Achilles tendon Total Rupture Score, Tegner activity scale, tendon length, Achilles Tendon Resting Angle (ATRS), and complications. Outcomes were assessed at 6 and 12 months. Overall, the results revealed no significant differences in the primary functional outcome between CARTA and either comparator. However, CARTA reduced reruptures and improved patient-reported outcomes compared with non-operative treatment, while requiring fewer operations than routine operative care; suggesting that ultrasound-guided treatment selection may reduce unnecessary surgery without compromising recovery.