Early weight-bearing after Achilles tendon repair improved quality of life and activity .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):51 J Bone Joint Surg Am. 2008 Sep;90(9):1876-83Exclusive Author Interview
Dr. Beaupre on Early Weight-Bearing after Surgical Repair of the Achilles Tendon.
110 patients (ages of 17-70 years) after undergoing a surgical repair for Achilles tendon rupture were kept non-weight-bearing for the first two weeks after surgery. Subsequently, they were randomized to be kept either weight-bearing or non-weight-bearing for an additional four weeks. Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Achilles tendon rupture is a common condition, often managed with open surgical repair. The importance of post-operative rehabilitation can't be over emphasized. The study was conducted, as the the optimal rehabilitation protocol post surgical repair of an Achilles tendon rupture was not well outlined.
What was the principal research question?
Does the early weight-bearing translates into quicker postoperative recovery following repair of an acutely ruptured Achilles tendon in comparison to non-weight bearing?
- At 6 weeks, the weight-bearing group had significantly better scores in RAND-36 domains of physical functioning, social functioning, role-emotional and vitality scores, than the non-weight-bearing group (p<0.05). Also, the weight-bearing group reported fewer limitations of daily activities (p < 0.001).
- 89% (98/109) patients completed the 6-month follow-up
- At 6 months, no significant differences between the groups were seen in any of the outcome measures, although both groups had poor endurance of the calf musculature.
- No re-rupture reportedly occurred in either group at 6 month follow up.
What should I remember most?
Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
How will this affect the care of my patients?
In the light of this study's findings, this protocol of early weight bearing should be recommended for adoption, as the new standard of care for carefully selected group of patients. Further research with larger sample sizes is needed.
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