Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.


 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29.

Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.



To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In all but one study, the limb was immobilized for six to eight weeks. Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone.


Patients were randomized to operative or nonoperative treatment for acute Achilles tendon rupture. All patients underwent an accelerated rehabilitation protocol that featured early weight-bearing and early range of motion. The primary outcome was the rerupture rate as demonstrated by a positive Thompson squeeze test, the presence of a palpable gap, and loss of plantar flexion strength. Secondary outcomes included isokinetic strength, the Leppilahti score, range of motion, and calf circumference measured at three, six, twelve, and twenty-four months after injury.


A total of 144 patients (seventy-two treated operatively and seventy-two treated nonoperatively) were randomized. There were 118 males and twenty-six females, and the mean age (and standard deviation) was 40.4 ± 8.8 years. Rerupture occurred in two patients in the operative group and in three patients in the nonoperative group. There was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were thirteen complications in the operative group and six in the nonoperative group, with the main difference being the greater number of soft-tissue-related complications in the operative group.


This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those for operative treatment. In addition, this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.

Age is a main factor for length of stay after primary elective ankle sugery


Age is a main factor for length of stay after primary elective ankle sugery 

  • January 6, 2014
Pakzad H. J Bone Joint Surg Am. 2014;doi:10.2106/JBJS.K.00834
Age is a significant factor in indicating patients who will have lengthier inpatient recoveries after primary elective total ankle replacement or ankle arthrodesis, according to a recently published data.
In the study, Hossein Pakzad, MD, and colleagues studied 343 patients who underwent open or arthroscopic ankle fusion or total ankle replacement for end-stage ankle arthritis from 2003 to 2010. The researchers concluded that with every yearly increase in age, the length of stay increased by 1%. The median length of stay was 75 hours.
Both Short Form 36 General Health (SF-36 GH) and Physical Component Summary (PCS) scores were significantly associated with the length of stay.Higher SF-36 GH or PCS scores resulted in a shorter length of stay. Female gender, higher American Society of Anesthesiologists grade, multiple medical comorbidities, rheumatoid arthritis and open surgery were also significant factors in length of stay.
Pakzad and his colleagues concluded for those who have risk factors, both better education and more focused perioperative care would aid in shortening length of stay while reducing health care costs. – by Christian Ingram
Disclosure: No authors have received payments or services in support of this work. One or more of the authors, or his or her institution, has had a financial relationship with an entity in the biomedical arena that could be perceived to have the potential to influence this study.