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Early weight-bearing improves health-related quality of life during recovery following surgical repair of acute Achilles tendon rupture, study data indicate

Friday, October 03 2008 | Comments

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What's This? Early weight-bearing following surgical repair of an acute Achilles tendon rupture may improve health-related quality of life (HRQOL) during the early postoperative period with no detrimental effect on recovery, according to study findings.

Researchers enrolled 110 patients with a surgically repaired Achilles tendon rupture from 1 of 2 major trauma-care tertiary hospitals; all patients were non-weight-bearing for the first 2 weeks postoperatively. At the 2-week postoperative visit, patients were randomized to either a weight-bearing group--in which patients were encouraged to discard their clutches as soon as they were comfortable--or a non-weight-bearing group that remained on crutches for an additional 4 weeks. The primary endpoint of the study was HRQOL, as assessed by the RAND 36-Item Health Survey (RAND-36).

Overall, 98 patients (89%) completed 6 months of follow-up. Between the 2-week and 6-week visits, the weight-bearing group had a median number of 5,985 steps compared with 960 steps in the non-weight-bearing group (P=.01).

At the 6-week follow-up visit, the weight-bearing group had significantly better outcomes than the non-weight-bearing group in the domains of physical functioning (61.4 vs 47.6; P=.03), vitality (69.4 vs 60.6; P=.04), social functioning (72.7 vs 60.7; P=.03), and role emotional (84.6 vs 67.3; P=.02).

Furthermore, 23 patients (43%) in the weight-bearing group reported either no limitations or limitations only in recreation at the 6-week follow-up visit compared with 5 patients (9%) in the non-weight-bearing group (P<.001).

However, 2-way repeated-measures analysis of variance comparison for the RAND-36 questionnaire indicated that only social functioning differed between groups over time (P<.001), whereby the weight-bearing group had significantly better social functioning than the non-weight-bearing group during the overall recovery period (P=.04).

All patients demonstrated substantial recovery during follow-up. At the 6-month follow-up visit, the calculated calf endurance of both groups was approximately 50% of that of the unaffected side (no between-group difference), and 97% of patients had returned to work. Also at 6 months, 67% of patients in the weight-bearing group and 63% of patients in the non-weight-bearing group had returned to at least partial sports activity.

No reruptures occurred in either group, and major complications occurred only among patients in the non-weight-bearing group, including 1 patient (2%) who developed a deep venous thrombosis and 1 patient (2%) who sustained a wound slough. Minor complications--including sural nerve dysesthesias, superficial infections, delayed wound healing, and scar adhesions--occurred in 8 patients (15%) in the weight-bearing group and 9 patients (16%) in the non-weight-bearing group.

"The postoperative early weight-bearing protocol provided enhanced quality of life and activity level without an increase in complications in the early postoperative period," the authors concluded. "Given these findings, this protocol has been adopted as the new standard of care in our tertiary health-care region for appropriately selected patients." (Suchak AA, et al. J Bone Joint Surg Am 2008;90:1876-1883.)

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