Plaster cast and walking boot, each with rehabilitation, are comparable in patients with acute Achilles tendon rupture

Référence

Maempel JF, Clement ND, Duckworth AD, Keenan OJF, White TO, Biant LC. A randomized controlled trial comparing traditional plaster cast rehabilitation with functional walking boot rehabilitation for acute achilles tendon ruptures. Am J Sports Med 2020;48(11):2755-2764.

Sommaire

This study included patients with acutely ruptured Achilles tendons who initially presented to a single hospital in Scotland. The researchers randomized the patients (all of whom were older than 33 years) to treatment with a walking boot (n = 69) or with a below-knee plaster cast (n = 71). The plaster casts placed the patient into full equinus position. After 4 weeks, the casts were replaced to hold the foot in the semi-equinus position for an additional 4 weeks, after which the patients were re-casted into neutral position and they could begin to bear weight. The walking boots had internal heel pads that were initially raised 3 cm and the patients could begin immediate weight-bearing (with the aid of crutches, if needed). The boot allowed more frequent, gradual repositioning of the foot into a neutral position over the subsequent 8 weeks before removal of the brace. After removal of the cast or boot, all patients underwent the same rehabilitation program. The main outcome was a 6-month and 12-month functional assessment score that the authors don't really describe. Additionally, the authors calculated the Achilles tendon Total Rupture Score (ATRS) for each patient. Four patients converted from boot to cast treatment and one went from cast to boot. The authors had 1-year follow-up on only 100 of the original 140 patients. This worrisome 29% loss to follow-up taints the findings. Patients in each group improved from baseline. The authors report statistically significant differences in various measures (of uncertain clinical significance) at 6 months, but these were gone after a year. After 12 months, more than 90% of the patients in each group had returned to normal daily activities, including driving and working. Since 130 of the 140 original patients were fully employed, the study sample may not represent the patients we see. Finally, we recently reviewed a larger, multicenter study that reached similar conclusions and more completely describes the ATRS.