Outcomes of Non-operatively Managed Achilles Tendon Rupture: A Retrospective, Single-Centre Study

TL;DR

This study examines the outcomes of non-surgical treatment for Achilles tendon ruptures using the LAMP protocol and finds generally satisfactory recovery.

Contribution

The study provides new evidence on the effectiveness of the LAMP protocol for non-operative Achilles tendon rupture management in a UK hospital setting.

Findings

The mean Achilles Tendon Total Rupture Score (ATRS) was 67.1, indicating varied but generally satisfactory recovery.

Most patients were male with an average age of 52.1 years.

Non-operative management avoided surgical complications while achieving functional recovery.

Abstract

Introduction

Achilles tendon ruptures can be managed surgically or conservatively. Due to the increased risk of post-operative complications, non-surgical management is often preferred. Evidence suggests that non-operative approaches can achieve outcomes comparable to surgical repair. One such approach is the Leicester Achilles Management Protocol (LAMP), which involves immobilisation in a VACOped boot for eight weeks. Patient outcomes following non-operative management are commonly assessed using the Achilles Tendon Total Rupture Score (ATRS). In this retrospective study, it is hypothesised that patients managed with the LAMP protocol will report favourable outcomes as measured by the ATRS.

Methodology

This retrospective cohort study analysed patients who presented and were managed for Achilles tendon rupture at a district general hospital in the West Midlands, UK, between January 2022 and October 2024. Patients aged 18 years and above with confirmed Achilles tendon injuries (International Classification of Diseases, Tenth Revision (ICD-10) code: S86.0), managed through fracture or elective clinics, were included in the analysis. Data obtained from electronic health records included demographics, comorbidities, management duration, time to rehabilitation, and patient-reported outcomes using the ATRS. ATRS data were collected via telephone interviews conducted by local clinicians and analysed descriptively using frequencies, means, and ranges.

Results

A total of 53 patients were initially screened for inclusion. Eight patients were excluded following clinic reassessment due to misdiagnosis (no rupture or posterior tibial rupture) or death. Of the remaining 45 patients contacted by telephone, 16 did not respond after two attempts, and one declined participation. The final study cohort comprised 28 patients.

The analysis showed that patients were mainly male, with an average age of 52.1 years (range: 29-82). Patient-reported outcome measures showed the mean ATRS was 67.1 (range: 26-100), reflecting a wide variation in self-reported recovery.

Conclusion

Despite a lower ATRS compared to previous studies with non-operative management, this retrospective study showed that LAMP provides satisfactory functional recovery whilst avoiding operative and post-operative complications.

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