The optimal treatment for acute rupture of the Achilles tendon still
remains controversial. This well-done study by Möller et
al. had a large sample size and several methods of evaluation including
clinical examination, visual analog scores, functional performance
testing, and comparison of time lost from work. The duration of
immobilization was substantially different between the 2 groups.
In the nonsurgical treatment group, the ankle was immobilized in
a cast in equinus for 4 weeks and then in a cast in a neutral position
for another 4 weeks. In the surgical treatment group, the cast was worn
for only 12 days postoperatively, after which a functional brace
was worn with full weight-bearing and range-of-motion exercises
from weeks 3 to 8. In my view, this important difference in the
treatment protocol could have influenced the outcome.
Joint motion enhances soft-tissue healing, particularly of tendon and
ligament injuries1. More specifically,
motion and functional rehabilitation have been shown to be beneficial
in the treatment of ruptures of the Achilles tendon, and immobilization
may actually be detrimental2-4.
Although the authors of this article found surgery with early
mobilization to be superior, a well-controlled, randomized study
that includes comparable post-treatment rehabilitation for both
the surgical and the nonsurgical treatment group still needs to
be done so that the effect of surgery is the only variable assessed.