Treatment of acute Achilles tendon rupture with a standardised protocol



A treatment protocol favouring non-operative treatment and based on early weight-bearing and early range-of-motion exercises was implemented in standard clinical care of a level I trauma clinic.

Materials and methods

All patients treated due to acute Achilles tendon rupture between 2008 and 2014 were included in the study (n = 411). The patient records were retrospectively evaluated.


The mean age of patients was 47 (range 17–88) years. In total, 213 (52%) acute Achilles tendon ruptures were treated operatively and 198 (48%) non-operatively. The annual proportion of operatively treated patients declined from 70 to 21% during the study period. The traumatic re-rupture rate was similar between the operative (4%) and the non-operative (6%) treatment groups (p = 0.385), even though the patients in the non-operative group were significantly older and had more co-morbidities than the operatively treated patients. Of the operatively treated patients, 10% (n = 21) had wound healing problems. In 6/198 patients, the non-operative treatment had to be converted to surgical treatment in the early phase. Unsatisfactory functional outcome after the treatment was reported in 7/213 patients in the operative and 10/198 in the non-operative group (p = 0.234).


Our study showed that it is possible to implement a standardised treatment protocol to guide the decision-making and treatment and of an acute Achilles tendon rupture as a part of the daily care in a large standard trauma hospital. The clinical outcome and the rate of complications were fully comparable to the good clinical results achieved in RCT-study settings despite the heterogeneity of the treated patients and non-specialisation of the medical staff, showing that the protocol could find the most reasonable treatment for each patient and reduced dramatically the rate of operative treatment.

Level of evidence

Level III, comparative series.

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The study was financially supported by the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, grant numbers 9R006 and 9R031.

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Corresponding author

Correspondence to Heidi Haapasalo.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study protocol has been approved by the Ethics Committee of Pirkanmaa District Hospital (approval number R11005).

Informed consent

The study data were collected retrospectively from the medical records of the patients who were treated according the hospital treatment protocol, so informed consent was not needed.

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Haapasalo, H., Peltoniemi, U., Laine, H. et al. Treatment of acute Achilles tendon rupture with a standardised protocol. Arch Orthop Trauma Surg 138, 1089–1096 (2018).

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  • Achilles tendon
  • Acute Achilles tendon rupture
  • Treatment protocol
  • Complications