Achilles Tendon Rupture Patient Outcomes at 12 Months
ConditionAchilles Tendon Rupture
Trial statusNot yet recruiting
Trial phaseNot listed
Trial typeObservational
Biological sexAll
Age18+
SponsorLiverpool University Hospitals NHS Foundation Trust
About this trial
The Achilles tendon is the strongest and largest tendon in the human body, playing a critical role in plantarflexion and facilitating activities such as walking, running, and jumping. However, it is also the most frequently ruptured tendon. The injury and associated disability have a significant impact on patient quality of life and healthcare services. Achilles tendon ruptures are increasingly common, particularly among middle-aged recreational athletes, with an incidence estimated at 18 per 100,000 person-years.
The Swansea Morriston Achilles Rupture Treatment (SMART) protocol represents a structured, progressive approach to non-operative rehabilitation. It emphasizes early mobilization, protected weight-bearing, and a gradual return to sport or high-level function through targeted strength and neuromuscular training. While short-term outcomes of non-surgical protocols have demonstrated promising results, there remains limited high-quality data on long-term isokinetic strength and patient-reported functional outcomes beyond six months in this patient group.
This study aims to evaluate isokinetic plantarflexor strength and self-reported functional outcomes at 12 months following non-surgical management of Achilles tendon ruptures using the SMART rehabilitation protocol. By assessing both objective and subjective recovery metrics, we aim to contribute to the growing evidence base for evidence-informed, conservative Achilles tendon rehabilitation. A secondary aim of the study is to examine the relationship between isokinetic strength scores and self reported functional recovery scores using the ATRS questionnaire.
Participants will attend one 60-90 minute visit to complete a short questionnaire and perform a safe, clinic-based ankle strength test using an isokinetic machine; the test feels like pushing against a footplate, similar to resisted ankle movements. The results of these tests will be collected and analysed. The study will help to gain further insight into patient recovery from this injury.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Adults aged 18 years or older at the time of recruitment.
Confirmed diagnosis of Achilles tendon rupture, diagnosed clinically and recorded within the NHS database.
Injury managed non-surgically using the SMART (Swansea Morriston Achilles Rupture Treatment) protocol.
12-15 months post-injury at the time of assessment.
Disqualifiers
Unable to provide informed consent.
Previous surgical repair of the Achilles tendon or documented re-rupture.
Presence of a neuromuscular disorder affecting lower limb strength or function.
Did not follow the SMART protocol for non-surgical management.
Trial population
Adults who previously sustained an Achilles tendon rupture and were treated non-surgically using the SMART rehabilitation protocol within Liverpool University Hospitals NHS Foundation Trust. Eligible participants are identified from an existing clinical database and represent patients 12-15 months post-injury who completed standard physiotherapy rehabilitation. All participants are drawn from routine NHS orthopaedic and physiotherapy services at Aintree and Broadgreen Hospitals.
Trial design
Design model
Cohort
Time perspective
Cross-sectional
Treatments tested in this trial
Non-Surgical Management Using the SMART Protocol
Other interventionParticipants previously received standard non-surgical treatment for Achilles tendon rupture following the SMART (Swansea Morriston Achilles Rupture Treatment) functional rehabilitation protocol as part of routine NHS care. No interventions are assigned as part of this study; all data are collected at a single follow-up visit.
Treatment groups
115 Participants
are divided into 1 treatment groupGroup A: Non-Surgically Managed Achilles Tendon Rupture Cohort1 intervention
Trial outcomes
Primary outcomes
1
Peak Plantarflexion Torque (Nm)
Maximum rotational force produced by the plantarflexor muscles during an isokinetic concentric contraction, measured using an isokinetic dynamometer. This measure reflects calf muscle strength and tendon function following non-surgical Achilles tendon rupture management.
Time frame
12-15 months post-injury (single study visit)2
Peak Plantarflexion Torque Normalized to Bodyweight (Nm/kg)
Peak plantarflexion torque adjusted for each participant's bodyweight. Normalisation allows strength comparisons between individuals of different body sizes and provides a more functional evaluation of recovery.
Time frame
12-15 months post-injury (single study visit)3
Limb Symmetry Index (LSI) for Peak Torque (%)
Ratio of injured limb peak plantarflexion torque to the uninjured limb, expressed as a percentage. An LSI ≥90% is typically considered indicative of satisfactory recovery.
Time frame
12-15 months post-injury (single study visit)4
Achilles Tendon Total Rupture Score
A validated patient-reported outcome measure assessing symptoms and functional limitations following Achilles tendon rupture. Scores range from 0 to 100, with higher scores indicating better perceived recovery.
Time frame
12-15 months post-injury (single study visit)Secondary outcomes
1
Correlation Between Isokinetic Strength Measures and Achilles Tendon Total Rupture Score
Statistical correlation between objective isokinetic strength metrics (peak torque, PT:BW, and LSI) and subjective functional recovery measured by ATRS. Pearson's correlation coefficient will be used unless data violate normality assumptions, in which case Spearman's rank correlation will be applied.
Time frame
12-15 months post-injury (single study visit)Sponsors and contacts
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Source ClinicalTrials.gov
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