Achilles Tendon Rupture Patient Outcomes at 12 Months

NCT07391553 | Not Yet Recruiting

• 2 other identifiers: JRO-0663IRAS ID: 357432
• Study Type: observational
• Target: 115
• Locations: 1 country
• Sites: 2

Brief Summary

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.

Conditions

Achilles Tendon Rupture

Keywords

Achilles tendon rupture; Physiotherapy; orthopaedics; trauma; rehabilitation

Outcome Measures

Primary Outcomes (4)

• 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.

  12-15 months post-injury (single study visit)

• 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.

  12-15 months post-injury (single study visit)

• 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.

  12-15 months post-injury (single study visit)

• 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.

  12-15 months post-injury (single study visit)

Secondary Outcomes (1)

• Correlation Between Isokinetic Strength Measures and Achilles Tendon Total Rupture Score

  12-15 months post-injury (single study visit)

Study Arms (1)

Non-Surgically Managed Achilles Tendon Rupture Cohort

Adults who sustained an Achilles tendon rupture and were managed non-surgically using the SMART rehabilitation protocol within Liverpool University Hospitals NHS Foundation Trust. All participants are 12-15 months post-injury at the time of assessment.

Other: Non-Surgical Management Using the SMART Protocol

Interventions

Non-Surgical Management Using the SMART Protocol OTHER

Participants 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.

Non-Surgically Managed Achilles Tendon Rupture Cohort

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study 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.

You may qualify if:

• 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.
• months post-injury at the time of assessment.
• Able and willing to provide informed written consent to participate in the study.

You may not qualify if:

• 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.
• History of Achilles tendinopathy or rupture in the contralateral (uninjured) leg.
• Unable to tolerate isokinetic strength testing due to pain, discomfort, or other medical reasons.

Sponsors & Collaborators

• Liverpool University Hospitals NHS Foundation Trust: lead

Study Sites (2)

Broadgreen Hospital Physiotherapy department

Liverpool, Merseyside, L14 3LB, United Kingdom

Location

Aintree University Hospital Therapies department

Liverpool, Merseyside, L9 7 AL, United Kingdom

Location

MeSH Terms

Conditions

Wounds and Injuries

Study Officials

• Jeff Morton, BSc. (Hons) Physiotherapy

  Liverpool University Hospitals NHS Foundation Trust

  STUDY CHAIR

Central Study Contacts

Raymond Healy, BSc. (Hons) Physiotherapy

CONTACT

0151 529 3335; raymond.healy@liverpoolft.nhs.uk

Jeff Morton, BSc. (Hons) Physiotherapy

CONTACT

0151 706 2760; jeff.morton@liverpoolft.nhs.uk

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Physiotherapist

Study Record Dates

• First Submitted: January 25, 2026
• First Posted: February 6, 2026
• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): January 1, 2029
• Last Updated: March 3, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

GB (2)