Achilles Tendon Rupture Patient Outcomes at 12 Months

Achilles tendon rupture is a common injury that can significantly impact strength, function, and quality of life. While non-surgical management using structured rehabilitation protocols such as the Swansea Morriston Achilles Rupture Treatment (SMART) protocol is increasingly adopted, there is limited evidence on long-term recovery outcomes, particularly beyond six months. This study aims to evaluate recovery at 12-15 months following non-surgical management of Achilles tendon rupture in an NHS population. Participants will attend a single study visit during which plantarflexor muscle strength will be assessed using isokinetic dynamometry, and patient-reported outcomes will be collected using the Achilles Tendon Total Rupture Score (ATRS) and EQ-5D-5L questionnaire. Achilles Tendon Resting Angle (ATRA) will also be measured to provide an estimate of tendon elongation. The primary objectives are to quantify plantarflexor strength recovery and self-reported functional outcomes. Secondary analyses will explore associations between strength, tendon elongation, quality of life, return to sport, and pre-injury symptoms. This cross-sectional observational study will recruit adult patients managed non-surgically with the SMART protocol from Liverpool University Hospitals NHS Foundation Trust. Findings will provide clinically relevant data on long-term recovery following conservative treatment and may inform rehabilitation strategies and return-to-activity decision-making.

Inclusion Criteria: Aged 18 years or older at the time of recruitment * Have a confirmed diagnosis of Achilles tendon rupture, diagnosed clinically and recorded within the NHS clinical database * Have been managed non-surgically using the SMART (Swansea Morriston Achilles Rupture Treatment) rehabilitation protocol * Be between 12 and 15 months post-injury at the time of study assessment * Be able and willing to provide written informed consent to participate in the study Exclusion Criteria: * Unable to provide informed consent * Have previously undergone surgical repair of the Achilles tendon or experienced a re-rupture * Have a neuromuscular or neurological condition that could affect lower limb strength or function * Did not follow the SMART rehabilitation protocol for non-surgical management * Have a history of Achilles tendinopathy or rupture in the contralateral (uninjured) limb * Are unable to tolerate isokinetic strength testing due to pain, discomfort, or other medical reasons