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Major functional deficits persist 2 years after acute Achilles tendon rupture



The purpose of this prospective randomized controlled study was to evaluate the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically. The focus was to evaluate whether any improvements occurred between the one and 2-year evaluation.


Eighty-one patients (67 men, 14 women) with a mean (SD) age of 42 (9.1) were included in this study. Forty-two patients were treated surgically, and 39 treated non-surgically otherwise the treatment was identical for the two groups. All patients were evaluated using the Achilles tendon Total Rupture Score (ATRS), the Physical Activity Scale (PAS) and validated functional tests one and 2 years after injury.


There were significant functional deficits on the injured side compared with the contralateral side 2 years after Achilles tendon rupture, regardless of treatment. Only minor improvements, even though statistically significant, occurred between the 1- and 2-year evaluations. The physical activity level remained significantly reduced as compared with prior to injury, but the ATRS mean was relatively high in both groups (89 and 90).


This long-term follow-up indicates that the majority of patients with an Achilles tendon rupture have not fully recovered (in regards to symptoms, physical activity level and function) 2 years after injury regardless of surgical or non-surgical treatment. Furthermore, only minor improvements occur between the 1- and 2-year evaluations. This indicates that to enhance the final outcome the focus should be on improvements in treatment within the first year. The patients appear to have adjusted to their impairments since the patient-reported outcome is relatively high in spite of functional deficits and lower activity level compared with pre-injury.

Level of evidence

Prospective randomized study, Level I.

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The authors thank Lotta Falkheden-Henning and Annelie Brorsson for their help treating and evaluating the patients. We would also thank Toran MacLeod for manuscript review. This study was supported by the Swedish National Centre for Research and Sports (CIF).

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Nicklas Olsson.

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Olsson, N., Nilsson-Helander, K., Karlsson, J. et al. Major functional deficits persist 2 years after acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 19, 1385–1393 (2011).

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  • Achilles tendon rupture
  • Long-term results
  • Functional tests
  • Heel-rise work
  • Patient-reported outcome
  • ATRS