Optimizing Achilles Tendon Rupture Care: The Efficacy of Physiotherapy-Led Conservative Management in a District General Hospital.

Introduction Achilles tendon rupture (ATR) represents a significant musculoskeletal injury that can affect many patients' mobility and quality of life. Treatment of ATR consists of both conservative and surgical options, with the traditional belief being that surgical intervention reduces the risk of re-rupture. However, with the introduction of physiotherapy-led functional rehabilitation strategies with early mobilization, it has been shown that re-rupture rates are equal among surgical and non-surgical patients. This study focuses on evaluating the effectiveness of non-surgical, physiotherapy-led management, specifically within the context of patients at a district general hospital. The rationale for investigating this approach lies in the growing interest and adoption of conservative management strategies for ATR across orthopaedic practices within the National Health Service (NHS). Methods This is a retrospective cross-sectional study assessing the efficacy of the physiotherapy-led treatment pathway in our district general hospital. Data were retrospectively collected from Hive, which is the trust's electronic patient record (EPR) and has comprehensive access to all patients' history, notes, images, investigations, and previous letters. We looked at all patients treated by physiotherapists for ATR from September 2022 to December 2023. Results In total, 76 patients were treated along the physiotherapy-led pathway for ATR between September 2022 and December 2023. The ages ranged from 22 to 82 years, with a mean age of 47 years. Of the patients, 48.6% (n = 37) were in the 40-60 years age range. The gender distribution was 69.7% (n = 53) males and 30.3% (n = 23) females (total = 76). The injury characteristics revealed a predominance of complete ATR, with 88.1% (n = 67) of cases being complete ATR, and 11.9% (n = 9) being partial ATR. Patients experiencing re-ruptures ranged from 34 to 64 years old, with three males and one female. Re-escalation to a consultant in only 14.5% of cases (n = 11) reflects successful initial management, minimizing the need for further interventions. Based on the available data, on average, younger patients (≤49 years) returned to work approximately 5.7 weeks post injury (n = 32). Conversely, older patients (above the average age) took 13.5 weeks on average to return to work. The dataset revealed that, on average, patients under the physiotherapy-led pathway returned to sports activities in about 29.9 weeks. Thromboprophylaxis was prescribed for 93.5% (n = 71) of patients with ATR. The data revealed a low incidence rate of deep vein thrombosis with only 4% (n = 3) of patients experiencing this complication post rupture. Conclusion This audit offers insight into physiotherapy-led ATR management at Wythenshawe Hospital, evaluating treatment results and challenges. The findings suggest that a conservative approach is effective in promoting patient recovery, with low re-rupture rates and successful return-to-function outcomes. While limitations such as sample size and retrospective design exist, the findings underscore the need for tailored rehabilitation protocols and continued research to optimize patient care in ATR management.