Methodology: 3.5/5
Usefulness: 3.5/5

Costa ML et al. Lancet. 2020 Feb 8;395(10222):441-448.

Question and Methods: The UKSTAR trial was a pragmatic, multicenter RCT that compared plaster cast against walking boot for non-operative management of Achilles tendon rupture in terms of functional outcomes, complications, costs and health-related quality of life.

Findings: There was no difference in all outcomes between treatment groups at 3, 6 and 9 months. There was a minimal difference at 8 weeks in favor of the walking boot (ATRS score difference of 5.53 (95% CI 2.0-9.1; p = 0.0024) but the clinical significance was equivocal, and the main outcome was at 9 months.

Limitations: This study was not blinded, have bias in outcome assessment due to this.

Interpretation: The walking boot can be offered as a safe and effective alternative to plaster cast for non-operative treatment of Achilles tendon rupture.

By: Dr. Evelyn Tran


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

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