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.