Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science



Collaborative Specialization

Musculoskeletal Health Research


Birmingham, Trevor B.


It is unknown if deficits in the involved limb following acute Achilles tendon rupture (AATR) persist in the long-term, or differ between patients treated operatively or non-operatively. This study investigated 43 patients 15±1 years post-AATR from a previous randomized controlled trial (RCT) that compared operative and non-operative treatment. Structural characteristics in the Achilles tendon and surrounding musculature were assessed using magnetic resonance imaging. We also performed physical examinations and evaluated performance-based and patient-reported outcomes. Overall, there were substantial differences between the involved and uninvolved limbs in most outcomes. Some outcomes improved over time from the initial RCT to the final follow-up, while others deteriorated. No outcomes favoured operative over non-operative treatment.

Summary for Lay Audience

Tendons connect muscle to bone. The Achilles tendon attaches your calf muscles to your heel bone, and is largest and strongest tendon in the human body. Despite these qualities, the Achilles is the most commonly ruptured tendon in the adult population, and has the potential to be a devastating injury. An Achilles tendon rupture can be treated with surgery or conservative care (e.g. physiotherapy); however, not much is known about the long-term effects following either treatment. This study evaluated patients 15 years following rupture. There were substantial differences between the injured and non-injured limbs. Some measures improved over time since the initial rupture, while others deteriorated. We did not find any evidence that surgery is better than conservative care.