Patients recovering from repair surgery for acute Achilles tendon rupture who used weight-bearing mobility aids may achieve quicker functional recovery but could experience higher rates of complications compared with those using non–weight-bearing devices, according to a prospective cohort study.
In the study, researchers evaluated the recovery outcomes of 198 patients with acute Achilles tendon rupture who underwent surgical repair between April 2023 and February 2025. The patients were grouped by the mobility aid they used during the early rehbailitation phase, postoperative weeks 3 to 6: wheelchair, knee scooter, axillary crutches, or leg-support (LS) walker. Primary outcomes included unplanned emergency department (ED) visits, calf muscle preservation measured by the affected-to-unaffected calf circumference ratio, and direct rehabilitation costs. Secondary outcomes included the Visual Analog Scale, functional scores such as the Achilles Tendon Total Rupture Score [ATRS] and the American Orthopedic Foot & Ankle Society Ankle-Hindfoot Score [AOFAS]), and the time to recovery milestones.
During the early rehabilitation phase, safety outcomes differed across the patient groups. For instance, the patients using axillary crutches had more than eight times the odds of an unplanned ED visit compared with those using wheelchairs. ED visit rates were highest with crutches and there were statistically insignificant between LS walkers and wheelchairs during weeks 3 to 6, with no statistically significant differences observed after week 6.
Weight-bearing aids were associated with improved recovery outcomes. Patients using axillary crutches or LS walkers had less calf muscle atrophy at 6 weeks and reached recovery milestones earlier, including return to light exercise, return to work, and return to preinjury activity. Functional scores also favored these groups during the first 12 weeks, with differences narrowing over time.
Cost patterns also varied by the mobility aids used. Axillary crutches and knee scooters were associated with the lowest overall direct medical costs, while LS walkers had the highest costs. Wheelchair use was associated with fewer early complications but slower functional recovery.
Some statistically significant differences didn't appear to offer clinically perceptible benefit. Differences in pain scores between the groups were small and below the established thresholds for patient-perceived benefit.
The researchers noted several limitations. Mobility aid selection wasn't randomized and was based on shared decision-making, introducing potential selection bias. The study was conducted at a single center with a predominantly male population, and adherence to rehabilitation protocols wasn't directly measured.
“[M]obility aid selection should be regarded as an integral component of postoperative rehabilitation planning rather than a purely logistical decision,” wrote lead study author Zhuoqi Wei, of the Department of Orthopedics at the Peking University Third Hospital in China, and colleagues.
The study was supported by the National Key R&D Program of China, Capital health development research project, and Peking University Third Hospital. The study authors reported no competing interests.
