{
  "abstract": "Objective To evaluate whether individualised treatment using the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) is superior to default operative or non-operative strategies.Methods We conducted a multicentre, three-arm, randomised controlled trial. Adults with acute Achilles tendon rupture were randomised (1:1:1) to individualised CARTA, non-operative or operative treatment. In the CARTA arm, surgery was indicated if ultrasound showed<25% tendon overlap or ≥7% elongation. The primary outcome was the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT at 6 months, and at both 6 and 12 months, the Heel-Rise Height, Achilles tendon Total Rupture Score (ATRS), Tegner activity scale, Copenhagen Achilles tendon Length Measure, Achilles Tendon Resting Angle (ATRA) and complication recordings.Results Between May 2018 and June 2023, 970 patients were screened; 300 were randomised (male/female 76%/24%, mean age 41 (SD 1)). At 12 months, data were available for 98 CARTA (64% operated), 100 non-operative and 97 operative patients. There were no significant between-group differences in HRWT at 12 months. However, CARTA significantly reduced rerupture rates by 73% compared with non-operative treatment (3% (95% CI) (1 to 8) vs 11% (6 to 19), p=0.03), improved ATRS by 8 points (1 to 15, p=0.02) and improved ATRA by −2° (−4 to −1), p=0.01). No difference between CARTA and operative treatment was found except 36% less underwent surgery.Conclusion Individualised CARTA did not improve functional outcomes based on the HRWT at 12 months, but among secondary outcomes, it reduced rerupture rates and improved patient-reported outcomes compared with non-operative treatment and with fewer surgeries than routine operative care.Trial registration number NCT03525964.",
  "authors": [
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark"
      ],
      "name": "Marianne Toft"
    },
    {
      "affiliations": [
        "Physical Medicine and Rehabilitation Research - Copenhagen, Department of Physical and Occupational Therapy, and Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark"
      ],
      "name": "Maria Swennergren Hansen"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark"
      ],
      "name": "Jannie Dybsoe Vestergaard"
    },
    {
      "affiliations": [
        "Physical Medicine and Rehabilitation Research - Copenhagen, Department of Physical and Occupational Therapy, and Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark"
      ],
      "name": "Julie Jenlar"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Zealand University Hospital Køge, Køge, Denmark"
      ],
      "name": "Anna Kathrine Pramming"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark"
      ],
      "name": "Stefan Møller"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark"
      ],
      "name": "Bjørn Slott Korvenius Nedergaard"
    },
    {
      "affiliations": [
        "Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Morten Tange Kristensen"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Zealand University Hospital Køge, Køge, Denmark"
      ],
      "name": "Louise Lau Simonsen"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark",
        "Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Bjarke Viberg"
    },
    {
      "affiliations": [
        "Sports Orthopaedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark"
      ],
      "name": "Per Hölmich"
    },
    {
      "affiliations": [
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark",
        "Sports Orthopaedic Research Center - Copenhagen, Department of Orthopaedic Surgery, Hvidovre, Section for Sports Traumatology, Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg, Copenhagen University Hospital, Copenhagen, Denmark"
      ],
      "name": "Kristoffer W Barfod"
    }
  ],
  "title": "Randomised three-armed trial investigation of the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA) for individualised treatment of acute Achilles tendon rupture",
  "uid": "9f26826f-1634-5968-8ab2-ae243f7011e5"
}