Comparative analysis of different mobility aids in the early accelerated rehabilitation phase following acute achilles tendon repair surgery: a prospective cohort study

BACKGROUND: The objective of this study was to evaluate and compare the safety, efficacy, and cost-effectiveness of different mobility aids during the early rehabilitation phase following surgical repair of acute Achilles tendon rupture (AATR). METHODS: This prospective cohort study included 198 patients who underwent surgical repair for AATR between April 2023 and February 2025, with 171 males (86.4%) and a mean age of 36.4 years. Based on the mobility aid used weeks 3-6 postoperatively, participants were categorized into four groups: Wheelchair (n = 43), Knee Scooter (n = 41), Axillary Crutches (n = 78), and Leg Support (LS) Walker (n = 36). Patients were scheduled for assessments at 2, 4, 6, 12, and 24 weeks, with an additional telephone follow-up conducted approximately one year after surgery. Primary outcomes included the rate of unplanned Emergency Department (ED) visits, the affected-to-unaffected (A: U) calf circumference ratio, and expected rehabilitation costs. Secondary outcomes encompassed the Visual Analog Scale, the Achilles Tendon Total Rupture Score, the American Orthopedic Foot & Ankle Society Ankle-Hindfoot Score, and time to key recovery milestones, including single-leg heel raise to 50% of contralateral side, return to light exercise, return to work, and return to pre-injury exercise. Continuous variables were analyzed using one-way ANOVA or Kruskal-Wallis test, and categorical variables using chi-square or Fisher's exact test, while linear mixed-effects models were employed for longitudinal outcomes. RESULTS: During the early rehabilitation phase (Weeks 3-6), unplanned ED visit rates differed significantly among the four groups (p = 0.032), with the Axillary Crutches showing significantly higher odds than the Wheelchair (OR = 8.24, 95% CI 1.16-58.53, p = 0.040). A significant difference in the A: U ratio was observed among the four groups at 6 weeks postoperatively (p = 0.037), and post-hoc comparisons showed significant differences for LS Walker vs. Wheelchair (p < 0.001), Axillary Crutches vs. Wheelchair (p = 0.002), and LS Walker vs. Knee Scooter (p = 0.038). The LS Walker and Axillary Crutches also demonstrated superior performance in VAS, ATRS, and AOFAS scores from Week 4 to Week 12, and achieved key recovery milestones significantly earlier (p < 0.001). Economic analysis revealed the lower direct treatment costs in the Axillary Crutches (477 RMB) and Knee Scooter (539 RMB), followed by the Wheelchair (664 RMB) and LS Walker (1126 RMB) (p < 0.001). CONCLUSIONS: LS Walker demonstrated superior efficacy in preserving muscle and accelerating functional recovery, while Knee Scooter offered a favorable profile for fall prevention and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04663542), registered on 22 September 2020.