Abstract
Purpose
The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over traditional immobilization. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to compare functional rehabilitation to immobilization in the treatment of ATR.
Method
This meta-analysis was conducted using the databases: PubMed, EMBASE, Rehabilitation and Sports Medicine Source, AMED, CINAHL, Cochrane Library and PEDro using the search terms: “Achilles tendon,” “rupture,” “mobilization” and “immobilization”. Seven RCTs involving 427 participants were eligible for inclusion, with a total of 211 participants treated with functional rehabilitation and 216 treated with immobilization.
Results
Re-rupture rate, other complications, strength, range of motion, duration of sick leave, return to sport and patient satisfaction were examined. There were no statistically significant differences between groups. A trend favoring functional rehabilitation was seen regarding the examined outcomes.
Conclusion
Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low-to-average quality, and the basic constructs of the examined treatment and study protocols vary considerably. Larger, randomized controlled trials using validated outcome measures are needed to confirm the findings.
Level of evidence
II.
Similar content being viewed by others
References
Armbrecht A, Zenker W, Egbers HJ, Havemann D (1993) Plaster-free, early functional after-care of surgically managed Achilles tendon rupture. Chirurg 64(11):926–930
Barfod KW, Nielsen F, Helander KN et al (2013) Treatment of acute Achilles tendon rupture in scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments. J Foot Ankle Surg 52(5):629–633
Cetti R, Henriksen LO, Jacobsen KS (1994) A new treatment of ruptured Achilles tendons: a prospective randomized study. Clin Orthop Relat Res 308:155–165
Cetti R (1988) Ruptured Achilles tendon–preliminary results of a new treatment. Br J Sports Med 22(1):6–8
Costa ML, MacMillan K, Halliday D et al (2006) Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo achilles. J Bone Joint Surg Br 88(1):69–77
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Jaakkola JI, Beskin JL, Griffith LH, Cernansky G (2001) Early ankle motion after triple bundle technique repair versus casting for acute Achilles tendon rupture. Foot Ankle Int 22(12):979–984
Jacob KM, Paterson R (2007) Surgical repair followed by functional rehabilitation for acute and chronic Achilles tendon injuries: excellent functional results, patient satisfaction and no reruptures. ANZ J Surg 77(4):287–291
Kangas J, Pajala A, Ohtonen P, Leppilahti J (2007) Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med 35(1):59–64
Kangas J, Pajala A, Siira P, Hamalainen M, Leppilahti J (2003) Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 54(6):1171–1180 discussion 1180-1
Kauranen K, Kangas J, Leppilahti J (2002) Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment versus early immobilization of Achilles tendon in tension. Foot Ankle Int 23(7):600–605
Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R (2003) Early weight bearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med 31(5):692–700
Maffulli N, Tallon C, Wong J, Peng LK, Bleakney R (2003) No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness 43(3):367–379
Majewski M, Schaeren S, Kohlhaas U, Ochsner PE (2008) Postoperative rehabilitation after percutaneous Achilles tendon repair: early functional therapy versus cast immobilization. Disabil Rehabil 30(20–22):1726–1732
Mortensen HM, Skov O, Jensen PE (1999) Early motion of the ankle after operative treatment of a rupture of the Achilles tendon: a prospective, randomized clinical and radiographic study. J Bone Joint Surg Am 81(7):983–990
Möller M, Movin T, Granhed H, Lind K, Faxén E, Karlsson J (2001) Acute rupture of tendo Achilles: a prospective, randomized study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83(6):843–848
Nilsson-Helander K, Silbernagel KG, Thomee R et al (2010) Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38(11):2186–2193
Nistor L (1981) Surgical and non-surgical treatment of Achilles tendon rupture: a prospective randomized study. J Bone Joint Surg Am 63(3):394–399
Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ (2008) Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 88(2):156–175
Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J (2013) Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med 41(12):2867–2876
Petersen OF, Nielsen MB, Jensen KH, Solgaard S (2002) Randomized comparison of CAM walker and light-weight plaster cast in the treatment of first-time Achilles tendon rupture. Ugeskr Laeg 164(33):3852–3855
Saleh M, Marshall PD, Senior R, MacFarlane A (1992) The Sheffield splint for controlled early mobilisation after rupture of the calcaneal tendon: a prospective, randomised comparison with plaster treatment. J Bone Joint Surg Br 74(2):206–209
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (2012) Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am 94(23):2136–2143
Suchak AA, Bostick GP, Beaupre LA, Durand DC, Jomha NM (2008) The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am 90(9):1876–1883
Suchak AA, Spooner C, Reid DC, Jomha NM (2006) Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res 445:216–221
Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med 35(12):2033–2038
Wallace RG, Traynor IE, Kernohan WG, Eames MH (2004) Combined conservative and orthotic management of acute ruptures of the Achilles tendon. J Bone Joint Surg Am 86-A(6):1198–1202
Willits K, Amendola A, Bryant D et al (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 92(17):2767–2775
Zwipp H, Thermann H, Sudkamp N et al (1990) An innovative concept for primary functional treatment of Achilles tendon rupture. Sportverletz Sportschaden 4(1):29–35
Acknowledgments
We thank Mr. Anders Mark-Christensen for his grammatical and statistical assistance.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mark-Christensen, T., Troelsen, A., Kallemose, T. et al. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc 24, 1852–1859 (2016). https://doi.org/10.1007/s00167-014-3180-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3180-5