Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair

  • Mareen Braunstein
  • Sebastian F. Baumbach
  • Wolfgang Boecker
  • Mike R. Carmont
  • Hans PolzerEmail author



Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair.


A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included.


One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment.


Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician.

Level of evidence



Achilles tendon rupture Minimal invasive repair Accelerated rehabilitation 



Achilles Rupture Performance Score


Achilles Tendon Total Rupture Score


Below knee cast


Combined functional treatment


Coleman Methodology Score






Deep vein thrombosis


Early mobilization


Full weight bearing








Non-weight bearing


Plantar flexion


Partial weight bearing


Return to sports


Return to work


Sural nerve damage


p < 0.01



We thank Mrs. Maren Hella Thun for the preparation of the figures.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Mareen Braunstein
    • 1
  • Sebastian F. Baumbach
    • 1
  • Wolfgang Boecker
    • 1
  • Mike R. Carmont
    • 2
  • Hans Polzer
    • 1
    Email author
  1. 1.Department of Trauma Surgery, Munich University HospitalLudwig-Maximilians-UniversityMunichGermany
  2. 2.Princess Royal Hospital, Shrewsbury and Telford NHS Trust and the Northern General HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK

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