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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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

II.

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Fig. 1
Fig. 2

Abbreviations

ARPS:

Achilles Rupture Performance Score

ATRS:

Achilles Tendon Total Rupture Score

BKC:

Below knee cast

CFT:

Combined functional treatment

CMS:

Coleman Methodology Score

d:

Days

DF:

Dorsiflexion

DVT:

Deep vein thrombosis

EM:

Early mobilization

FWB:

Full weight bearing

I:

Infection

IM:

Immobilization

m:

Months

NWB:

Non-weight bearing

PF:

Plantar flexion

PWB:

Partial weight bearing

RTS:

Return to sports

RTW:

Return to work

SND:

Sural nerve damage

*:

p < 0.01

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Acknowledgments

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

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Correspondence to Hans Polzer.

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Braunstein, M., Baumbach, S.F., Boecker, W. et al. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc 26, 846–853 (2018). https://doi.org/10.1007/s00167-015-3795-1

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Keywords

  • Achilles tendon rupture
  • Minimal invasive repair
  • Accelerated rehabilitation