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Rehabilitation of Achilles Tendon Tears (Operative and Nonoperative)

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The Achilles Tendon

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Abstract

The school of thought relating to optimal recovery after Achilles tendon rupture has evolved. While traditional protocols consisted of prolonged immobilization and restricted weight-bearing, early functional rehabilitation has now become the standard of care in both nonoperative and operative treatment settings. Early functional rehabilitation has demonstrated similar strength and range of motion outcomes to longer immobilization protocols, without an increase in rerupture rates. Some data further support improved patient-reported outcomes with early functional mobilization. This chapter discusses rehabilitation after Achilles tendon injuries and demonstrates sample early functional rehabilitation protocols for nonoperatively and operatively managed Achilles ruptures. Both global strategies for rehabilitation and specific exercises are discussed. Key differences among early functional mobilization protocols are highlighted between those undergoing surgery and those undergoing conservative treatment. Understanding the framework and principles of Achilles tendon rehabilitation can benefit clinicians and surgeons managing these injuries and physical therapists designing rehabilitative programming, in addition to helping guide patient expectations for recovery.

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References

  1. Gillies H, Chalmers J. The management of fresh ruptures of the Tendo Achillis. J Bone Joint Surg. 1970;52(2):337–43.

    Article  CAS  PubMed  Google Scholar 

  2. Keller J, Rasmussen TB. Closed treatment of Achilles tendon rupture. Acta Orthop Scand. 1984;55(5):548–50.

    Article  CAS  PubMed  Google Scholar 

  3. Maxwell LC, Enwemeka CS. Immobilization-induced muscle atrophy is not reversed by lengthening the muscle. Anat Rec. 1992;234(1):55–61.

    Article  CAS  PubMed  Google Scholar 

  4. Rantanen J, Hurme T, Kalimo H. Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats. Comparison of postoperative immobilization of the muscle-tendon complex in relaxed and tensioned positions. Scand J Med Sci Sports. 1999;9(1):57–61.

    Article  CAS  PubMed  Google Scholar 

  5. Suchak AA, Bostick GP, Beaupré LA, Durand DC, Jomha NM. The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am. 2008;90(9):1876–83.

    Article  PubMed  Google Scholar 

  6. Khan RJK, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005;87(10):2202–10.

    PubMed  Google Scholar 

  7. Barfod KW, Nielsen EG, Olsen BH, Vinicoff PG, Troelsen A, Holmich P. Risk of deep vein thrombosis after acute Achilles tendon rupture: a secondary analysis of a randomized controlled trial comparing early controlled motion of the ankle versus immobilization. Orthop J Sports Med. 2020;8(4):232596712091590.

    Article  Google Scholar 

  8. Matsumoto F, Trudel G, Uhthoff HK, Backman DS. Mechanical effects of immobilization on the Achilles’ tendon. Arch Phys Med Rehabil. 2003;84(5):662–7.

    PubMed  Google Scholar 

  9. Yamamoto E, Hayashi K, Yamamoto N. Mechanical properties of collagen fascicles from stress-shielded patellar tendons in the rabbit. Clin Biomech (Bristol, Avon). 1999;14(6):418–25.

    Article  CAS  PubMed  Google Scholar 

  10. Speck M, Klaue K. Early full weightbearing and functional treatment after surgical repair of acute achilles tendon rupture. Am J Sports Med. 1998;26(6):789–93.

    Article  CAS  PubMed  Google Scholar 

  11. Booth FW. Physiologic and biochemical effects of immobilization on muscle. Clin Orthop Relat Res. 1987;219:15–20.

    Article  CAS  Google Scholar 

  12. Qin L, Appell HJ, Chan KM, Maffulli N. Electrical stimulation prevents immobilization atrophy in skeletal muscle of rabbits. Arch Phys Med Rehabil. 1997;78(5):512–7.

    Article  CAS  PubMed  Google Scholar 

  13. Bring D, Reno C, Renstrom P, Salo P, Hart D, Ackermann P. Prolonged immobilization compromises up-regulation of repair genes after tendon rupture in a rat model: immobilization post-injury impact mRNA levels. Scand J Med Sci Sports. 2009;20(3):411–7.

    Article  PubMed  Google Scholar 

  14. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010;92(17):2767–75.

    Article  PubMed  Google Scholar 

  15. Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining components of early functional rehabilitation for acute Achilles tendon rupture: a systematic review. Orthop J Sports Med. 2019;7(11):232596711988407.

    Article  Google Scholar 

  16. Zellers JA, Carmont MR, Grävare SK. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med. 2016;50(21):1325–32.

    Article  PubMed  Google Scholar 

  17. Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. 2007;35(12):2033–8.

    Article  PubMed  Google Scholar 

  18. Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38(11):2186–93.

    Article  PubMed  Google Scholar 

  19. Lawrence JE, Nasr P, Fountain DM, Berman L, Robinson AHN. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J. 2017;99-B(1):87–93.

    Article  CAS  PubMed  Google Scholar 

  20. McCormack R, Bovard J. Early functional rehabilitation or cast immobilisation for the postoperative management of acute Achilles tendon rupture? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2015;49(20):1329–35.

    Article  CAS  PubMed  Google Scholar 

  21. Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229–43.

    Article  PubMed  Google Scholar 

  22. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012;94(23):2136–43.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture—development of an evidence-based treatment protocol. Injury. 2014;45(11):1782–90.

    Article  PubMed  Google Scholar 

  24. Glazebrook M, Rubinger D. Functional rehabilitation for nonsurgical treatment of acute Achilles tendon rupture. Foot Ankle Clin. 2019;24(3):387–98.

    Article  PubMed  Google Scholar 

  25. Hutchison AM, Topliss C, Beard D, Evans RM, Williams P. The treatment of a rupture of the Achilles tendon using a dedicated management programme. Bone Joint J. 2015;97-B(4):510–5.

    Article  CAS  PubMed  Google Scholar 

  26. Barfod KW, Bencke J, Lauridsen HB, Ban I, Ebskov L, Troelsen A. Nonoperative dynamic treatment of acute achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. J Bone Joint Surg Am. 2014;96(18):1497–503.

    Article  PubMed  Google Scholar 

  27. Revak A, Diers K, Kernozek TW, Gheidi N, Olbrantz C. Achilles tendon loading during heel-raising and -lowering exercises. J Athl Train. 2017;52(2):89–96.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Saxena A, Ewen B, Maffulli N. Rehabilitation of the operated achilles tendon: parameters for predicting return to activity. J Foot Ankle Surg. 2011;50(1):37–40.

    Article  PubMed  Google Scholar 

  29. Christensen M, Zellers JA, Kjær IL, Silbernagel KG, Rathleff MS. Resistance exercises in early functional rehabilitation for Achilles tendon ruptures are poorly described: a scoping review. J Orthop Sports Phys Ther. 2020;23:1–41.

    Google Scholar 

  30. Zhao J-G, Meng X-H, Liu L, Zeng X-T, Kan S-L. Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses. Sci Rep. 2017;7(1):39871.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Siira P, Laine V, Leppilahti J. A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. Am J Sports Med. 2016;44(9):2406–14.

    Article  PubMed  Google Scholar 

  32. Huang J, Wang C, Ma X, Wang X, Zhang C, Chen L. Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med. 2015;43(4):1008–16.

    Article  PubMed  Google Scholar 

  33. Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1852–9.

    Article  PubMed  Google Scholar 

  34. Eliasson P, Agergaard A-S, Couppé C, Svensson R, Hoeffner R, Warming S, Warming N, Holm C, Jensen MH, Krogsgaard M, Kjaer M, Magnusson SP. The ruptured Achilles tendon elongates for 6 months after surgical repair regardless of early or late weightbearing in combination with ankle mobilization: a randomized clinical trial. Am J Sports Med. 2018;46(10):2492–502.

    Article  PubMed  Google Scholar 

  35. Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, Mosca M, Zaffagnini S. Minimally invasive versus open repair for acute Achilles tendon rupture: meta-analysis showing reduced complications, with similar outcomes, after minimally invasive surgery. J Bone Joint Surg Am. 2018;100(22):1969–81.

    Article  PubMed  Google Scholar 

  36. Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Open versus minimally-invasive surgery for Achilles tendon rupture: a meta-analysis study. Arch Orthop Trauma Surg. 2020;

    Google Scholar 

  37. Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):846–53.

    Article  PubMed  Google Scholar 

  38. Groetelaers RPTGC, Janssen L, van der Velden J, Wieland AWJ, Amendt AGFM, Geelen PHJ, Janzing HMJ. Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: prospective, randomized trial. Foot Ankle Int. 2014;35(8):771–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of California San Francisco Medical Center, San Francisco, CA, USA

    Sachin Allahabadi

  2. Physical Therapy, Duke Sport Science Institute, Duke University, Durham, NC, USA

    Christopher Antonelli

  3. Division of Sports Medicine, Department of Orthopaedics, Duke Sport Science Institute, Duke University, Durham, NC, USA

    Sarah Lander & Brian C. Lau

Authors
  1. Sachin Allahabadi
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  2. Christopher Antonelli
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  3. Sarah Lander
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  4. Brian C. Lau
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Corresponding author

Correspondence to Brian C. Lau .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Samuel B. Adams

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Allahabadi, S., Antonelli, C., Lander, S., Lau, B.C. (2023). Rehabilitation of Achilles Tendon Tears (Operative and Nonoperative). In: Adams, S.B. (eds) The Achilles Tendon. Springer, Cham. https://doi.org/10.1007/978-3-031-45594-0_12

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  • DOI: https://doi.org/10.1007/978-3-031-45594-0_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-45593-3

  • Online ISBN: 978-3-031-45594-0

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