Research Review by Dr. Shawn Thistle©

Date:

Feb. 2006

Study Title:

Postoperative rehabilitation protocols for Achilles tendon ruptures: A meta-analysis

Authors:

Suchak AA, Spooner C, Reid DC, Jomha NM

Publication Information:

Clinical Orthopaedics and Related Research (2006)

Summary:

Although Achilles tendon ruptures are relatively uncommon, they are severe and debilitating injuries that normally require surgery, and a lengthy rehabilitation before normal function is restored. To date, the optimal postoperative protocol to speed recovery is unknown. The typical regimen involves 6 weeks of immobilization in a below-knee non-weightbearing cast followed by subsequent range of motion (ROM) and ankle strengthening exercise.

More recently, smaller studies have investigated early functional protocols involving early weightbearing (often on the first postoperative day), with early ROM and splinting in a walking boot or modified orthotic instead of a cast.

Studies done with this type of approach have generally lacked control groups, but have shown good patient satisfaction and low re-rupture rates.

The aim of this study was to evaluate prospective, randomized (or quasirandomized) controlled trials investigating early functional rehabilitation protocols versus cast immobilization for surgical repair or torn Achilles tendons from a perspective of patient satisfaction and re-rupture rates.

Inclusion criteria for studies used in this analysis were:
  1. prospective randomized or quasirandomized controlled trial
  2. trials enrolling adults (? 18 yoa) diagnosed with acute rupture of the Achilles tendon
  3. comparison of a control group using the standard immobilization protocol with delayed weightbearing versus early functional rehab
  4. outcomes include subjective patient satisfaction, re-ruptures, infections, minor surgical complications, and functional measures
Six trials including 315 patients (average age 40) met the inclusion criteria, and were included in this analysis.

Despite some difficulty in statistically combining the results of these trials, the following general points emerged:
  • early functional rehab protocols led to better subjective responses when compared to immobilization (88% vs. 62%)
  • the re-rupture rate did not differ between the functional and immobilization groups (2.5% vs. 3.8% respectively)
  • no difference in infections was noted

Conclusions & Practical Application:

This small meta-analysis suggests that early functional rehabilitation may be superior, or at least equivalent, to traditional rehabilitation involving lengthy immobilization for Achilles tendon ruptures. A functional approach would involve early weightbearing and ROM exercises combined with utilization of a weightbearing boot or orthotic.

Further studies involving larger numbers of patients with appropriately designed control groups are required to clarify this issue. At the very least, a more functional approach appears to be safe, with higher patient satisfaction, than a more traditional approach to this injury.