Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials

Dai, Wenli; Leng, Xi; Wang, Jian; Hu, Xiaoqing; Ao, Yingfang

doi:10.1016/j.jsams.2020.12.005

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…All specimens survived the 20-100 N cyclic loading. This result was consistent with those obtained for early ankle passive range of motion exercises after Achilles tendon repair, which was suggested in a recent clinical metaanalysis study [50,51]. The results of the present study showed that the JKIB technique was stronger than the 4sK, but there was still felt to be a risk of a failed repair when weight-bearing ambulation with a cam under a 1-in.…”

Section: Discussionsupporting

confidence: 92%

Jigless knotless internal brace versus other open Achilles tendon repairs using a progressive rehabilitation protocol: a biomechanical study

Hsu

Hong

et al. 2021

BMC Musculoskelet Disord

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Background The jigless knotless internal brace surgery (JKIB), a modified minimal invasive surgery (MIS) for acute Achilles tendon injury, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as demonstrated in previous clinical research. However, to date, biomechanical testing has not yet been validated. Materials and methods Sixty fresh porcine Achilles tendons were used to compare the JKIB with other open surgery techniques, the four-stranded Krackow suture (4sK) and the triple-bundle suture (TBS) in biomechanical testing with cyclic loading set at 1 Hz. This approach simulated a progressive rehabilitation protocol where 20-100 N was applied in the first 1000 cycles, followed by 20-190 N in the second 1000 cycles, and then 20-369 N in the third 1000 cycles. The cycles leading to repair gaps of 2 mm, 5 mm, and 10 mm were recorded. The survival cycles were defined as repair gap of 10 mm. Results With respect to survival cycles, a significant difference was found among the three groups, in which the TBS was the most robust, followed by the JKIB and the 4sK, where the mean survived cycles were 2639.3 +/− 263.55, 2073.6 +/− 319.92, and 1425.25 +/− 268.96, respectively. Significant differences were verified via a post hoc analysis with the Mann–Whitney U test after the Bonferroni correction (p < 0.017). Conclusions The TBS was the strongest suture structure in acute Achilles tendon repair. However, the JKIB could be an option in acute Achilles tendon repair with the MIS technique due to it being more robust than the 4sK, which has been typically favored for use in open repair.

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Section: Discussionsupporting

confidence: 92%

Jigless knotless internal brace versus other open Achilles tendon repairs using a progressive rehabilitation protocol: a biomechanical study

Hsu

Hong

et al. 2021

BMC Musculoskelet Disord

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“…In our cohort, median time to weightbearing ranged from 9 to 10.6 weeks for traumatic tears vs. ruptures by muscular contraction, and there was a near-equal divide between initial immobilization type, with 48.7% of patients immobilized in a cast and 46.2% in a splint for a median period of 11 weeks. This contrasts recent literature ;on adult Achilles tendon injuries, which reveals a trend toward earlier time to weightbearing and less rigid immobilization methods for shorter durations 18–21 . This literature has demonstrated many benefits of early dynamic functional rehabilitation among operative and non-operative treatment, including higher patient satisfaction, faster return to play/work, fewer outpatient PT visits, and comparable complication rates.…”

Section: Discussionmentioning

confidence: 65%

“…This contrasts recent literature ;on adult Achilles tendon injuries, which reveals a trend toward earlier time to weightbearing and less rigid immobilization methods for shorter durations. [18][19][20][21] This literature has demonstrated many benefits of early dynamic functional rehabilitation among operative and non-operative treatment, including higher patient satisfaction, faster return to play/work, fewer outpatient PT visits, and comparable complication rates. Though our findings are not in line with these trends in adult care, this could be due to the large portion of our patient cohort presenting with open injuries or different standards of clinical care for pediatric patients relative to adults.…”

Section: Discussionmentioning

confidence: 99%

Achilles Tendon Injuries in the Pediatric Population

Ashebo

Stevens

MacAlpine

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries. Methods: A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings. Results: Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9). Conclusions: We found that older adolescents (≥14 y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12 y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population. Level of Evidence: Level—IV.

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“…Accelerated rehabilitation protocols have now even been implemented for nonoperative management of acute Achilles tendon ruptures. Several recent meta-analyses compared accelerated rehabilitation to delayed rehabilitation protocols ( 44 , 45 , 46 ). Similar to our study, they found no differences between the different rehabilitation regimes for re-rupture rate or complications.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis

Maßen¹,

Shoap

Vosseller

et al. 2022

EFORT Open Reviews

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Purpose The aim of this systematic review and meta-analysis was to compare re-rupture rates, complication rates, functional outcomes, as well as return to work (RTW)/sport (RTS) among different rehabilitation protocols following operative treatment of acute Achilles tendon ruptures. Methods Systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases were searched for randomized controlled trials (RCTs) comparing at least two rehabilitation protocols following surgical repair of acute Achilles tendon ruptures. Rehabilitation protocols were classified as a variation of either non-weightbearing (NWB) or weightbearing (WB) and immobilization (IM) or mobilization (M). The data collection consisted of re-ruptures, complications, and RTW/RTS. Results Out of 2760 studies screened, 20 RCTs with 1007 patients were eligible. Fourteen studies included a group consisting of WB + M (Group 1), 11 of WB + IM (Group 2), 3 of NWB + M (Group 3), and 13 of NWB + IM (Group 4). Outcome parameters available for a meta-analysis were re-ruptures, complications, RTW, and RTS. Re-ruptures overall occurred in 2.7%, with prevalences ranging between 0.04 and 0.08. Major complications occurred in 2.6%, with prevalences ranging between 0.02 and 0.03. Minor complications occurred in 11.8% with prevalances ranging between 0.04 to 0.17. Comparing the odds-ratios between the four different groups revealed no significant differences with overall favourable results for group 1 (WB+M). Conclusion Early functional rehabilitation protocols with early ankle M and WB following surgical repair of acute Achilles tendon ruptures are safe and they apparently allow for a quicker RTW and RTS and seem to lead to favourable results.

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Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials

Cited by 7 publications

References 38 publications

Jigless knotless internal brace versus other open Achilles tendon repairs using a progressive rehabilitation protocol: a biomechanical study

Jigless knotless internal brace versus other open Achilles tendon repairs using a progressive rehabilitation protocol: a biomechanical study

Achilles Tendon Injuries in the Pediatric Population

Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis

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