Rerupture Rate after Early Weightbearing in Operative Versus Conservative Treatment of Achilles Tendon Ruptures: A Meta-analysis

Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair

“…Given these factors, the traditional rehabilitation model, which is based on non-weight bearing and immobilization, remains standard practice after AT repair. [3][4][5][6]8,14,16,21 However, the negative changes to plantar flexors 11,12 may be modified, as our findings suggested. Moreover, magnetic resonance imaging revealed that an organized scar forms over the AT during the 4 weeks after surgery in early rehabilitation models, 6 and no differences in rerupture rates between early and traditional models have been described in systematic reviews or meta-analyses.…”

“…The other begins with some degree of immobilization or non-weight bearing in the first 4 weeks after AT repair, normally via a rest period during the first 2 weeks after surgery. 21 Currently, managing AT rehabilitation after operative repair remains controversial 1,2,4,5,8,16,22 because of the unknown mechanical tolerances of different operative techniques 4,6 for preventing clinical failure 22 ; the comorbidities associated with traditional management, [3][4][5][6]8,14,16,22 such as muscle atrophy, adherences, delayed collagen remodeling, thromboembolism, and high rerupture rates [2][3][4][5][6]22,23 ; and the risks and complications that can occur during early rehabilitation, 3,4,6,15,21,22 such as tendinous elongation and early reruptures. 3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,…”

“…3,4,6,15,22 However, most treatments include recommendations for primary reattachment of the damaged ends to achieve appropriate mechanical stability, a percutaneous approach to avoid excessive tissue damage, 1,2,4,8 and early rehabilitation 3,5,6,8,10,16,[21][22][23] to promote better clinical outcomes than are typical with open or traditional rehabilitation programs. 3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks.…”

“…3,5,6,8,10,16,22,23 Traditional models do not appear to provide the tissue and neuromuscular benefits that early models provide. 3,6,10,16,[21][22][23] Indeed, they result in pathologic adaptations to plantar-flexion tasks. 12 For example, using velocityencoded cine phase-contrast magnetic resonance images, Finni et al 12 found greater velocity and displacement of the medial gastrocnemius about the deep plantar flexors during submaximal isometric voluntary contractions 13 weeks after AT repair in patients treated with traditional rehabilitation compared with healthy control participants.…”

Achilles tendon ruptures

“…More recently in 2013, van der Eng et al published a meta-analysis reviewing re-rupture rate after early weight bearing in operative vs conservative treatment and found no difference in rerupture rate between the 2 groups. The study also found a 2-fold greater complication rate in the surgical group [91]. Kearney and Costa [92] recently reported on the current concepts in rehabilitation of an acute Achilles tendon rupture.…”