Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis

Am J Sports Med. 2015 Apr;43(4):1008-16. doi: 10.1177/0363546514531014. Epub 2014 May 2.


Background: The choice of rehabilitation management after the surgical repair of acute Achilles tendon (AT) ruptures remains controversial because of insufficient clinical evidence. The current study analyzes the postoperative rehabilitation of AT ruptures based on the current clinical evidence.

Purpose: To identify and analyze the high-level clinical evidence regarding postoperative rehabilitation after the surgical repair of AT ruptures. Subgroup analyses were also performed to obtain more reliable and specific results.

Study design: Meta-analysis.

Methods: The studies were retrieved by searching the Medline, Embase, and Cochrane databases through the OVID retrieval engine from 1990 to August 14, 2013. Two independent reviewers critically reviewed the studies using preset inclusion and exclusion criteria. The quality of the eligible studies was assessed by the Cochrane 12-item scale. All included studies were summarized, and their data were extracted. Subgroup analyses were performed according to the different protocols of early functional rehabilitation.

Results: Nine studies, consisting of 6 randomized controlled trials and 3 quasi-randomized studies, were ultimately included. A total of 402 patients were identified. Six of the included studies utilized early weightbearing combined with early ankle motion exercises, while the other 3 only employed early ankle motion exercises. The subgroup analyses demonstrated that 11 of the 15 functional outcome measurements were significantly superior for patients who underwent both early weightbearing and ankle motion exercises than for those who underwent conventional cast immobilization. Similar rates of reruptures (odds ratio [OR], 1.36; 95% CI, 0.38-4.91; P = .64) and major complications (OR, 0.67; 95% CI, 0.24-1.87; P = .44) as well as a significantly lower rate of minor complications (OR, 0.51; 95% CI, 0.27-0.95; P = .03) were also observed in this early functional rehabilitation group. For the patients who solely performed early ankle motion exercises, only 2 of the 14 functional measurements were observed to be significantly superior to immobilization. There were also no significant differences in the rates of reruptures (OR, 0.47; 95% CI, 0.08-2.70; P = .40) and other complications (OR, 1.09; 95% CI, 0.41-2.92; P = .86) between the 2 groups.

Conclusion: Postoperative early weightbearing combined with early ankle motion exercises is associated with a lower minor complication rate and achieves superior and more rapid functional recovery than conventional immobilization after surgical AT repair. In contrast, few advantages were identified when only early ankle motion exercises were applied.

Keywords: Achilles tendon; early weightbearing; meta-analysis; postoperative rehabilitation.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Achilles Tendon / pathology
  • Achilles Tendon / surgery*
  • Exercise Therapy / methods*
  • Humans
  • Immobilization / methods
  • Physical Therapy Modalities
  • Postoperative Period
  • Recovery of Function
  • Rupture / surgery
  • Tendon Injuries / rehabilitation*
  • Tendon Injuries / surgery
  • Weight-Bearing / physiology