Research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHAO Jiaguo ¹ , GUO Wenxuan ² , ZENG Xiantie ¹ , KAN Shilian ³

1. Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China;
2. School of Graduates, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
3. Department of Hand Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

ZHAO Jiaguo, Email: orthopaedic@163.com

Keywords：

Acute Achilles tendon rupture; surgical treatment; early functional rehabilitation

DOI：

10.7507/1002-1892.201807146

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the latest research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair.Methods The high-quality randomized controlled trials and systematic reviews/meta-analyses regarding early postoperative rehabilitation for acute Achilles tendon rupture in recent years were reviewed.Results There are three functional rehabilitations after acute Achilles tendon rupture surgery, including early postoperative mobilization, early weight-bearing with immobilization, and early weight-bearing combined with mobilization. The results of randomized controlled trials show that the effectiveness of early postoperative rehabilitation is similar or better than the early postoperative immobilization. The results of systematic reviews/meta-analyses show that the early postoperative rehabilitation is beneficial to the early function recovery of the Achilles tendon, can reduce the time for functional recovery, and do not adversely affect the outcomes.Conclusion Early postoperative rehabilitation is beneficial to the functional recovery, and do not increase postoperative complications. There is still no uniform protocol of early postoperative rehabilitation and the timing of weight-bearing, and further studies are needed in the future.

Citation： ZHAO Jiaguo, GUO Wenxuan, ZENG Xiantie, KAN Shilian. Research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 382-386. doi: 10.7507/1002-1892.201807146 Copy

1.	Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States population. Foot Ankle Int, 2013, 34(4): 475-480.
2.	Thevendran G, Sarraf KM, Patel NK, et al. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal Surg, 2013, 97(1): 9-20.
3.	Dams OC, van den Akker-Scheek I, Diercks RL, et al. Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines. Knee Surg Sports Traumatol Arthrosc, 2018.[Epub ahead of print].
4.	詹俊锋, 方家刘, 张积森, 等. 改良缝合法治疗急性闭合性跟腱断裂的疗效分析. 中国修复重建外科杂志, 2017, 31(8): 952-956.
5.	田建, 许亚军, 陈政, 等. 有限小切口下简易Krackow缝合法治疗急性闭合性跟腱断裂的疗效观察. 中国修复重建外科杂志, 2017, 31(11): 1322-1325.
6.	高尚, 唐康来, 张吉强, 等. 不同强度跑台训练对大鼠跟腱微损伤修复影响的实验研究. 中国修复重建外科杂志, 2017, 31(5): 574-581.
7.	Kauwe M. Acute Achilles tendon rupture. Clin Podiatr Med Surg, 2017, 34(2): 229-243.
8.	Brumann M, Baumbach SF, Mutschler W, et al. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. Injury, 2014, 45(11): 1782-1790.
9.	Mortensen HM, Skov O, Jensen PE. Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg (Am), 1999, 81(7): 983-990.
10.	Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment vs. early immobilization of Achilles tendon in tension. Foot Ankle Int, 2002, 23(7): 600-605.
11.	Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma, 2003, 54(6): 1171-1181.
12.	Kangas J, Pajala A, Ohtonen P, et al. Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med, 2007, 35(1): 59-64.
13.	Lantto I, Heikkinen J, Flinkkila T, et al. Early functional treatment versus cast immobilization in tension after achilles rupture repair: results of a prospective randomized trial with 10 or more years of follow-up. Am J Sports Med, 2015, 43(9): 2302-2309.
14.	Zhang YJ, Zhang C, Wang Q, et al. Augmented versus nonaugmented repair of acute Achilles tendon rupture: A systematic review and Meta-analysis. Am J Sports Med, 2018, 46(7): 1767-1772.
15.	Kerkhoffs GM, Struijs PA, Raaymakers EL, et al. Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg, 2002, 122(2): 102-105.
16.	Maffulli N, Tallon C, Wong J, et al. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness, 2003, 43(3): 367-379.
17.	Maffulli N, Tallon C, Wong J, et al. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med, 2003, 31(5): 692-700.
18.	Suchak AA, Bostick GP, Beaupre LA, et al. 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): 1876-1883.
19.	Porter MD, Shadbolt B. Randomized controlled trial of accelerated rehabilitation versus standard protocol following surgical repair of ruptured Achilles tendon. ANZ J Surg, 2015, 85(5): 373-377.
20.	Cetti R, Henriksen LO, Jacobsen KS. A new treatment of ruptured Achilles tendons. A prospective randomized study. Clin Orthop Relat Res, 1994, (308): 155-165.
21.	Costa ML, Shepstone L, Darrah C, et al. Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study. Injury, 2003, 34(11): 874-876.
22.	Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
23.	Schepull T, Aspenberg P. Early controlled tension improves the material properties of healing human achilles tendons after ruptures: a randomized trial. Am J Sports Med, 2013, 41(11): 2550-2557.
24.	Groetelaers RP, Janssen L, van der Velden J, et al. Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: Prospective, randomized trial. Foot Ankle Int, 2014, 35(8): 771-778.
25.	Valkering KP, Aufwerber S, Ranuccio F, et al. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1807-1816.
26.	Eliasson P, Agergaard AS, Couppé C, et al. 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): 2492-2502.
27.	Zhao JG, Zeng XT, Wang J, et al. Association between calcium or Vitamin D supplementation and fracture incidence in community-dwelling older adults: A systematic review and Meta-analysis. JAMA, 2017, 318(24): 2466-2482.
28.	赵嘉国, 赵力, 阚世廉. 富血小板血浆修复肩袖损伤的研究进展. 中华医学杂志, 2015, 95(25): 2042-2044.
29.	Khan RJ, Fick D, Keogh A, et al. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
30.	Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
31.	Huang J, Wang C, Ma X, et al. Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med, 2015, 43(4): 1008-1016.
32.	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): 1329-1335.
33.	Braunstein M, Baumbach SF, Boecker W, et al. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc, 2015, 26(3): 846-853.
34.	Mark-Christensen T, Troelsen A, Kallemose T, et al. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6): 1852-1859.
35.	Zhao J, Meng X, Liu L, et al. Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses. Scientific Reports, 2017, 7(1): 39871.

1. Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States population. Foot Ankle Int, 2013, 34(4): 475-480.
2. Thevendran G, Sarraf KM, Patel NK, et al. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal Surg, 2013, 97(1): 9-20.
3. Dams OC, van den Akker-Scheek I, Diercks RL, et al. Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines. Knee Surg Sports Traumatol Arthrosc, 2018.[Epub ahead of print].
4. 詹俊锋, 方家刘, 张积森, 等. 改良缝合法治疗急性闭合性跟腱断裂的疗效分析. 中国修复重建外科杂志, 2017, 31(8): 952-956.
5. 田建, 许亚军, 陈政, 等. 有限小切口下简易Krackow缝合法治疗急性闭合性跟腱断裂的疗效观察. 中国修复重建外科杂志, 2017, 31(11): 1322-1325.
6. 高尚, 唐康来, 张吉强, 等. 不同强度跑台训练对大鼠跟腱微损伤修复影响的实验研究. 中国修复重建外科杂志, 2017, 31(5): 574-581.
7. Kauwe M. Acute Achilles tendon rupture. Clin Podiatr Med Surg, 2017, 34(2): 229-243.
8. Brumann M, Baumbach SF, Mutschler W, et al. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. Injury, 2014, 45(11): 1782-1790.
9. Mortensen HM, Skov O, Jensen PE. Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg (Am), 1999, 81(7): 983-990.
10. Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of the foot after Achilles rupture repair: a randomized clinical study about early functional treatment vs. early immobilization of Achilles tendon in tension. Foot Ankle Int, 2002, 23(7): 600-605.
11. Kangas J, Pajala A, Siira P, et al. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma, 2003, 54(6): 1171-1181.
12. Kangas J, Pajala A, Ohtonen P, et al. Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens. Am J Sports Med, 2007, 35(1): 59-64.
13. Lantto I, Heikkinen J, Flinkkila T, et al. Early functional treatment versus cast immobilization in tension after achilles rupture repair: results of a prospective randomized trial with 10 or more years of follow-up. Am J Sports Med, 2015, 43(9): 2302-2309.
14. Zhang YJ, Zhang C, Wang Q, et al. Augmented versus nonaugmented repair of acute Achilles tendon rupture: A systematic review and Meta-analysis. Am J Sports Med, 2018, 46(7): 1767-1772.
15. Kerkhoffs GM, Struijs PA, Raaymakers EL, et al. Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg, 2002, 122(2): 102-105.
16. Maffulli N, Tallon C, Wong J, et al. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness, 2003, 43(3): 367-379.
17. Maffulli N, Tallon C, Wong J, et al. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med, 2003, 31(5): 692-700.
18. Suchak AA, Bostick GP, Beaupre LA, et al. 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): 1876-1883.
19. Porter MD, Shadbolt B. Randomized controlled trial of accelerated rehabilitation versus standard protocol following surgical repair of ruptured Achilles tendon. ANZ J Surg, 2015, 85(5): 373-377.
20. Cetti R, Henriksen LO, Jacobsen KS. A new treatment of ruptured Achilles tendons. A prospective randomized study. Clin Orthop Relat Res, 1994, (308): 155-165.
21. Costa ML, Shepstone L, Darrah C, et al. Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study. Injury, 2003, 34(11): 874-876.
22. Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
23. Schepull T, Aspenberg P. Early controlled tension improves the material properties of healing human achilles tendons after ruptures: a randomized trial. Am J Sports Med, 2013, 41(11): 2550-2557.
24. Groetelaers RP, Janssen L, van der Velden J, et al. Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: Prospective, randomized trial. Foot Ankle Int, 2014, 35(8): 771-778.
25. Valkering KP, Aufwerber S, Ranuccio F, et al. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1807-1816.
26. Eliasson P, Agergaard AS, Couppé C, et al. 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): 2492-2502.
27. Zhao JG, Zeng XT, Wang J, et al. Association between calcium or Vitamin D supplementation and fracture incidence in community-dwelling older adults: A systematic review and Meta-analysis. JAMA, 2017, 318(24): 2466-2482.
28. 赵嘉国, 赵力, 阚世廉. 富血小板血浆修复肩袖损伤的研究进展. 中华医学杂志, 2015, 95(25): 2042-2044.
29. Khan RJ, Fick D, Keogh A, et al. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
30. Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
31. Huang J, Wang C, Ma X, et al. Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med, 2015, 43(4): 1008-1016.
32. 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): 1329-1335.
33. Braunstein M, Baumbach SF, Boecker W, et al. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc, 2015, 26(3): 846-853.
34. Mark-Christensen T, Troelsen A, Kallemose T, et al. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6): 1852-1859.
35. Zhao J, Meng X, Liu L, et al. Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses. Scientific Reports, 2017, 7(1): 39871.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair

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