SLR - December 2015 - Mitch Hulbert

Title: Rehabilitation Regimen After Surgical Treatment of Acute Achilles Tendon Ruptures: A Systemic Review with Meta-Analysis

Reference:
Huang J, Wang C, Ma X, Wang X, Zhang C, Chen L. Rehabilitation Regimen After Surgical Treatment of Acute Achilles Tendon Ruptures: A Systemic Review with Meta-Analysis.  Am J Sports Med. 2015 Apr; 43(4): 1008-1016.

Reviewed By: Mitch Hulbert, DPM
Residency Program: Columbia-St Mary’s Hospital, Milwaukee WI

Podiatric Relevance: After the surgical reconstruction of the Achilles rupture there are numerous rehabilitation methods proposed without sufficient clinical evidence to back them. Being that this is a relatively common procedure more evidence is needed to provide a more concrete rehabilitation program. There is commonly a question of whether early range of motion or early weightbearing is superior to immobilization.  

Methods: This was a retrospective analysis of six randomized controlled trials and three quasi randomized studies ultimately included. There were a total of 402 patients included in all studies. Quality and eligibility of the studies was assessed by the Cochrane12-item scale. Subgroup analyses were performed according to the different protocols of early functional rehabilitation.  

Results: There were nine studies totaling 402 patients. Six of the studies used early weightbearing combined with early ankle motion exercises compared to cast immobilization. The other three included only early range of motion exercises compared to cast immobilization. It was noted that 11 of the 14 functional outcome measurements were significantly superior for patients who underwent both early ankle range of motion as well as early weightbearing when compared with cast immobilization. Only two of the 14 functional measurements were observed to be superior to immobilization in the early range of motion without early weightbearing group versus cast immobilization. Both groups had similar re-rupture and major complication rates. Minor complications however were lower in the early range of motion with early weightbearing group.   

Conclusions: The Achilles tendon is incredibly strong, but remains prone to ruptures. Various treatments have reported differing results leading to a controversy over which will produce the best outcomes. It is quite well accepted that there is a decrease in re-rupture rates when a complete rupture is treated surgically and this article only focuses on the rehabilitation after the surgery is complete. There is evidence presented in this article that early weightbearing in conjunction with early ankle range of motion is the superior and more rapidly functional rehabilitation option. Even though early range of motion without weightbearing is superior to immobilization alone, it falls significantly short of results achieved when the patient is also allowed to weight bear as well.  

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