gms | German Medical Science

Background: The primary aim of medical professionals should be to return patients following acute Achilles tendon ruptures (AATR), to fully functional pain-free activity in the shortest time possible, without increasing their susceptibility to re-rupture. Herein lays the controversy in the literature. The question remains whether surgery is always indicated, or can early, gradual rehabilitation in a functional boot, achieve the same or even better short and long term functional results.

Materials and Methods: A search was conducted including the Cochrane Musculoskeletal Injuries Group's specialized register, the Medline, PubMed, Embase and Cinahl (to July 2011). All prospective, level 1 and 2, randomized and quasi-randomized were reviewed. Subject-specific search was based on the terms "achilles tendon rupture", "surgery" and "conservative treatment". The search was restricted to studies about humans published in

Results: Fourteen trials involving 891 patients qualified for the analysis. Most trials showed good to excellent long-term results in the non-operated group, with no significantly higher re-rupture rate compared to the operative cases. Patients who were fitted post-operatively with a functional brace rather than a cast, tended to have shorter in-patient stay, fewer days off work, a quicker return to sporting activity, and better range of ankle motion and strength.

Conclusion: Contrary to previously reported studies, there exists good evidence that AATR may be successfully rehabilitated in a non-operative manner, without increasing susceptibility to re-rupture. This needs to be further investigated with larger sample sizes and further high-quality research protocols. What is more apparent is that early functional rehabilitation in an active brace post-surgery is more advantageous than the current protocol of immobilization. This is irrespective of whether surgery has occurred or not. Level of Evidence: 3