The purpose of the present study was to compare the outcomes of patients with Achilles tendon rupture treated with minimally invasive repair and early functional rehabilitation with the outcomes of similar patients treated with cast immobilization. After undergoing minimally invasive surgery, a below-knee splint with the foot in 30° of plantarflexion was applied to each patient for the first week. Patients were then assigned to a cast immobilization group (IG; n = 25) or a functional group (FG; n = 16). Data were collected during outpatient checks at 6 weeks, 3 months, 6 months, and 1 year. Outcomes of interest included range of motion (ROM), heel height, calf circumference, pain and functional score, return to work and light sports activity, and complications. The time interval for return to work in the FG was faster than that in the IG (p = .026). There was no clinically important difference between the 2 groups with regard to heel height, ROM, return to sports, calf circumference, visual analog scale, American Orthopaedic Foot and Ankle Society score, or Achilles tendon Total Rupture Score at every outpatient check except ROM difference at 6 weeks and heel height at 3 months. Rerupture occurred in 2 patients (1 [4%] in the IG and 1 [6.25%] in the FG). Early functional rehabilitation seemed to be as safe as traditional postoperative immobilization with a similar functional result and complications, but it was advantageous for the early phase of rehabilitation only.
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Current concepts in the rehabilitation of an acute rupture of the tendo Achillis.J Bone Joint Surg Br. 2012; 94: 28-31
- The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases.Am J Sports Med. 1989; 17: 338-343
- Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.J Bone Joint Surg Am. 2010; 92: 2767-2775
- Achilles' tendon ruptures: operative versus nonoperative management.Oper Tech Orthop. 1995; 5: 290-294
- Surgical treatment of ruptures of the Achilles tendon: a review of long-term results.Br J Sports Med. 1995; 29: 121-125
- Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study.Am J Sports Med. 2013; 41: 2867-2876
- Surgical repair of acute Achilles tendon rupture using a “mini-open” technique.Foot Ankle Clin. 2002; 7: 611-619
- A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture.Injury. 2018; 49: 712-719
- Early, active rehabilitation following mini-open repair of Achilles tendon rupture: a prospective study.Br J Sports Med. 2005; 39: 857-859
- Functional treatment or cast immobilization after minimally invasive repair of an acute Achilles tendon rupture: prospective, randomized trial.Foot Ankle Int. 2014; 35: 771-778
- Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis.Am J Sports Med. 2015; 43: 1008-1016
- Achilles tendon ruptures a new method of repair, early range of motion, and functional rehabilitation.Am J Sports Med. 1995; 23: 392-395
- Acute Achilles tendon ruptures: a comparison of minimally invasive and open approach repairs followed by early rehabilitation.Am J Orthop (Belle Mead NJ). 2014; 43: E221-E225
- Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 846-853
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- The Achilles tendon Total Rupture Score (ATRS): development and validation.Am J Sports Med. 2007; 35: 421-426
- Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis.J Bone Joint Surg Br. 2006; 88: 69-77
- Influences of flexor sheath continuity and early motion on tendon healing in dogs.J Hand Surg Am. 1990; 15: 69-77
- 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: 983-990
- The Sheffield splint for controlled early mobilisation after rupture of the calcaneal tendon. A prospective, randomised comparison with plaster treatment.J Bone Joint Surg Br. 1992; 74: 206-209
- Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon.Am J Sports Med. 2003; 31: 692-700
- 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: 1876-1883
- The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment.Injury. 2007; 38: 839-844
- Avoiding sural nerve injuries during percutaneous Achilles tendon repair.Am J Sports Med. 2006; 34: 793-798
- Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study.J Bone Joint Surg Am. 2002; 84: 161-170
- Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study.Am J Sports Med. 2005; 33: 1369-1379
- Mini-open tenorrhaphy of acute Achilles tendon ruptures: medium-term follow-up of 100 cases.Am J Sports Med. 2014; 42: 731-736
- Effect of complications after minimally invasive surgical repair of acute Achilles tendon ruptures: report on 211 cases.Am J Sports Med. 2011; 39: 820-824
Published online: May 23, 2019
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.