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.
OBJECTIVE
To determine which postoperative rehabilitation regime is superior following surgical repair of acute Achilles tendon rupture. The primary outcomes were patient safety and satisfaction.


METHODS
Intervention meta-analysis.


METHODS
The MEDLINE and CINAHL electronic databases were searched from their date of inception until June 2015 using keywords related to acute Achilles tendon rupture, surgical repair and rehabilitation. The electronic database search was supplemented with forward citation tracking using the Web of Science.


METHODS
Randomised controlled trials comparing clinical and/or patient-reported outcomes between patients receiving early functional postoperative ankle motion and weight bearing (bracing group), and traditional ankle immobilisation with a non-weight bearing rigid cast (cast group) were eligible for inclusion. Fourteen articles were identified as potentially eligible; 10 sufficient-quality randomised controlled trials involving 570 patients were included for meta-analysis.


RESULTS
A high proportion of patients were able to return to prior employment and sporting activity in both groups. Five of the six trials measuring the time interval showed a faster return to prior sporting level in the bracing group. Subjective patient outcomes were significantly better in the bracing group (for good and excellent results, p=0.01; OR, 3.13; 95% CI 1.30 to 7.53). There was no difference in major complications between the two groups (p=0.21; RD, -0.03; 95% CI -0.06 to 0.01). Dynamometry and anthropometry measurements favoured functional rehabilitation at 6-12 weeks postoperation; however, by 6 months postoperative, the differences were negligible.


CONCLUSIONS
Compared to traditional ankle immobilisation, with a non-weight bearing cast following surgical repair of acute Achilles tendon rupture, early dynamic functional rehabilitation is as safe with higher patient satisfaction.
Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada.
R
R
McCormack
Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada.
J
J
Bovard
D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001265:Athletic Injuries / Q000534:rehabilitation* / Q000601:surgery; D002370:Casts, Surgical; D004651:Employment; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D063868:Patient Outcome Assessment; D061214:Patient Safety; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D000068958:Return to Sport / Q000502:physiology; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D013708:Tendon Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D055815:Young Adult
Achilles; Meta-analysis; Rehabilitation