title: Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair.
abstract: OBJECTIVE
  Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair.
  
  
  METHODS
  A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included.
  
  
  RESULTS
  One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment.
  
  
  CONCLUSIONS
  Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician.
  
  
  METHODS
  II.
authors.affiliation: Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University, Campus Innenstadt, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Mareen
authors.initials: M
authors.lastname: Braunstein
authors.affiliation: Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University, Campus Innenstadt, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Baumbach
authors.affiliation: Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University, Campus Innenstadt, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Boecker
authors.affiliation: Princess Royal Hospital, Shrewsbury and Telford NHS Trust and the Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Mike R
authors.initials: MR
authors.lastname: Carmont
authors.affiliation: Department of Trauma Surgery, Munich University Hospital, Ludwig-Maximilians-University, Campus Innenstadt, Nussbaumstr. 20, 80336, Munich, Germany. Hans.Polzer@med.uni-muenchen.de.
authors.forename: Hans
authors.initials: H
authors.lastname: Polzer
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001915:Braces; D004434:Early Ambulation / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D026741:Physical Therapy Modalities; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D016474:Weight-Bearing
keywords: Accelerated rehabilitation; Achilles tendon rupture; Minimal invasive repair