title: Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine?
abstract: BACKGROUND
  Ruptures of the Achilles tendon are the most common tendon injuries of the lower extremities. Besides the initial operative or non-operative treatment, rehabilitation of patients plays a crucial role for tendon healing and long-term outcome. As only limited evidence is available for optimized rehabilitation regimen and guidelines for the initial (e.g., first 6 weeks) rehabilitation are limited, this study investigated the current rehabilitation concepts after Achilles tendon rupture.
  
  
  METHODS
  We analyzed 213 written rehabilitation protocols that are provided by orthopedic and trauma surgery institutions throughout Germany in terms of recommendations for weight-bearing, range of motion (ROM), physiotherapy, and choice of orthosis. All protocols for operatively and non-operatively treated Achilles tendon ruptures were included. Descriptive analysis was carried out and statistical analysis applied where appropriate.
  
  
  RESULTS
  Of 213 institutions, 204 offered rehabilitation protocols for Achilles tendon rupture and, therefore, 243 protocols for operative and non-operative treatment could be analyzed. While the majority of protocols allowed increased weight-bearing over time, significant differences were found for durations of fixed plantar flexion between operative (o) and non-operative (n) treatments [fixed 30° (or 20)° to 15° (or 10)°: 3.6 weeks (±0.1; o) vs 4.7 weeks (±0.3; n) (p ≤ 0.0001) and fixed 15° (or 10)° to 0°: 5.8 weeks (±0.1; o) vs 6.6 weeks (±0.2; n) (p ≤ 0.001)]. The mean time of the recommended start of physiotherapy is at 2.9 weeks (±0.2; o) vs 3.3 weeks (±0.4; n), respectively.
  
  
  CONCLUSIONS
  Our study shows that a huge variability in rehabilitation after Achilles tendon rupture exists. This study shows different strategies in rehabilitation of Achilles tendon ruptures using a convertible vacuum brace system. To improve patient care, further clinical as well as biomechanical studies need to be conducted. This study might serve as basis for prospective randomized controlled trials to optimize rehabilitation for Achilles tendon ruptures.
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Frankewycz
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Krutsch
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Weber
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ernstberger
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Nerlich
authors.affiliation: Department of Trauma and Orthopedic Surgery, FIFA-Medical Centre of Excellence, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany. christian.pfeifer@ukr.de.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Pfeifer
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D001915:Braces; D002985:Clinical Protocols; D004434:Early Ambulation; D005858:Germany; D006801:Humans; D007103:Immobilization; D009985:Orthopedics; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012421:Rupture / Q000534:rehabilitation* / Q000601:surgery; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery; D013997:Time Factors; D014193:Trauma Centers; D016474:Weight-Bearing
keywords: Achilles tendon rupture; Early function; Immobilization; Non-operative treatment; Orthosis; Post-operative rehabilitation