Is Early Controlled Motion and Weightbearing Recommended for Nonoperatively Treated Acute Achilles Tendon Rupture? A...

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation

Background:

• Disagreement exists regarding the efficacy of early controlled motion and weightbearing versus immobilization for acute Achilles tendon rupture (ATR) in nonoperative treatment.
• Understanding optimal rehabilitation protocols is crucial for patient recovery and functional outcomes.

Purpose of the Study:

• To perform a meta-analysis of randomized controlled trials (RCTs) comparing early controlled motion and weightbearing with immobilization and late weightbearing for nonoperative acute ATR.
• To evaluate differences in key outcomes including functional scores, re-rupture rates, and return to activity.

Main Methods:

• Systematic review of RCTs published between 1981 and 2020, identified through PubMed, Web of Science, and EMBASE.
• Primary outcome: Achilles Tendon Total Rupture Score (ATRS) at 1-year follow-up. Secondary outcomes: rerupture rate, return to sports/work, and heel-rise work (limb symmetry index).
• Study quality assessed using the Cochrane Collaboration risk of bias tool, indicating a low risk of bias in all included RCTs.

Main Results:

• Seven RCTs involving 424 participants were analyzed.
• No statistically significant differences were observed between early motion/weightbearing and immobilization groups for ATRS (P = .920), rerupture rates (P = .775), return to sports (P = .351), return to work (P = .234), or heel-rise work LSI (P = .965).
• Time to return to work also showed no significant difference (P = .140).

Conclusions:

• For nonoperative acute Achilles tendon rupture, early controlled motion and weightbearing do not yield significantly different outcomes compared to immobilization and late weightbearing.
• Current evidence suggests comparable functional recovery, re-rupture risk, and return to daily activities and sports between the two rehabilitation approaches.