Should We Reevaluate Post-Op Rehab Protocol For Achilles Tendon Ruptures?

Achilles tendon ruptures are known for their long recovery times, which authors have described as requiring five to nine months of rehabilitation on average.¹

A recently published case study in the Journal of Foot and Ankle Surgery focuses on a shortened recovery time after surgeons repaired an acute Achilles tendon rupture with the InternalBrace (Arthrex) knotless technique.¹ The patient was a 36-year-old physical trainer and elite bobsled pilot who made a complete recovery return to a full baseline level of training after only 12 weeks. The surgery occurred 11 days post-injury.

Postoperatively, the patient wore a removable walking boot with partial weightbearing with crutches. After seven days, the patient was able to remove the boot and begin gentle active mobilization with full weightbearing and walking at four weeks. At eight weeks post-surgery, the patient was out of the walking boot. A magnetic resonance image (MRI) at 10 weeks demonstrated definite tendon continuity with mild fusiform swelling. At 12 weeks post-op, he began running. He returned to full competition at 18 weeks. At 29 weeks, the patient competed in the Winter Olympic Games. 

I think this case study, albeit on one patient, should remind us to reexamine our current standard of care for the rehabilitation and treatment of Achilles tendon ruptures. While use of the InternalBrace for an Achilles tendon repair may not be something all surgeons are comfortable with, we are seeing other options for percutaneous repair of Achilles tendon ruptures.^2,3 I believe we could adjust the postoperative protocol discussed in this article for open repairs as well. Current literature is supporting the use of early active rehabilitation for acute Achilles ruptures, which involves early weightbearing and controlled mobilization.⁴

If you are still following the outdated patterns of long immobilization and non-weightbearing for your Achilles rupture patients after surgical repair, it is important to review the current literature and make changes to reduce the recovery time for your patients.

References

1. Byrne PA, Hopper GP, Wilson WT, Mackay GM. Knotless repair of Achilles tendon rupture in an elite athlete: return to competition in 18 weeks. J Foot Ankle Surg. 2017;56(1):121-124.

2. DeVries JG, Scharer BM, Summerhays BJ. Acute Achilles rupture percutaneous repair: approach, materials, techniques. Clin Podiatr Med Surg. 2017;34(2):251-262.

3. Santrock RD, Friedmann AJ, Hanselman AE. Acute rupture open repair techniques. Clin Podiatr Med Surg. 2017;34(2):245-250.

4. Kauwe M. Acute Achilles tendon rupture: clinical evaluation, conservative management, and early active rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229-243.