Immediate mobilization speeds recovery following Achilles tendon rupture surgery

Patients treated nonoperatively and nonweight-bearing or full weight-bearing showed no differences in time to return to activities.

Mobilizing patients to full weight-bearing following surgical repair of an Achilles tendon rupture helps speed return to daily activities, such as walking and stair climbing, a randomized study shows.

However, groups had no significant difference in their times to return to sports or work, the study authors noted.

Matthew L. Costa, PhD, FRCS(Orth), and colleagues at the University of East Anglia in Norfolk, England, conducted two separate studies to assess the effect of immobilization with either immediate full weight-bearing or traditional non-weight-bearing following Achilles tendon rupture.

The first trial included 48 patients with a mean age of 42 years, of whom all but two (one in each study group) were classified as either recreational or club-level athletes. All these patients received surgery, which mainly involved a simple, open, end-to-end repair under general anesthesia.

Following surgery, the researchers randomly assigned patients to either immediate mobilization in a carbon fiber orthosis (Tyco), which had three 1.5-cm heel raises, or to traditional plaster cast immobilization.

All surgically treated patients began rehabilitation the first postoperative day and were followed biweekly until removal of the orthosis or cast at eight weeks.

Five patients were lost to follow-up, leaving complete one-year follow-up data for 43 patients.

The researchers found that immediately mobilized patients had a significantly faster return to both normal walking and stair climbing compared to control patients. Mobilized patients returned to normal walking at a mean of 12.5 weeks postop compared to a mean of 18 weeks for control patients (P=.027). Mobilized patients resumed stair climbing at a mean of 13 weeks postop compared to a mean of 22 weeks for control patients (P=.023), according to the study.

However, “There was no evidence of a treatment effect in terms of time to return to sport (P=.341) or work (P=.593),” the authors said in the study.

For the second trial, all patients received conservative, nonoperative treatment. The researchers immobilized control patients in below-knee gravity equinus casts and allowed nonweight-bearing ambulation. Patients in the treatment group were fitted with the same carbon fiber orthosis used in the surgery trial and were allowed immediate full weight-bearing. Both groups had a mean age of 53 years, according to the study.

In contrast to the results noted in the first trial, the researchers found no significant differences between the nonoperatively treated groups in times to return to walking and stair climbing. “In addition, there was no evidence of a treatment effect in terms of the time to return to either sport or work,” the authors said.

For more information:
Costa ML, MacMillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg Br. 2006;88-B;69-77.