Early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures:a systematic review

Objective To evaluate the effectiveness of early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures.Methods Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures were identified from MEDLINE (from 1966 to 2011.1),EMBASE (from 1966 to 2011.1),Cochrane Library (Issue 1,2011),Cochrane Musculoskeletal Injuries Group Database (2011.1) and CBM disc (from 1979 to 2011.1).We hand-searched Chinese Journal of Orthopaedics (from the llrst issue to January issue,2011 ) and Chinese Journal of Orthopaedic Trauma (from the first issue to January issue,2011 ) for RCTs and CCTs of our interest.Data were extracted by 2 reviewers with designed extraction form.RevMan 4.2.8 software was used for data analysis.Results Four RCTs and 3 CCTs were included for the present meta analysis.Compared with postoperative immobilization,early functional rehabilitation significantly improved patients' subjective satisfaction [ RR =1.27,95％ CI (1.01,1.61),P =0.04]and reduced the complication rate [ RR =0.43,95％ CI (0.22,0.83),P =0.01 ]but did not significantly increase the rerupture rate [ RR =0.59,95％ CI (0.20,1.80),P =0.92],the infection rate [ RR =0.70,95％ CI (0.26,1.86),P =0.48],or the achilles elongation at either 6 weeks [SMD=1.50,95％ CI(-3.40,6.40)]or at 12 weeks[SMD=-0.25,95％ CI(-5.64,5.14)].Conclusions Compared with postoperative immobilization for acute achilles tendon ruptures,early functional rehabilitation can obviously increase patients' subjective satisfaction and reduce complications without increasing risks of rerupture and infection.There is no significant difference in achilles elongation,calf strength and range of motion of the ankle between the 2 treatments. Key words: Achilles tendon;  Soft tissue injuries;  Recovery of function;  Meta-analysis