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Does early mobilisation following achilles tendon repair speed up recovery and improve functional outcome?

Three Part Question

In [patients with complete achilles tendon rupture repaired surgically] is [early mobilisation and weight-bearing better than the traditional immobilising cast treatment] in [speeding time to recovery and improving functional outcome]?

Clinical Scenario

A 27 year old athlete presents with acute rupture of his Achilles tendon, which is treated surgically. What is the best rehabilitation regimen for optimising his recovery and returning him to competitive sport?

Search Strategy

Medline via the OVID interface 1950 to week 4 April 2009:
{[exp achilles tendon or] AND [exp rupture or or or] AND [ or or exp immobilisation or or or]}.

Search Outcome

A total of 233 articles was found. Studies were included if they were randomised controlled trials (RCT) comparing a mobilising regime (either weight bearing or physical exercises) with full cast immobilisation, in postoperative patients. Simple cohort studies and before–after cohort studies were excluded. Two other publications from 2007 and 2003 were excluded as results from the same cohort of patients have already been reported and are included in the table

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Costa et al,
28 Active patients presenting with first-time unilateral acute rupture of the achilles tendonRCT comparing early weight-bearing with traditional serial cast immobilisation.Time to return to competitive sportTwo months shorter in the early mobilisation groupSmall sample size.
Peak torque deficitLess in the early mobilisation group
Postoperative complicationsNot increased in the early mobilisation group
Maffulli et al,
53 Patients presenting with first-time rupture of the Achilles tendonRCT comparing removable cast, ankle moilisation exercises and weight bearing when comfortable, with immobilsation in cast with weight bearing at 4 weeksNumber of Outpatient VisitsSignificantly reduced in early mobilisation groupRandomisation by day of week.
Time to walking without crutchesEarlier for the mobilisation group
Patient satisfactionHigher in the early mobilisation group
Average thickness of the tendonNo difference between the groups
Isometric muscle strengthNo difference between the groups
Kangas et al,
50 Patients presenting with first-time rupture of the Achilles TendonRCT comparing splint allowing free plantarflexion and immobile castIsokinetic calf muscle strengthBetter in the early mobilisation group, especially during the early phase of rehabilitationUse of non-parametric statistics for data analysis.
Pain, stiffness and postoperative complicationsNo difference between the groups
Mortensen et al,
71 Patients undergoing first-time Achilles tendon repairRCT comparing cast immobilisation with restricted-ankle-motion castRadiological assesssment of tendon separation (treatment failure)No difference between the groupsSmall sample size. Otherwise very well designed.
Loss of range of motionMore favourable results in the early motion group
Skin-tendon adhesionsFewer adhesions in the early motion group
ComplicationsNo difference between groups
Patient satisfactionHigher in the early motion group
Speed of rehabilitationReported to be quick, but no second arms for comparison
Cetti et al,
60 Active patients undergoing surgical repair of ruptured Achilles tendon.RCT of mobile versus immobile cast after surgical repair of ruptured Achilles tendon.Return to sporting activities at pre-injury levelMore patients in the early mobilisation groupWell designed and executed study.
Post-operative complicationsIdentical for major complications; fewer minor complications in the early mobilisation group
Recovery of ankle movementsBetter in the early mobilisation group
Sick leave durationShorter in the early mobilisation group
Tendon lengtheningLess in the early mobilisation group
Arner–Lindholm rating scaleMostly excellent and occurring earlier in the course of rehabilitation than "normal"


There is evidence that early ankle motion and weight bearing do not compromise the surgical repair of ruptured Achilles tendon. One meta-analysis concluded that the only statistically significant outcome was improved patient satisfaction.

Editor Comment

RCT, randomised controlled trial.

Clinical Bottom Line

Early weight-bearing and ankle motion is likely to be of considerable benefit following surgical repair of ruptured achilles tendon and should be encouraged.


  1. Costa ML. Shepstone L. Darrah C. Marshall T. Donell ST. Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study. Injury 2003:34(11):874-6.
  2. Maffulli N. Tallon C. Wong J. Peng Lim K. Bleakney R. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness. 2003;43(3):367-79.
  3. Kangas J. Pajala A. Siira P. Hamalainen M. Leppilahti J. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 2003;54(6):1171-1180.
  4. Mortensen HM. Skov O. Jensen PE. Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study. J Bone Joint Surg (Am) 1999;81(7):983-90.
  5. Cetti R. Henriksen LO. Jacobsen KS. A new treatment of ruptured Achilles tendons. A prospective randomized study. Clin Orthop 1994;308:155-65.