Review Question - QID 655

Operative treatment with early range of motion has a lower rate of rerupture compared to immobilization in a short leg cast for 6 weeks. However, there is recent evidence that an aggressive nonoperative rehabilitation protocol can have equivalent rates of rerupture compared to operative treatment.

Wilits et al performed a Level 1 study with an aggressive rehabilitation protocol with weightbearing and range of motion starting at the 2 week interval(shown in Illustration A) for achilles tendon ruptures. They found that there was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were twice as many complications in the operative group than the nonoperative group with the main difference being the greater number of soft-tissue-related complications.

Bhandari et al, in a pooled statistical analysis of 6 randomized studies, found surgical repair significantly reduced the risk of rerupture when compared with nonsurgical treatment. However, it increases the risk of infection and skin complications.

Khan et al found that for postoperative immobilization, functional bracing has been shown to have a significantly lower rate of complications compared with casting, particularly with regard to adhesion formation. Other complications with casting post-operatively include disturbed sensibility, keloid hypertrophic scarring, and infection.