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Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials

  • Abdullah A Ghaddaf
    Correspondence
    Corresponding author.
    Affiliations
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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  • Mohammed S Alomari
    Affiliations
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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  • Jawaher F Alsharef
    Affiliations
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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  • Eyad Alakkas
    Affiliations
    Department of Surgery/Orthopedic Section, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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  • Mohammed S Alshehri
    Affiliations
    College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    King Abdullah International Medical Research Center, Jeddah, Saudi Arabia

    Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Published:January 20, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.028

      Highlights

      • Cast application and late weightbearing is the most common rehabilitation protocol following Achilles tendon rupture (ATR).
      • Recent trials support early weightbearing and ankle mobilization with removable orthosis over late weightbearing.
      • Our review revealed similar functional and patient-reported outcomes between early and late weightbearing for the conservative management of ATR.
      • Early weightbearing was not found to be associated with higher adverse event rate compared to late weightbearing.

      Abstract

      Background

      Achilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early functional rehabilitation or cast immobilization. The aim of the present systematic review and meta-analysis was to provide an update about the role of early weightbearing (WB) versus late WB on the clinical outcomes of adults with acute ATR.

      Methods

      We performed a systematic literature search in Web of Science, Ovid, Medline/PubMed, and CENTRAL. We included randomized controlled trials (RCTs) that compared early WB, defined as weight-bearing within 4 weeks of treatment, to late WB for individuals with acute (<14 days) ATR. We sought to evaluate the following outcomes: re-rupture rate, Achilles Tendon Rupture Score (ATRS), return to pre-injury sport activity, time to return to work, and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes.

      Results

      A total of 9 RCTs that enrolled 1046 participants were deemed eligible. There was no significant difference between early WB and late WB in terms of re-rupture rate (RR=0.75, 95% CI 0.49 to 1.16), ATRS (SMD=0.06, 95% CI 0.03 to 0.16), return to pre-injury sport activity (RR=1.05, 95% CI 0.86 to 1.28), time to return to work (SMD=0.03, 95% CI 0.20 to 0.26), or adverse event rate (RR=1.87, 95% CI 0.53 to 6.63).

      Conclusion

      This meta-analysis shows no difference in the functional outcomes and patient-reported outcomes between early functional rehabilitation and cast immobilization for conservatively treat individuals with acute ATR.

      Keywords

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