Functional Rehabilitation Versus Surgical Repair of Achilles Tendon Rupture: A Review of Rerupture Risk Across the Trial Literature
DOI:
https://doi.org/10.5281/zenodo.22548769Keywords:
Achilles tendon rupture, Surgical repair, Functional rehabilitation, Rerupture, Nonoperative management, Return to sportAbstract
The management of acute Achilles tendon rupture has shifted substantially over the past fifteen years as
trial evidence has clarified that the rehabilitation protocol used after either surgical or nonoperative
management matters as much for rerupture risk as the choice between surgery and nonoperative
treatment itself. Early randomised trials using traditional prolonged cast immobilisation reported a
meaningful rerupture-rate advantage for surgical repair, but subsequent trials incorporating early
functional rehabilitation protocols in both arms have found this advantage narrows substantially, while
surgical repair retains a consistently higher complication rate. This review synthesises the randomised
trial and meta-analytic literature comparing surgical and nonoperative management of acute Achilles
rupture, with particular attention to how rehabilitation protocol modifies the reported rerupture-risk
comparison, without undertaking new statistical pooling of its own.
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