It is rare to have this procedure immediately after going to the emergency room for an injury. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. sharing sensitive information, make sure youre on a federal bearing transitioning towards full weightbearing. Scribd is the world's largest social reading and publishing site. endobj /n%^xij_2]!J] n >!UGld Achilles Tendon Repair Rehabilitation Protocol Phase I (surgery to 2 weeks after): Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Cardiovascular: Upper body circuit training Patient Precautions: Keep elevated. <> Pool exercises if the wound is completely healed. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. postop. Y!_x"o7/_"H4IE(:}/1 Epub 2017 Jan 17. Functional movements (squats, step backs, lunges). In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Moderate load close/open chain calf strengthening to 2014. endobj Avoid overstressing the repair (avoid large movements up and down, forceful PF while in a dorsiflexed position, aggressive passive ROM, and impact activities). Active stretching. VQ4 L}3Sz~zzDM>{z?NO?UI(/oO=:0QI]WrDctQa4TxR6=&eA>F2z>'%62p2{c86Y82b%q}`D U4x$!fGjGg$grJ,l6hqs&Sn5?1qX:{6G|8(?Mu83V\kZO._C9=7R4z-XW3"tcFWPoJ^&K.HfZ5E.LJSe=jC7S'r++@7Tka'k{e1u_X\W{Rv3x:gj. Ruptures of the tendo achillis. Normal gait mechanics without the boot on all surfaces. Before ACHILLES RUPTURE: OPERATIVE PROTOCOL In this surgery, the torn ends of the tendon are sewn together with strong suture. An objective assessment of surgical and non-surgical treatment. FOIA Moderate load plyometrics at Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Patient must be willing to comply with the functional rehab protocol and strict guidelines. TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Time Frame Activity 0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. %PDF-1.7 Accessibility Review Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence . Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. An insight is given into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP to give an insight into the course of recovery after ATRs. Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. 2016 Jun;24(6):1852-9. doi: 10.1007/s00167-014-3180-5. Epub 2020 Dec 17. HHS Vulnerability Disclosure, Help CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 2nd week. The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. Before surgeon and physio. Very gently at first and gradually build up . Rerupture after Achilles repair is reported at about 2-12%, with no statistical difference reported between open, percutaneous, augmented, or closed treatment methods [1-4, 7, 9, 16].Open rerupture is an exceedingly rare complication and has only been described a handful of times [17-19].This report is the first case that we are aware of described in the literature of an . but an accelerated rehabilitation program should be accompanied by good results. endobj The Achilles tendon is a strong, fibrous cord in the lower leg. -, Injury. Shooting We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. <> A rupture of the Achilles Tendon (ATR) is a common pathology being the most commonly ruptured tendon in the human body. leg jumps, skipping). The Thompson Test should be applied in all suspected cases Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury 2,14,20 This finding was believed to . Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment. A re-rupture rate between one in 30 and One in 20. Goals: Physical therapy appointments are once every one to two weeks. 3 0 obj One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? scar mobilization and friction massage) to decrease fibrosis. knee strengthening as <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> 2014 2. <>/F 4/A<>/StructParent 0>> Brumann M, Baumbach SF, Mutschler W, Polzer H. Injury. 3 0 obj National Library of Medicine Tendon pathology can be a result of intrinsic and extrinsic factors.1 Intrinsic factors include: 1) Forces through the tendon; running and jumping forces have been estimated at 5000N. The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. endobj BMC Musculoskelet Disord. %%EOF management of Achilles tendon ruptures. 228 0 obj <>stream Cardiovascular: stationary bike, StairMaster, swimming. Careers. 2021 Apr 7;9:654084. doi: 10.3389/fcell.2021.654084. ^sR**aX^IZ9(cxq+{R r? Multiple surgical and nonsurgical approaches to treatment exist, 28 and the superiority of one over the other remains controversial and depends on patient factors and preferences. Injury to the Achilles tendon causes pain along the back of your leg near the heel. Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Jnsdttir US, Brorsson A, Nilsson Helander K, Tranberg R, Larson MEH. official website and that any information you provide is encrypted Foot Ankle Spec. without in air contact CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week weight) 2 0 obj -, Unfallchirurg. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Arch Orthop Trauma Surg. For best outcomes, the Achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. Clipboard, Search History, and several other advanced features are temporarily unavailable. partial weight Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. In some cases, the Achilles tendon can tear, or rupture. (50% BW) by 3 0 obj !.XyR-Kd-+"v+l3,~l|LR {Z^R}TTKS`p*9szqAdJAs2QGE6pzHf)'a n7=pMi-Sn3r7$5B"yUMQy^&hkj)V&a55JZp5JSb^]"37H919=N]?&h6.M{Af[Uf`0R;DW x^Q^5fu;%)Ptu$DtqEHg Westin et al. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Consequently, physicians may have reservations about adopting functional rehabilitation. The exercises stretch your Achilles tendon in ways that help it handle forces and stress better. Begin physio guided active range of motion ankle exercises from week 3-4. Weak . Do not perform exercises that create movement compensations. high load ankle, knee, hip . Initiate balance exercises (double leg wide base narrow . SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Acute Achilles Tendon Rupture Repair Rehab The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. Epub 2015 Sep 26. No tackling, sudden unexpected change 2 0 obj Gentle calf stretching with a towel (not body weight). endobj accelerated functional rehabilitation. A prospective randomized study. Graduated!resistanceexercises! 1 0 obj Zhang Z, Li Y, Zhang T, Shi M, Song X, Yang S, Liu H, Zhang M, Cui Q, Li Z. +2 b6b ] ]-oF%@ZUiV'US7\4yk@RAQA$EB-;D2yR"H#YH ~Z/K>S'E_ R>-C^^[i. Continue resisted inversion and eversion through range, Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves. eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. 0 Squat to 30 degrees knee flexion without weight shift. An official website of the United States government. 4 0 obj Lantto et al. Frontal and transverse plane agility drills (progress from low velocity to high, then gradually add in sagittal plane drills). Hepatocyte Growth Factor-Induced Tendon Stem Cell Conditioned Medium Promotes Healing of Injured Achilles Tendon. 2 0 obj Level of evidence: The use of early functional rehabilitation in the treatment of nonoperative Achilles tendon ruptures has been shown to provide patients with outcomes similar to operative treatments. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? ;ce%.WRu|^hR95eUmSkTusie\O~_TM6LoD,J/L-Y.Wjqw rU/>un+83ZI&|QUqsr7iWUJ/z\fv j7tvM bmmQ4Lz6kS2 K!bTFql:wGA?j)af/ \e9&Rx:V'mWJH~#u]2ZV=.7`yI10oRk 5sJ~bP[+;Ta;|r aQVJ~^%|8gd~YPnY@L}db'\2%k_ b7mQI00}yS$g7%i$wKfa58k&JV$ \&I[Z%sVl8= Bookshelf Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). <> 2 0 obj Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. The body then heals the tendon in the appropriate position. eCollection 2023 Feb. Warneke K, Lohmann LH, Keiner M, Wagner CM, Schmidt T, Wirth K, Zech A, Schiemann S, Behm D. Int J Environ Res Public Health. (open!andclosed!kinetic!chainas!well!as!functional activities)-!start!withTheraband!tubingexercises! The site is secure. Front Cell Dev Biol. endobj 2021 May 21;36(4):e360407. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. . Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion. Active ROM between 15 degrees of dorsiflexion and 50 degrees of plantarflexion. Can begin upper limb sports specific training eg. IRh3J@+ZR*RNE+Ni$Gg3) x):+!#$SEL*u:Jd4r York (UK): Centre for Reviews and Dissemination (UK); 1995-. 2020-2023 Mr Daniel Goldbloom | Privacy Policy | Disclaimer | Website design: Berwick - St John of God Consulting Suites. Healing time clock restarts from day of surgery rather than day of injury May begin sports specific training drills: if returning to contact sport only controlled Cardiovascular: Upper body circuit training, Physical therapy appointments begin one to two visits per week. Epub 2010 Oct 29. Unauthorized use of these marks is strictly prohibited. Low velocity and partial ROM for functional movements (squat, step back, lunges). Purpose: etc until cleared by 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. official website and that any information you provide is encrypted Mastering proprioceptive control in wearing normal footwear. This article describes a high-quality accelerated functional rehabilitation program that begins with early diagnosis and appropriate patient selection to allow initiation of the nonoperative protocol. 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. %PDF-1.5 Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks. Splint/Boot: Locked 20-30 degree plantarflexion for two weeks <>>> Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Knee Surg Sports Traumatol Arthrosc. Unable to load your collection due to an error, Unable to load your delegates due to an error. Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. Post-op weeks 4-6: If the pt can reach neutral PF/DF comfortably, then neutral boot with small heel lifts, sleep in boot, WBAT (based on pain, swelling and wound) with crutches and boot, active DF to neutral. Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra . FOIA The acute rupture of the Achilles tendon is a protracted injury. 1 0 obj Must be a complete, mid-substance Achilles tendon rupture & not a tendon avulsion from the calcaneus or gastroc/soleus. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. J Sci Med Sport. Treatments are chosen based on the size of the tendon defect. Good control and no pain with functional movements, including step-up/down, squats and lunges. endobj 2023 Feb 10;11(2):23259671221145199. doi: 10.1177/23259671221145199. E=wNh|3Ln]8iwGuxfws7xl+|Y0~Pu Initially a walking boot is used for the first 4-5 weeks. <> Place heel raises (1-2cm) in shoes to take some of the pressure off the Achilles tendon. Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Keywords: Acta Cir Bras. < training. Knee Surg Sports Traumatol Arthrosc. Open navigation menu. Surgery is only the beginning of a long rehabilitation period. Achilles tendon rupture is a common sports injury encountered in younger populations. Everything went well, had the staples removed yesterday. Achilles tendon ruptures (ATRs) mainly occur during sports activities . Open chain strength exercises for quads, hamstrings, glutes hip flexors. Wilkins R, Bisson Lj. government site. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! 1.Introduction. %PDF-1.5 % Achilles tendon rupture is a clinical diagnosis. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. Cardiovascular: replicate sport/work-specific energy demands. Lightsey HM, Noback PC, Caldwell JE, Trofa DP, Greisberg JK, Vosseller JT. 3. Goals: Achilles Tendon Repair Rehabilitation Protocol, North Fork Orthopaedic and Sports Medicine, Lower Extremity Fracture Care Post-Op Instructions. 2,3 Controversy still surrounds what the optimal treatment for achilles tendon ruptures is. ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. Bookshelf Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation. In revision cases or when the tendon was damaged before the rupture, the tendon may need to be reconstructed using a graft from another tendon in your body. NCI CPTC Antibody Characterization Program, Foot Ankle Surg. 2014 Nov;45(11):1782-90 Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. 4d1olrz?+Vg.TxH38@ g%L Design Scoping review. The acute rupture of the Achilles tendon is a protracted injury. This combination was most beneficial. 1990 Mar;18(2):188-95. Rehabilitation phases after an Achilles tendon rupture The rehabilitation can be divided into four phases (1): The decision when a patient should proceed from one phase to the next is proposed to be based on both the recovery of the patient and the time since the injury. The Accelerated Rehabilitation Program lasts for 12 weeks and is supervised by your Physiotherapist. hb```>VNAd`0p`8pLYY[R'}500Tttt40( C1C(?4 With!weighted!resisted . Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. [1] [2] Achilles tendinopathy has a detrimental effect on physical and mental well-being [3] [4]. Post-op weeks 2-3: boot at 20 degrees, sleep in boot, TTWB with crutches, no active DF. Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. MeSH Fibrin biopolymer sealant and aquatic exercise association for calcaneal tendon repair. x=ko8?hsQH{i~Pb%1{$[lt@Y$ujzS^/W8X:RNj]_/U9..7z" 204 0 obj <>/Filter/FlateDecode/ID[<5F38DF44F3FF7641895593BD7106A5BB>]/Index[179 50]/Info 178 0 R/Length 115/Prev 119698/Root 180 0 R/Size 229/Type/XRef/W[1 3 1]>>stream bearing To correct these problems, a physical therapist may show you exercises or use hands-on techniques to ease the tension. Sport/work-specific balance and proprioceptive drills. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. In an acute Achilles Tendon Rupture, there are two options: Surgical repair with accelerated rehab protocol. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. The injury is often accompanied by an audible and palpable pop with limited ability to push off of the injured limb. The Achilles Tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. Introduction. The guiding principle for this rehabilitation protocol is early ankle motion, since it is believed to be the main reason why surgically treated Achilles tendon ruptures show a lesser rate of recurrence than those treated conservatively with a period of immobilization. . Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;137(3):333-340. doi: 10.1007/s00402-017-2627-9. HHS Vulnerability Disclosure, Help Movement control exercises beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities. Five trials compared full to non weight bearing, all applying immobilization in equinus. Clipboard, Search History, and several other advanced features are temporarily unavailable. Arch Orthop Trauma Surg. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. It helps you walk, run, and jump. 8]z].U3wKI2 Unauthorized use of these marks is strictly prohibited. Detailed Description: The https:// ensures that you are connecting to the The acute rupture of the Achilles tendon is a protracted injury. Strengthening (can be performed Closed chain weight bearing quads, hamstrings, glutes, calf strengthening with physio guidance. Your surgeon and you will determine what is best for you by discussing your specific injury and goals. CAMBOOT with 20mm heel lift or VACOPED (2) and wedge sole for 3rd week. Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. Stretching for patient-specific muscle imbalances. Accelerated rehab protocol without surgery. This combination was most beneficial. Hydrotherapy, stationary cycling. It's the largest tendon in your body. Disadvantages. 2019 Feb;12(1):16-24. doi: 10.1177/1938640017751185. eCollection 2021. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. ,dDu=hQ*S:m6 _0}NTD4%Dw $k7pQ(@Wi:s.K^ Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. MeSH After the second postoperative week controlled ankle mobilization by free. Surgery is only the beginning of a long rehabilitation period. Discussion. Centre for Reviews and Dissemination (UK), York (UK). An official website of the United States government. It is found at the back of the lower leg, just above the heel bone. After nonoperative treatment with an accelerated rehabilitation program, the patient still experienced significant strength and functional deficits. Accessibility Treatment of acute Achilles tendon rupture in Scandinavia does not adhere to evidence-based guidelines: a cross-sectional questionnaire-based study of 138 departments . sharing sensitive information, make sure youre on a federal (10% body Begin by using one to two-inch heel lifts in tennis shoes for short distances on level surfaces and gradually remove heel lifts during the fifth through the eighth week depending on symptoms. 2011 Apr;39(4):820-4 8600 Rockville Pike Hydrotherapy It connects the muscles of your calf to your heel. % Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral. If you have a concern, please consult with Dr. Roe. of direction, jumping % =+Q%90Z6U='-rj\Ig pV.4FqW%W)53s^#D3 a`CN3=z[lmOgEA5CWwpLz9r4-+94Is9>}n-9k=n6R LAJxeF$ylM>MY@0vFEviCM ml@5s? Low level calf plyometric exercises (fast CRs, tip toe In addition, surgical repair involves, but is not limited to, an increased risk of infection, adhesions and disturbed skin sensibility with a pooled relative risk of 10.6 (95% CI; 4.8;23.3) as . It attaches your two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and helps you go up onto tiptoes. Knee Surg Sports Traumatol Arthrosc. The Alfredson Protocol is an exercise program for people with Achilles tendonitis ( tendinopathy ). Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. We performed a systematic literature search in Medline, Embase and Cochrane library. L6YZN Ko:7}BFk| endobj View a complete list of our locations and hours. -, Am J Sports Med. Sports massage techniques and ultrasound can aid torn Achilles rehabilitation by helping to realign the new fibres in line with the tendon. <>/Metadata 358 0 R/ViewerPreferences 359 0 R>> The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. The American journal of sports medicine. $AIsQ(P>U[bwA4po@-CIqRg ;qjt*]&a7Vc)]|1:|0_ 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. government site. No wound complications. Wr5)Z nK!e*~[~[)$WoU]sMHUoUbmJ9yOJ}` This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). Please enable it to take advantage of the complete set of features! basketball, tennis shots from standing start, contralateral Hydrotherapy may begin if wound healing is adequate. Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. An Achilles tendon rupture is a full or partial tear of the Achilles tendon. Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW. Continue hip and The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. x\*"S&Rd9l)+%\hwMROw3$\Z1~v/^x|m],^}3fdY7iTe*)XU6ugshO_KQ`F5vYU? J Bone Joint Surg Am 2010; 92: 2767 - 75. )$Ffni(G"okg]3io m"7r ;NOsGL8ad{qF%k-+c0R N-1@i[L6Sy=0C4ddB2@g.! IM5^]rCFWD-0y- 9NL~4,MHJOh A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed.
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