Postoperative Weight Bearing

A systematic review identified four Level II studies^{40, 5, 41,42} that compared early postoperative weight bearing to non-weight bearing following surgical repair of the Achilles tendon.  All studies compared patients with either six weeks of non-weight bearing in a cast to early weight bearing.  Two studies^{40, 42}  permitted immediate weight bearing starting the day of surgery in a cast, defined as toe-touch weight bearing in one study.⁴⁰ The second study⁵ allowed the weight bearing group to begin immediate rehabilitation on the first post-operative day in a modified splint.  The patients in the third study⁴¹ began weight bearing two weeks after surgery.  By two weeks, three investigators^{40, 5, 41} used a splint device that limited dorsiflexion to prevent compromise of the repair.  After four weeks, Maffulli et al.^{40, 42} allowed the non-weight bearing group to begin full weight bearing in a cast, while the other two studies^{5, 41} kept the non-weight bearing group on crutches for six weeks. 
 
One study,⁵ found a significantly higher re-rupture rate in the early postoperative weight bearing group (2 of 23 patients) compared to non-weight bearing group (0 of 25 patients).  Both patients had documented non-compliance with the use of their postoperative splint and fell during the first four weeks after surgery.
 
Three studies^{40, 5, 42}  found that the weight bearing group had statistical improvement in the time to return to activities including work, sports, and normal walking.  Suchak et al.⁴¹ found significantly better scores in physical functioning and reported fewer limitations of daily living six weeks after the operation.  By 12 months, all four studies found that there was no significant difference between the two groups in outcomes such as pain and function.  
 
Although the ultimate level of function achieved after operative repair of an Achilles rupture is similar regardless of the post-operative weight bearing protocol, early post-operative weight bearing allows the patient to achieve a quicker return to activities during the first six months than those patients treated with traditional postoperative casting.  Treatment decisions should be made in light of all circumstances presented by the patient. Mutual communication between patient and physician should include a discussion of the importance of patient compliance when a program is prescribed for the use of early weight bearing. Patient compliance to protocol is important to prevent re-rupture.