Rehabilitation and Return to Play Following Achilles Tendon Repair

Although emerging evidence has identified an expanded role for nonoperative treatment of Achilles tendon ruptures, there remains a preference to treat young, active patients operatively to reduce the risk of rerupture and improve return to play. To ensure an adequate repair while minimizing risks for wound complications, the senior authors (B.J.C. and J.L.L.) prefer a limited open technique to repair. Additionally, we recommend a brief period of immobilization and nonweight bearing which is quickly followed by an early, active rehabilitation phase to balance the functional benefits of early loading with the risk of early reinjury. Recent literature has linked patient demographic factors, such as older age and elevated body mass index, to worse postoperative symptomatic outcomes. Although higher preoperative activity levels are correlated with improved postoperative functional outcomes, these patients report reduced satisfaction, likely attributable to unmet expectations of restored function. Because of the large loads placed on the Achilles tendon during certain athletic activities, these injuries can be very difficult for explosive athletes, such as jumpers or sprinters, to effectively return from, regardless of management approach.