The optimal postoperative rehabilitation protocol after surgical repair of an Achilles tendon rupture is unknown. Although a 6-week cast immobilization is common, many early functional rehabilitation protocols have been implemented. The purpose of this study was to conduct a meta-analysis to determine if an early functional protocol for surgical repair of an acute Achilles tendon rupture improves subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes of interest from an early functional protocol include infections, range of motion, strength, and minor complications. An extensive literature search for randomized or quasirandomized studies identified six trials involving 315 patients. Early functional treatment protocols, when compared with postoperative immobilization, led to more excellent rated subjective responses and no difference in rerupture rate. Our conclusions are based on six trials with small sample sizes, and larger randomized trials are required to confirm these results. LEVEL OF EVIDENCE: Therapeutic study, level II (systematic review of level II studies or level I studies with inconsistent results).
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